Health Care Emergency Guarantee Act

I 116TH CONGRESS 2D SESSION H. R. 6906 To provide reimbursements for certain costs of health care items and services, including prescription drugs, furnished during the public health emer- gency declared with respect to COVID–19. IN THE HOUSE OF REPRESENTATIVES MAY 15, 2020 Ms. JAYAPAL (for herself, Ms. BASS, Ms. BONAMICI, Mr. DEFAZIO, Mrs. DIN- GELL, Mr. ESPAILLAT, Mr. GARCI´A of Illinois, Mr. KENNEDY, Mr. KHANNA, Ms. MENG, Ms. NORTON, Ms. OCASIO-CORTEZ, Ms. OMAR, Mr. POCAN, Ms. PRESSLEY, Mr. RASKIN, Ms. TLAIB, Mr. COHEN, and Mr. BLUMENAUER) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Veterans’ Affairs, Armed Services, Oversight and Reform, and Natural Resources, for a period to be subsequently deter- mined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide reimbursements for certain costs of health care items and services, including prescription drugs, fur- nished during the public health emergency declared with respect to COVID–19. 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 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6906 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Health Care Emer- 2 gency Guarantee Act’’. 3 SEC. 2. REIMBURSEMENTS FOR CERTAIN COSTS OF 4 HEALTH CARE ITEMS AND SERVICES INCLUD- 5 ING PRESCRIPTION DRUGS FURNISHED DUR- 6 ING PUBLIC HEALTH EMERGENCY. 7 (a) IN GENERAL.—During the period beginning on 8 the date of enactment of this Act and ending on the date 9 the Secretary certifies to Congress that a vaccine approved 10 by the Food and Drug Administration for COVID–19 is 11 widely available to the public, the Secretary shall make 12 payments to qualified providers with respect to applicable 13 health care items and services as defined in subsection (b) 14 that are furnished to an applicable individual an amount 15 equal to— 16 (1) in the case of any portion of such period in 17 which an applicable individual is enrolled in a public 18 or private health insurance plan, the amount of any 19 cost-sharing, including any deductibles, copayments, 20 coinsurance or similar charges, that would otherwise 21 be applicable under such plan, including with respect 22 to prescription drug coverage under the plan; and 23 (2) in the case of any portion of such period in 24 which an applicable individual is uninsured, an 25 amount equal to the amount that would be paid to 26 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6906 IH the qualified provider for the same or equivalent 1 items or services, including with respect to any inpa- 2 tient or physician-administered drugs (and excluding 3 outpatient prescription drugs or biologicals with re- 4 spect to which coverage is provided under subsection 5 (e)), under the Medicare program under title XVIII 6 of the Social Security Act (42 U.S.C. 1395 et seq.). 7 (b) APPLICABLE HEALTH CARE ITEMS AND SERV- 8 ICES; APPLICABLE INDIVIDUAL DEFINED.—In this sec- 9 tion: 10 (1) APPLICABLE HEALTH CARE ITEMS AND 11 SERVICES.—The term ‘‘applicable health care items 12 and services’’ means, with respect to an applicable 13 individual, any health care items and services that 14 are medically necessary or appropriate for the main- 15 tenance of health or for the diagnosis, treatment, or 16 rehabilitation of a health condition of the applicable 17 individual, including— 18 (A) any testing services and treatments for 19 COVID–19 or related complications, including 20 vaccines, diagnostic tests, drugs and biologicals, 21 and therapies; and 22 (B) in the case of an applicable individual 23 who is enrolled in a public or private health in- 24 surance plan, any health care items and serv- 25 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6906 IH ices covered by such plan as of March 1, 2020, 1 or in the case of an applicable individual who 2 enrolls in such plan after the date, any health 3 care items and services covered by such plan as 4 of the date of such enrollment. 5 (2) APPLICABLE INDIVIDUAL.—The term ‘‘ap- 6 plicable individual’’ means an individual who is a 7 resident of the United States. 8 (c) REQUIREMENTS.— 9 (1) NO EFFECT ON APPLICABLE COST-SHARING 10 REQUIREMENTS.—Nothing in this section shall af- 11 fect the application of any requirements applicable 12 under Federal or State law with respect to coverage 13 of health care items and services without any cost- 14 sharing. 15 (2) MAINTENANCE OF EFFORT.— 16 (A) IN GENERAL.