To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person during the COVID-19 emergency.

I 116TH CONGRESS 2D SESSION H. R. 6644 To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person during the COVID-19 emergency. IN THE HOUSE OF REPRESENTATIVES APRIL 28, 2020 Ms. SCHRIER (for herself, Mr. DAVID P. ROE of Tennessee, Mr. MORELLE, and Mr. VAN DREW) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Commit- tees on Ways and Means, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee con- cerned A BILL To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person during the COVID-19 emergency. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 21:28 May 01, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6644.IH H6644 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 6644 IH SECTION 1. REQUIRING GROUP HEALTH PLANS AND 1 HEALTH INSURANCE ISSUERS OFFERING 2 GROUP OR INDIVIDUAL HEALTH INSURANCE 3 COVERAGE TO PROVIDE COVERAGE FOR 4 SERVICES FURNISHED VIA TELEHEALTH IF 5 SUCH SERVICES WOULD BE COVERED IF FUR- 6 NISHED IN-PERSON DURING THE COVID-19 7 EMERGENCY. 8 (a) IN GENERAL.—During any portion of the emer- 9 gency period described in section 1135(g)(1)(B) of the So- 10 cial Security Act (42 U.S.C. 1320b–5(g)(1)(B)), notwith- 11 standing sections 2703 and 2715(d)(4) of the Public 12 Health Service Act (42 U.S.C. 300gg–2, 300gg–15(d)(4)), 13 a group health plan and a health insurance issuer offering 14 group health insurance coverage, including a grand- 15 fathered health plan (as defined in section 1251(e) of the 16 Patient Protection and Affordable Care Act (42 U.S.C. 17 18011(e)))— 18 (1) shall— 19 (A) provide benefits under such plan or 20 such coverage for any eligible service (as de- 21 fined in subsection (c)), including a mental 22 health and substance use disorder service, fur- 23 nished via a qualifying telecommunications sys- 24 tem (as defined in subsection (c)) by a health 25 care provider to an individual who is a partici- 26 VerDate Sep 11 2014 21:28 May 01, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6644.IH H6644 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 6644 IH pant, beneficiary, or enrollee under such plan or 1 such coverage, notwithstanding that such pro- 2 vider furnishing such service is not at the same 3 location as the individual; 4 (B) so provide such benefits for such serv- 5 ice under the same terms and with application 6 of the same cost-sharing requirements (includ- 7 ing a deductible, copayment, or coinsurance) as 8 would apply if such service were furnished by 9 such provider to such individual in-person; 10 (C) reimburse such provider for such serv- 11 ice in an amount equal to the amount of reim- 12 bursement for such service had such service 13 been furnished by such provider to such indi- 14 vidual in-person; 15 (D) not impose any requirement under 16 such plan or coverage that such provider have 17 a prior relationship with such individual; and 18 (E) not restrict the ability of any health 19 care provider with a contractual relationship for 20 furnishing an eligible service under such plan or 21 coverage from furnishing such service via a 22 qualifying telecommunications system, and shall 23 not establish incentives or penalties under such 24 plan or coverage for receiving such an eligible 25 VerDate Sep 11 2014 21:28 May 01, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6644.IH H6644 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 6644 IH service from such a provider via such a system; 1 and 2 (2) may waive any cost-sharing requirement 3 (including application of a deductible, copayment, or 4 coinsurance) for an item or service furnished for 5 purposes of diagnosing or treating COVID-19, in- 6 cluding any such service that is an eligible service 7 furnished via a qualifying telecommunications sys- 8 tem. 9 (b) APPLICATION.—The provisions of this section 10 shall be applied by the Secretary of Health and Human 11 Services, Secretary of Labor, and Secretary of the Treas- 12 ury to group health plans and health insurance issuers of- 13 fering group or individual health insurance coverage as if 14 included in the provisions of part A of title XXVII of the 15 Public Health Service Act, part 7 of the Employee Retire- 16 ment Income Security Act of 1974, and subchapter B of 17 chapter 100 of the Internal Revenue Code of 1986, as ap- 18 plicable. 19 (c) DEFINITIONS.—In this section: 20 (1) ELIGIBLE SERVICE.—The term ‘‘eligible 21 service’’ means, with respect to a group health plan 22 and a health insurance issuer offering group or indi- 23 vidual health insurance coverage, a service— 24 VerDate Sep 11 2014 21:28 May 01, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6644.IH H6644 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 6644 IH (A) for which benefits are provided under 1 such plan or such coverage when such service is 2 furnished in-person; 3 (B) that is medically necessary (as deter- 4 mined by the health care provider furnishing 5 such service); and 6 (C) that is able to be safely and effectively 7 furnished via a telecommunications system. 8 (2) HEALTH INSURANCE TERMS.—The terms 9 ‘‘group health plan’’, ‘‘health insurance issuer’’, 10 ‘‘group health insurance coverage’’, and ‘‘individual 11 health insurance coverage’’ have the meanings given 12 such terms in section 2791 of the Public Health 13 Service Act (42 U.S.C. 300gg–91), section 733 of 14 the Employee Retirement Income Security Act of 15 1974 (29 U.S.C. 1191b), and section 9832 of the 16 Internal Revenue Code of 1986, as applicable. 17 (3) QUALIFYING TELECOMMUNICATIONS SYS- 18 TEM.—The term ‘‘qualifying telecommunications 19 system’’ means a telecommunications system that in- 20 cludes, at a minimum, audio capabilities permitting 21 two-way, real-time interactive communication be- 22 tween the individual receiving an eligible service via 23 such system and the health care provider furnishing 24 such system, including a telephone, videoconferenc- 25 VerDate Sep 11 2014 21:28 May 01, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6644.IH H6644 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 6644 IH ing system, internet communications system, stream- 1 ing media communications system, and such other 2 systems as specified by the Secretary of Health and 3 Human Services. 4 (d) EFFECTIVE DATE.—This section shall apply with 5 respect to items and services furnished on or after the first 6 day of the emergency period described in subsection (a). 7 Æ VerDate Sep 11 2014 21:28 May 01, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H6644.IH H6644 pbinns on DSKJLVW7X2PROD with BILLS