Medicare Advantage COVID Treatment Act

I 116TH CONGRESS 2D SESSION H. R. 6640 To amend title XVIII of the Social Security Act to provide coverage for COVID–19 at no cost sharing under the medicare advantage program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 28, 2020 Ms. MUCARSEL-POWELL (for herself and Mr. KIND) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 amend title XVIII of the Social Security Act to provide coverage for COVID–19 at no cost sharing under the medicare advantage program, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicare Advantage 4 COVID Treatment Act’’. 5 VerDate Sep 11 2014 03:40 May 01, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6640.IH H6640 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 6640 IH SEC. 2. COVERAGE OF TREATMENTS FOR COVID–19 AT NO 1 COST SHARING UNDER THE MEDICARE AD- 2 VANTAGE PROGRAM. 3 (a) IN GENERAL.—Section 1852(a)(1)(B) of the So- 4 cial Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is 5 amended by adding at the end the following new clause: 6 ‘‘(vii) SPECIAL COVERAGE RULES FOR 7 SPECIFIED COVID–19 TREATMENT SERV- 8 ICES.— 9 ‘‘(I) IN GENERAL.—Notwith- 10 standing clause (i), in the case of a 11 specified COVID-19 treatment service 12 that is furnished during a plan year 13 occurring during any portion of the 14 emergency period defined in section 15 1135(g)(1)(B) beginning on or after 16 the date of the enactment of this 17 clause, a Medicare Advantage plan 18 may not, with respect to such service, 19 impose— 20 ‘‘(aa) any cost-sharing re- 21 quirement (including a deduct- 22 ible, copayment, or coinsurance 23 requirement); and 24 ‘‘(bb) in the case such serv- 25 ice is a critical specified COVID- 26 VerDate Sep 11 2014 03:40 May 01, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6640.IH H6640 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 6640 IH 19 treatment service (including 1 ventilator services and intensive 2 care unit services), any prior au- 3 thorization or other utilization 4 management requirement. 5 A Medicare Advantage plan may not 6 take the application of this clause into 7 account for purposes of a bid amount 8 submitted by such plan under section 9 1854(a)(6). 10 ‘‘(II) SPECIFIED COVID-19 11 TREATMENT SERVICE DEFINED.—For 12 purposes of this clause, the term 13 ‘specified COVID-19 treatment serv- 14 ice’ means any item or service fur- 15 nished to an individual for which pay- 16 ment may be made under part A or 17 part B of title XVIII of the Social Se- 18 curity Act if such item or service is 19 included in a claim with an ICD–10– 20 CM code relating to COVID-19 (as 21 described in the document entitled 22 ‘ICD–10–CM Official Coding Guide- 23 lines—Supplement Coding encounters 24 related to COVID-19 Coronavirus 25 VerDate Sep 11 2014 03:40 May 01, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6640.IH H6640 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 6640 IH Outbreak’ published on February 20, 1 2020, or as otherwise specified by the 2 Secretary).’’. 3 (b) REIMBURSEMENT OF MEDICARE ADVANTAGE 4 PLANS FOR ELIMINATION OF COST SHARING.—Section 5 1853 of the Social Security Act (42 U.S.C. 1395w–23) 6 is amended by adding at the end the following new sub- 7 section: 8 ‘‘(p) ADDITIONAL PAYMENT TO ACCOUNT FOR COST 9 SHARING ELIMINATION FOR COVID-19 TREATMENT 10 SERVICES.— 11 ‘‘(1) IN GENERAL.—A Medicare Advantage plan 12 shall notify the Secretary of the total dollar amount 13 of cost sharing that, but for the application of sec- 14 tion 1852(a)(1)(B)(vii), would have been required 15 under such plan for specified COVID-19 treatment 16 services (as defined in subclause (II) of such section) 17 furnished during a plan year described in such sec- 18 tion to individuals enrolled in the plan. The Sec- 19 retary shall make periodic and timely payments in 20 accordance with this subsection to such plan that, in 21 the aggregate, equal such total dollar amount. 22 ‘‘(2) TIMING OF PAYMENT.—Payments by the 23 Secretary under this subsection shall be made begin- 24 ning March 1, 2021, for amounts described in such 25 VerDate Sep 11 2014 03:40 May 01, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6640.IH H6640 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 6640 IH paragraph that would have been required under such 1 plan for specified COVID-19 treatment services fur- 2 nished during plan year 2020. Payments by the Sec- 3 retary under this subsection for such amounts that 4 would have been so required under such plan for 5 such services furnished during a plan year subse- 6 quent to plan year 2020 shall be made beginning 7 March 1 of the plan year following such subsequent 8 plan year. 9 ‘‘(3) NON-APPLICATION.—Section 1853(c)(7) 10 shall not apply with respect to the application of this 11 subsection. 12 ‘‘(4) APPROPRIATION.—There are transferred 13 to the Centers for Medicare & Medicaid Program 14 Management Fund, out of any monies in the Treas- 15 ury not otherwise obligated, such sums as may be 16 necessary to the Secretary for purposes of making 17 payments under this subsection.’’. 18 (c) IMPLEMENTATION.—Notwithstanding any other 19 provision of law, the Secretary of Health and Human 20 Services may implement the amendments made by this 21 section by program instruction or otherwise. 22 Æ VerDate Sep 11 2014 03:40 May 01, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H6640.IH H6640 kjohnson on DSK79L0C42PROD with BILLS