Health Care Emergency Guarantee Act

II 116TH CONGRESS 2D SESSION S. 3790 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 SENATE OF THE UNITED STATES MAY 20, 2020 Mrs. GILLIBRAND (for Mr. SANDERS (for himself, Mrs. GILLIBRAND, Mr. MARKEY, Ms. WARREN, Mr. BOOKER, Mr. MERKLEY, and Ms. HARRIS)) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Care Emer- 4 gency Guarantee Act’’. 5 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 2 •S 3790 IS SEC. 2. REIMBURSEMENTS FOR CERTAIN COSTS OF 1 HEALTH CARE ITEMS AND SERVICES INCLUD- 2 ING PRESCRIPTION DRUGS FURNISHED DUR- 3 ING PUBLIC HEALTH EMERGENCY. 4 (a) IN GENERAL.—During the period beginning on 5 the date of enactment of this Act and ending on the date 6 the Secretary certifies to Congress that a vaccine approved 7 by the Food and Drug Administration for COVID–19 is 8 widely available to the public, the Secretary shall make 9 payments to qualified providers with respect to applicable 10 health care items and services as defined in subsection (b) 11 that are furnished to an applicable individual an amount 12 equal to— 13 (1) in the case of any portion of such period in 14 which an applicable individual is enrolled in a public 15 or private health insurance plan, the amount of any 16 cost-sharing, including any deductibles, copayments, 17 coinsurance or similar charges, that would otherwise 18 be applicable under such plan, including with respect 19 to prescription drug coverage under the plan; 20 (2) in the case of any portion of such period in 21 which an applicable individual is uninsured, an 22 amount equal to the amount that would be paid to 23 the qualified provider for the same or equivalent 24 items or services, including with respect to any inpa- 25 tient or physician-administered drugs (and excluding 26 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 3 •S 3790 IS outpatient prescription drugs or biologicals with re- 1 spect to which coverage is provided under subsection 2 (e)), under the Medicare program under title XVIII 3 of the Social Security Act (42 U.S.C. 1395 et seq.). 4 (b) APPLICABLE HEALTH CARE ITEMS AND SERV- 5 ICES; APPLICABLE INDIVIDUAL DEFINED.—In this sec- 6 tion: 7 (1) APPLICABLE HEALTH CARE ITEMS AND 8 SERVICES.—The term ‘‘applicable health care items 9 and services’’ means, with respect to an applicable 10 individual, any health care items and services that 11 are medically necessary or appropriate for the main- 12 tenance of health or for the diagnosis, treatment, or 13 rehabilitation of a health condition of the applicable 14 individual, including— 15 (A) any testing services and treatments for 16 COVID–19 or related complications, including 17 vaccines, diagnostic tests, drugs and biologicals, 18 and therapies; and 19 (B) in the case of an applicable individual 20 who is enrolled in a public or private health in- 21 surance plan, any health care items and serv- 22 ices covered by such plan as of March 1, 2020, 23 or in the case of an applicable individual who 24 enrolls in such plan after the date, any health 25 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 4 •S 3790 IS care items and services covered by such plan as 1 of the date of such enrollment. 2 (2) APPLICABLE INDIVIDUAL.—The term ‘‘ap- 3 plicable individual’’ means an individual who is a 4 resident of the United States. 5 (c) REQUIREMENTS.— 6 (1) NO EFFECT ON APPLICABLE COST-SHARING 7 REQUIREMENTS.—Nothing in this section shall af- 8 fect the application of any requirements applicable 9 under Federal or State law with respect to coverage 10 of health care items and services without any cost- 11 sharing. 12 (2) MAINTENANCE OF EFFORT.— 13 (A) IN GENERAL.—During the period de- 14 scribed in subsection (a), a public or private 15 health plan shall not increase cost-sharing, de- 16 crease benefits, or otherwise make coverage less 17 generous than the benefits offered on the date 18 of enactment of this Act. 19 (B) NEW ITEMS AND SERVICES.—During 20 such period, a public or private health plan 21 shall provide coverage of new items and serv- 22 ices, including those related to COVID–19, as 23 appropriate, at a minimum, at a level consistent 24 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 5 •S 3790 IS with the prior coverage practices and 1 formularies of the plan. 2 (3) LIMITATION ON OUT-OF-POCKET EX- 3 PENSES.