Health Care at Home Act of 2020

II 116TH CONGRESS 2D SESSION S. 3741 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 SENATE OF THE UNITED STATES MAY 14, 2020 Ms. SMITH (for herself, Ms. STABENOW, Mr. CARDIN, Mr. CASEY, Mr. UDALL, Mrs. SHAHEEN, Ms. HARRIS, Ms. KLOBUCHAR, and Mr. MAR- KEY) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Care at Home 4 Act of 2020’’. 5 VerDate Sep 11 2014 23:26 Jun 04, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3741.IS S3741 lotter on DSK9F5VC42PROD with BILLS 2 •S 3741 IS SEC. 2. REQUIRING GROUP HEALTH PLANS AND HEALTH 1 INSURANCE ISSUERS OFFERING GROUP OR 2 INDIVIDUAL HEALTH INSURANCE COVERAGE 3 TO PROVIDE COVERAGE FOR SERVICES FUR- 4 NISHED VIA TELEHEALTH IF SUCH SERVICES 5 WOULD BE COVERED IF FURNISHED IN PER- 6 SON DURING THE COVID–19 EMERGENCY. 7 (a) IN GENERAL.—During any portion of the emer- 8 gency period described in section 1135(g)(1)(B) of the So- 9 cial Security Act (42 U.S.C. 1320b–5(g)(1)(B)), notwith- 10 standing sections 2703 and 2715(d)(4) of the Public 11 Health Service Act (42 U.S.C. 300gg–2, 300gg–15(d)(4)), 12 a group health plan and a health insurance issuer offering 13 group health insurance coverage, including a grand- 14 fathered health plan (as defined in section 1251(e) of the 15 Patient Protection and Affordable Care Act (42 U.S.C. 16 18011(e)))— 17 (1) shall— 18 (A) provide benefits under such plan or 19 such coverage for any eligible service (as de- 20 fined in subsection (c)), including a mental 21 health and substance use disorder service, fur- 22 nished via a qualifying telecommunications sys- 23 tem (as defined in subsection (c)) by a health 24 care provider to an individual who is a partici- 25 pant, beneficiary, or enrollee under such plan or 26 VerDate Sep 11 2014 17:58 Jun 03, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3741.IS S3741 lotter on DSK9F5VC42PROD with BILLS 3 •S 3741 IS such coverage, notwithstanding that such pro- 1 vider furnishing such service is not at the same 2 location as the individual; 3 (B) so provide such benefits for such serv- 4 ice under the same terms and with application 5 of the same cost-sharing requirements (includ- 6 ing a deductible, copayment, or coinsurance) as 7 would apply if such service were furnished by 8 such provider to such individual in person; 9 (C) reimburse such provider for such serv- 10 ice in an amount equal to the amount of reim- 11 bursement for such service had such service 12 been furnished by such provider to such indi- 13 vidual in person; 14 (D) not impose any requirement under 15 such plan or coverage that such provider have 16 a prior relationship with such individual; and 17 (E) not restrict the ability of any health 18 care provider with a contractual relationship for 19 furnishing an eligible service under such plan or 20 coverage from furnishing such service via a 21 qualifying telecommunications system, and shall 22 not establish incentives or penalties under such 23 plan or coverage for receiving such an eligible 24 VerDate Sep 11 2014 17:58 Jun 03, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3741.IS S3741 lotter on DSK9F5VC42PROD with BILLS 4 •S 3741 IS 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 17:58 Jun 03, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3741.IS S3741 lotter on DSK9F5VC42PROD with BILLS 5 •S 3741 IS (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, 25 VerDate Sep 11 2014 17:58 Jun 03, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3741.IS S3741 lotter on DSK9F5VC42PROD with BILLS 6 •S 3741 IS videoconferencing system, internet communications 1 system, streaming media communications system, 2 and such other systems as specified by the Secretary 3 of Health and 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 17:58 Jun 03, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S3741.IS S3741 lotter on DSK9F5VC42PROD with BILLS