To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program.

I 116TH CONGRESS 2D SESSION H. R. 6727 To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program. IN THE HOUSE OF REPRESENTATIVES MAY 5, 2020 Ms. SCHRIER (for herself and Mr. MCEACHIN) introduced the following bill; which was referred to the Committee on Ways and Means, and in addi- tion to the Committees on Energy and Commerce, and Armed Services, 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 concerned A BILL To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. HOLDING MEDICARE BENEFICIARIES HARM- 3 LESS FOR SPECIFIED COVID-19 TREATMENT 4 SERVICES FURNISHED UNDER PART A OR 5 PART B OF THE MEDICARE PROGRAM. 6 (a) IN GENERAL.—Notwithstanding any other provi- 7 sion of law, in the case of a specified COVID-19 treatment 8 VerDate Sep 11 2014 03:35 May 15, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6727.IH H6727 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 6727 IH service (as defined in subsection (b)) furnished to an indi- 1 vidual entitled to benefits under part A or enrolled under 2 part B of title XVIII of the Social Security Act (42 U.S.C. 3 1395 et seq.) for which payment is made under such part 4 A or such part B, the Secretary of Health and Human 5 Services (in this section referred to as the ‘‘Secretary’’) 6 shall provide that— 7 (1) any cost-sharing required (including any de- 8 ductible, copayment, or coinsurance) applicable to 9 such individual under such part A or such part B 10 with respect to such item or service is paid by the 11 Secretary; and 12 (2) the provider of services or supplier (as de- 13 fined in section 1861 of the Social Security Act (42 14 U.S.C. 1395x)) does not hold such individual liable 15 for such requirement. 16 (b) DEFINITION OF SPECIFIED COVID-19 TREAT- 17 MENT SERVICES.—For purposes of this section, the term 18 ‘‘specified COVID-19 treatment service’’ means any item 19 or service furnished to an individual for which payment 20 may be made under part A or part B of title XVIII of 21 the Social Security Act (42 U.S.C. 1395 et seq.) if such 22 item or service is included in a claim with an ICD–10– 23 CM code relating to COVID-19 (as described in the docu- 24 ment entitled ‘‘ICD–10–CM Official Coding Guidelines— 25 VerDate Sep 11 2014 03:35 May 15, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6727.IH H6727 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 6727 IH Supplement Coding encounters related to COVID-19 1 Coronavirus Outbreak’’ published on February 20, 2020, 2 or as otherwise specified by the Secretary). 3 (c) RECOVERY OF COST-SHARING AMOUNTS PAID BY 4 THE SECRETARY IN THE CASE OF SUPPLEMENTAL IN- 5 SURANCE COVERAGE.— 6 (1) IN GENERAL.—In the case of any amount 7 paid by the Secretary pursuant to subsection (a)(1) 8 that the Secretary determines would otherwise have 9 been paid by a group health plan or health insurance 10 issuer (as such terms are defined in section 2791 of 11 the Public Health Service Act (42 U.S.C. 300gg– 12 91)), a private entity offering a medicare supple- 13 mental policy under section 1882 of the Social Secu- 14 rity Act (42 U.S.C. 1395ss), any other health plan 15 offering supplemental coverage, a State plan under 16 title XIX of the Social Security Act, or the Secretary 17 of Defense under the TRICARE program, such 18 plan, issuer, private entity, other health plan, State 19 plan, or Secretary of Defense, as applicable, shall 20 pay to the Secretary, not later than 1 year after 21 such plan, issuer, private entity, other health plan, 22 State plan, or Secretary of Defense receives a notice 23 under paragraph (3), such amount in accordance 24 with this subsection. 25 VerDate Sep 11 2014 03:35 May 15, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6727.IH H6727 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 6727 IH (2) REQUIRED INFORMATION.—Not later than 1 9 months after the date of the enactment of this 2 Act, each group health plan, health insurance issuer, 3 private entity, other health plan, State plan, and 4 Secretary of Defense described in paragraph (1) 5 shall submit to the Secretary such information as 6 the Secretary determines necessary for purposes of 7 carrying out this subsection. Such information so 8 submitted shall be updated by such plan, issuer, pri- 9 vate entity, other health plan, State plan, or Sec- 10 retary of Defense, as applicable, at such time and in 11 such manner as specified by the Secretary. 12 (3) REVIEW OF CLAIMS AND NOTIFICATION.— 13 The Secretary shall establish a process under which 14 claims for items and services for which the Secretary 15 has paid an amount pursuant to subsection (a)(1) 16 are reviewed for purposes of identifying if such 17 amount would otherwise have been paid by a plan, 18 issuer, private entity, other health plan, State plan, 19 or Secretary of Defense described in paragraph (1). 20 In the case such a claim is so identified, the Sec- 21 retary shall determine the amount that would have 22 been otherwise payable by such plan, issuer, private 23 entity, other health plan, State plan, or Secretary of 24 Defense and notify such plan, issuer, private entity, 25 VerDate Sep 11 2014 03:35 May 15, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6727.IH H6727 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 6727 IH other health plan, State plan, or Secretary of De- 1 fense of such amount. 2 (4) ENFORCEMENT.—The Secretary may im- 3 pose a civil monetary penalty in an amount deter- 4 mined appropriate by the Secretary in the case of a 5 plan, issuer, private entity, other health plan, or 6 State plan that fails to comply with a provision of 7 this section. The provisions of section 1128A of the 8 Social Security Act shall apply to a civil monetary 9 penalty imposed under the previous sentence in the 10 same manner as such provisions apply to a penalty 11 or proceeding under subsection (a) or (b) of such 12 section. 13 (d) FUNDING.—The Secretary shall provide for the 14 transfer to the Centers for Medicare & Medicaid Program 15 Management Account from the Federal Hospital Insur- 16 ance Trust Fund and the Federal Supplementary Medical 17 Trust Fund (in such portions as the Secretary determines 18 appropriate) $100,000,000 for purposes of carrying out 19 this section. 20 (e) REPORT.—Not later than 3 years after the date 21 of the enactment of this Act, the Inspector General of the 22 Department of Health and Human Services shall submit 23 to Congress a report containing an analysis of amounts 24 VerDate Sep 11 2014 03:35 May 15, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6727.IH H6727 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 6727 IH paid pursuant to subsection (a)(1) compared to amounts 1 paid to the Secretary pursuant to subsection (c). 2 (f) IMPLEMENTATION.—Notwithstanding any other 3 provision of law, the Secretary may implement the provi- 4 sions of this section by program instruction or otherwise. 5 Æ VerDate Sep 11 2014 03:35 May 15, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H6727.IH H6727 kjohnson on DSK79L0C42PROD with BILLS