—During such period, in order to be eligible 4 to receive payments under this section, a qualified 5 provider shall agree not to impose on an applicable 6 individual any charge for applicable health care 7 items and services furnished to the applicable indi- 8 vidual. 9 (4) PERMISSIBLE BILLING OF PLANS; LIMITA- 10 TION ON BALANCE BILLING.—During such period, in 11 order to be eligible to receive payments under this 12 section, a qualified provider shall agree, with respect 13 to applicable health care items and services fur- 14 nished to an applicable individual when such indi- 15 vidual is enrolled in a public or private health insur- 16 ance plan— 17 (A) not to impose any charge on the plan 18 for such items and services beyond the amount 19 otherwise payable by the plan; and 20 (B) not to bill the applicable individual for 21 any amounts in excess of the amount described 22 in subparagraph (A). 23 (5) MEDICAL DEBT COLLECTION.—A qualified 24 provider shall agree— 25 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 6 •S 3790 IS (A) to immediately halt all medical debt 1 collection, including collection activities carried 2 out by third parties, during such period and 3 shall not collect medical debt or have third par- 4 ties collect medical debt for applicable health 5 care items and services furnished during such 6 period; and 7 (B) to refrain from pursuing medical debt 8 collection, including collection activities carried 9 out by third parties, after such period with re- 10 spect to items and services related to the diag- 11 nosis or treatment of COVID–19 (regardless of 12 whether such services were furnished before, 13 during, or after such period) and shall not col- 14 lect medical debt or have third parties collect 15 medical debt for such items or services after 16 such period. 17 (6) SUBMISSION OF BILLS AND DOCUMENTA- 18 TION.—A qualified provider shall agree to submit 19 bills and any required supporting documentation re- 20 lating to the provision of applicable health care 21 items and services within 30 days after the date of 22 providing such services, in such manner as the Sec- 23 retary determines appropriate. 24 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 7 •S 3790 IS (d) WAIVER OF LATE ENROLLMENT PENALTIES 1 UNDER MEDICARE.—During the period described in sub- 2 section (a), no increase in the monthly premium of an indi- 3 vidual pursuant to section 1818(c), 1839(b), or 1860D– 4 13 of the Social Security Act (42 U.S.C. 1395i–2(c), 5 1395r(b), 1395w–113) shall be effected in the case of any 6 individual who enrolls for benefits under title XVIII of 7 such Act with respect to any period prior to the date of 8 such enrollment. 9 (e) COVERAGE WITH RESPECT TO OUTPATIENT PRE- 10 SCRIPTION DRUGS.— 11 (1) IN GENERAL.—During the period described 12 in subsection (a), with respect to outpatient pre- 13 scription drugs or biologicals described in subsection 14 (b)(1)(A) that are dispensed to uninsured individ- 15 uals, the Secretary shall establish procedures under 16 which— 17 (A) such drugs or biologicals are dispensed 18 at no cost to such individuals; 19 (B) pharmacies that dispense such drugs 20 or biologicals— 21 (i) are reimbursed by the Secretary 22 for such drugs or biologicals dispensed to 23 such individuals at an amount equal to the 24 price paid by the Secretary of Veterans Af- 25 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 8 •S 3790 IS fairs to procure the drug or biological 1 under the laws administered by the Sec- 2 retary of Veterans Affairs; and 3 (ii) agree not to charge such individ- 4 uals for any difference between the amount 5 reimbursed under clause (i) and the cost to 6 the pharmacy for the drug; and 7 (C) manufacturers of such drugs or 8 biologicals reimburse pharmacies for any dif- 9 ference described in subparagraph (B)(ii) with 10 respect to drugs or biologicals of the manufac- 11 turer that are dispensed to such individuals. 12 (2) CONDITION OF COVERAGE UNDER MEDI- 13 CARE.—During the period described in subsection 14 (a), no coverage may be provided under part B or 15 D of title XVIII of the Social Security Act (42 16 U.S.C. 1395j et seq., 1395w–101 et seq.) with re- 17 spect to a drug or biological of a manufacturer if the 18 manufacturer does not enter into an agreement with 19 the Secretary to carry out the requirements applica- 20 ble with respect to such manufacturers under this 21 subsection. 22 (3) REQUIREMENT FOR PARTICIPATING PHAR- 23 MACIES.