—During the period de- 17 scribed in subsection (a), a public or private 18 health plan shall not increase cost-sharing, de- 19 crease benefits, or otherwise make coverage less 20 generous than the benefits offered on the date 21 of enactment of this Act. 22 (B) NEW ITEMS AND SERVICES.—During 23 such period, a public or private health plan 24 shall provide coverage of new items and serv- 25 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 6906 IH ices, including those related to COVID–19, as 1 appropriate, at a minimum, at a level consistent 2 with the prior coverage practices and 3 formularies of the plan. 4 (3) LIMITATION ON OUT-OF-POCKET EX- 5 PENSES.—During such period, in order to be eligible 6 to receive payments under this section, a qualified 7 provider shall agree not to impose on an applicable 8 individual any charge for applicable health care 9 items and services furnished to the applicable indi- 10 vidual. 11 (4) PERMISSIBLE BILLING OF PLANS; LIMITA- 12 TION ON BALANCE BILLING.—During such period, in 13 order to be eligible to receive payments under this 14 section, a qualified provider shall agree, with respect 15 to applicable health care items and services fur- 16 nished to an applicable individual when such indi- 17 vidual is enrolled in a public or private health insur- 18 ance plan— 19 (A) not to impose any charge on the plan 20 for such items and services beyond the amount 21 otherwise payable by the plan; and 22 (B) not to bill the applicable individual for 23 any amounts in excess of the amount described 24 in subparagraph (A). 25 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 6906 IH (5) MEDICAL DEBT COLLECTION.—A qualified 1 provider shall agree— 2 (A) to immediately halt all medical debt 3 collection, including collection activities carried 4 out by third parties, during such period and 5 shall not collect medical debt or have third par- 6 ties collect medical debt for applicable health 7 care items and services furnished during such 8 period; and 9 (B) to refrain from pursuing medical debt 10 collection, including collection activities carried 11 out by third parties, after such period with re- 12 spect to items and services related to the diag- 13 nosis or treatment of COVID–19 (regardless of 14 whether such services were furnished before, 15 during, or after such period) and shall not col- 16 lect medical debt or have third parties collect 17 medical debt for such items or services after 18 such period. 19 (6) SUBMISSION OF BILLS AND DOCUMENTA- 20 TION.—A qualified provider shall agree to submit 21 bills and any required supporting documentation re- 22 lating to the provision of applicable health care 23 items and services within 30 days after the date of 24 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 6906 IH providing such services, in such manner as the Sec- 1 retary determines appropriate. 2 (d) WAIVER OF LATE ENROLLMENT PENALTIES 3 UNDER MEDICARE.—During the period described in sub- 4 section (a), no increase in the monthly premium of an indi- 5 vidual pursuant to section 1818(c), 1839(b), or 1860D– 6 13 of the Social Security Act (42 U.S.C. 1395i–2(c), 7 1395r(b), 1395w–113) shall be effected in the case of any 8 individual who enrolls for benefits under title XVIII of 9 such Act with respect to any period prior to the date of 10 such enrollment. 11 (e) COVERAGE WITH RESPECT TO OUTPATIENT PRE- 12 SCRIPTION DRUGS.— 13 (1) IN GENERAL.—During the period described 14 in subsection (a), with respect to outpatient pre- 15 scription drugs or biologicals described in subsection 16 (b)(1)(A) that are dispensed to uninsured individ- 17 uals, the Secretary shall establish procedures under 18 which— 19 (A) such drugs or biologicals are dispensed 20 at no cost to such individuals; 21 (B) pharmacies that dispense such drugs 22 or biologicals— 23 (i) are reimbursed by the Secretary 24 for such drugs or biologicals dispensed to 25 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 6906 IH such individuals at an amount equal to the 1 price paid by the Secretary of Veterans Af- 2 fairs to procure the drug or biological 3 under the laws administered by the Sec- 4 retary of Veterans Affairs; and 5 (ii) agree not to charge such individ- 6 uals for any difference between the amount 7 reimbursed under clause (i) and the cost to 8 the pharmacy for the drug; and 9 (C) manufacturers of such drugs or 10 biologicals reimburse pharmacies for any dif- 11 ference described in subparagraph (B)(ii) with 12 respect to drugs or biologicals of the manufac- 13 turer that are dispensed to such individuals. 