—During the period described in subsection 24 (a), a prescription drug plan under part D of title 25 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 9 •S 3790 IS XVIII of the Social Security Act (42 U.S.C. 1395w– 1 101 et seq.) may not contract with a pharmacy if 2 the pharmacy does not enter into an agreement with 3 the Secretary to carry out the requirements applica- 4 ble with respect to pharmacies under this subsection. 5 (f) OTHER DEFINITIONS.— 6 (1) PUBLIC OR PRIVATE HEALTH INSURANCE 7 PLAN.— 8 (A) IN GENERAL.—The term ‘‘public or 9 private health insurance plan’’ means any of 10 the following: 11 (i) A group health plan, or group 12 health insurance coverage, as such terms 13 are defined in section 2791 of the Public 14 Health Service Act (42 U.S.C. 300gg–91). 15 (ii) A qualified health plan, as defined 16 in section 1301 of the Patient Protection 17 and Affordable Care Act (42 U.S.C. 18 18021). 19 (iii) Subject to subparagraph (B), any 20 health insurance coverage (other than a 21 plan described in clause (ii)) offered in the 22 individual market, as such terms are de- 23 fined in section 2791 of the Public Health 24 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 10 •S 3790 IS Service Act, including any short-term lim- 1 ited duration insurance. 2 (iv) A health plan offered under chap- 3 ter 89 of title 5, United States Code. 4 (v) A Federal health care program (as 5 defined under section 1128B(f) of the So- 6 cial Security Act (42 U.S.C. 1320a–7b(f)), 7 including— 8 (I) health benefits furnished 9 under the TRICARE program (as de- 10 fined in section 1072 of title 10, 11 United States Code); 12 (II) health benefits furnished to 13 veterans under the laws administered 14 by the Secretary of Veterans Affairs; 15 and 16 (III) health benefits furnished to 17 Indians (as defined in section 4 of the 18 Indian Health Care Improvement Act 19 (25 U.S.C. 1603)) receiving health 20 services through the Indian Health 21 Service, including through an Urban 22 Indian Organization, regardless of 23 whether such benefits are for items or 24 services that have been authorized 25 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 11 •S 3790 IS under the purchased/referred care sys- 1 tem funded by the Indian Health 2 Service or are covered as a health 3 service of the Indian Health Service. 4 (B) LIMITATION ON INDIVIDUAL HEALTH 5 INSURANCE COVERAGE.—The term ‘‘public or 6 private health insurance coverage’’ includes the 7 health insurance coverage described in clause 8 (iii) of subparagraph (A) only with respect to 9 an individual who is enrolled in such coverage 10 on March 1, 2020. 11 (2) QUALIFIED PROVIDER.—The term ‘‘quali- 12 fied provider’’ means a health care provider who is 13 a participating provider under the Medicare program 14 under title XVIII of the Social Security Act (42 15 U.S.C. 1395 et seq.). Such term includes a health 16 care provider who is not a participating provider 17 under such program if the health care provider 18 would meet the criteria for such participation and, 19 if the State requires the health care provider to be 20 licensed by the State, is licensed by the State in 21 which the items or services are furnished. 22 (3) SECRETARY.—The term ‘‘Secretary’’ means 23 the Secretary of Health and Human Services. 24 (g) IMPLEMENTATION.— 25 VerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790 kjohnson on DSK79L0C42PROD with BILLS 12 •S 3790 IS (1) IN GENERAL.—The Secretary, in coordina- 1 tion with the Secretary of the Treasury, the Com- 2 missioner of Social Security, and the Secretary of 3 Labor, shall implement the provisions of this section 4 not later than the date that is 7 days after the date 5 of the enactment of this Act. 6 (2) ENSURING TIMELY PAYMENT.—The Sec- 7 retary shall establish a process and issue such guid- 8 ance as is necessary to ensure a qualified provider 9 receives payments under this section in a timely 10 manner. 11 (3) ENSURING COLLECTION OF DATA ON DIS- 12 PARITIES.—The Secretary shall implement this sec- 13 tion in a manner and issue such guidance as is nec- 14 essary to allow for the ongoing, accurate, and timely 15 collection and analysis of data on disparities in ac- 16 cordance with subsection (h). 17 (h) COLLECTION OF DATA ON DISPARITIES.— 18 (1) IN GENERAL.—During th [Text truncated for display. 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