14 (2) CONDITION OF COVERAGE UNDER MEDI- 15 CARE.—During the period described in subsection 16 (a), no coverage may be provided under part B or 17 D of title XVIII of the Social Security Act (42 18 U.S.C. 1395j et seq., 1395w–101 et seq.) with re- 19 spect to a drug or biological of a manufacturer if the 20 manufacturer does not enter into an agreement with 21 the Secretary to carry out the requirements applica- 22 ble with respect to such manufacturers under this 23 subsection. 24 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 6906 IH (3) REQUIREMENT FOR PARTICIPATING PHAR- 1 MACIES.—During the period described in subsection 2 (a), a prescription drug plan under part D of title 3 XVIII of the Social Security Act (42 U.S.C. 1395w– 4 101 et seq.) may not contract with a pharmacy if 5 the pharmacy does not enter into an agreement with 6 the Secretary to carry out the requirements applica- 7 ble with respect to pharmacies under this subsection. 8 (f) OTHER DEFINITIONS.— 9 (1) PUBLIC OR PRIVATE HEALTH INSURANCE 10 PLAN.— 11 (A) IN GENERAL.—The term ‘‘public or 12 private health insurance plan’’ means any of 13 the following: 14 (i) A group health plan, or group 15 health insurance coverage, as such terms 16 are defined in section 2791 of the Public 17 Health Service Act (42 U.S.C. 300gg–91). 18 (ii) A qualified health plan, as defined 19 in section 1301 of the Patient Protection 20 and Affordable Care Act (42 U.S.C. 21 18021). 22 (iii) Subject to subparagraph (B), any 23 health insurance coverage (other than a 24 plan described in clause (ii)) offered in the 25 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 6906 IH individual market, as such terms are de- 1 fined in section 2791 of the Public Health 2 Service Act, including any short-term lim- 3 ited duration insurance. 4 (iv) A health plan offered under chap- 5 ter 89 of title 5, United States Code. 6 (v) A Federal health care program (as 7 defined under section 1128B(f) of the So- 8 cial Security Act (42 U.S.C. 1320a–7b(f)), 9 including— 10 (I) health benefits furnished 11 under the TRICARE program (as de- 12 fined in section 1072 of title 10, 13 United States Code); 14 (II) health benefits furnished to 15 veterans under the laws administered 16 by the Secretary of Veterans Affairs; 17 and 18 (III) health benefits furnished to 19 Indians (as defined in section 4 of the 20 Indian Health Care Improvement Act 21 (25 U.S.C. 1603)) receiving health 22 services through the Indian Health 23 Service, including through an Urban 24 Indian Organization, regardless of 25 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 6906 IH whether such benefits are for items or 1 services that have been authorized 2 under the purchased/referred care sys- 3 tem funded by the Indian Health 4 Service or are covered as a health 5 service of the Indian Health Service. 6 (B) LIMITATION ON INDIVIDUAL HEALTH 7 INSURANCE COVERAGE.—The term ‘‘public or 8 private health insurance coverage’’ includes the 9 health insurance coverage described in clause 10 (iii) of subparagraph (A) only with respect to 11 an individual who is enrolled in such coverage 12 on March 1, 2020. 13 (2) QUALIFIED PROVIDER.—The term ‘‘quali- 14 fied provider’’ means a health care provider who is 15 a participating provider under the Medicare program 16 under title XVIII of the Social Security Act (42 17 U.S.C. 1395 et seq.). Such term includes a health 18 care provider who is not a participating provider 19 under such program if the health care provider 20 would meet the criteria for such participation and, 21 if the State requires the health care provider to be 22 licensed by the State, is licensed by the State in 23 which the items or services are furnished. 24 VerDate Sep 11 2014 16:32 Jun 05, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H6906.IH H6906 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 6906 IH (3) SECRETARY.—The term ‘‘Secretary’’ means 1 the Secretary of Health and Human Services. 2 (g) IMPLEMENTATION.— 3 (1) IN GENERAL.—The Secretary, in coordina- 4 tion with the Secretary of the Treasury, the Com- 5 missioner of Social Security, and the Secretary of 6 Labor, shall implement the provisions of this section 7 not later than the date that is 7 days after the date 8 of the enactment of this Act. 9 (2) ENSURING TIMELY PAYMENT.—The Sec- 10 retary shall establish a process and issue such guid- 11 ance as is necessary to ensure a qualified provider 12 [Text truncated for display. 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