COVID–19 Treatment Coverage Act

II 116TH CONGRESS 2D SESSION S. 4469 To ensure coverage of a COVID–19 vaccine and treatment. IN THE SENATE OF THE UNITED STATES AUGUST 6, 2020 Ms. SMITH (for herself, Mr. BENNET, and Ms. HARRIS) introduced the fol- lowing bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To ensure coverage of a COVID–19 vaccine and treatment. 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; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘COVID–19 Treatment Coverage Act’’. 5 (b) TABLE OF CONTENTS.—The table of contents of 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. Sec. 2. Coverage at no cost sharing of COVID–19 vaccine and treatment under Medicaid program. Sec. 3. Coverage of treatment and vaccines at no cost sharing for the unin- sured. Sec. 4. Coverage of COVID–19 treatment at no cost sharing under Medicare program. Sec. 5. Coverage of COVID–19 treatment at no cost sharing under Medicare Advantage program. VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 4469 IS Sec. 6. Coverage of COVID–19 Drugs at no cost sharing under Medicare pre- scription drug plans. Sec. 7. Coverage of COVID–19 treatment at no cost sharing under private health insurance. Sec. 8. Coverage of COVID–19 treatment at no cost sharing for TRICARE re- cipients. Sec. 9. Coverage of COVID–19 treatment at no cost sharing for veterans. Sec. 10. Coverage of COVID–19 treatment at no cost sharing for Federal civil- ian employees. Sec. 11. Coverage of COVID–19 treatment at no cost sharing under Indian Health Service. Sec. 12. Sense of Congress related to surprise medical bills. Sec. 13. Special enrollment period; outreach and enrollment activities. SEC. 2. COVERAGE AT NO COST SHARING OF COVID–19 VAC- 1 CINE AND TREATMENT UNDER MEDICAID 2 PROGRAM. 3 (a) MEDICAID.— 4 (1) IN GENERAL.—Section 1905(a)(4) of the 5 Social Security Act (42 U.S.C. 1396d(a)(4)) is 6 amended— 7 (A) by striking ‘‘and (D)’’ and inserting 8 ‘‘(D)’’; and 9 (B) by striking the semicolon at the end 10 and inserting ‘‘; (E) during the portion of the 11 emergency period described in paragraph (1)(B) 12 of section 1135(g) beginning on the date of the 13 enactment of the COVID–19 Treatment Cov- 14 erage Act, a COVID–19 vaccine licensed under 15 section 351 of the Public Health Service Act, or 16 approved or authorized under section 505 or 17 564 of the Federal Food, Drug, and Cosmetic 18 Act, and administration of the vaccine; (F) dur- 19 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 4469 IS ing such portion of the emergency period de- 1 scribed in paragraph (1)(B) of section 1135(g), 2 items or services for the prevention or treat- 3 ment of COVID–19, including drugs approved 4 or authorized under such section 505 or such 5 section 564 or, without regard to the require- 6 ments of section 1902(a)(10)(B) (relating to 7 comparability), in the case of an individual who 8 is diagnosed with or presumed to have COVID– 9 19, during such portion of such emergency pe- 10 riod during which such individual is infected (or 11 presumed infected) with COVID–19, the treat- 12 ment of a condition that may complicate the 13 treatment of COVID–19;’’. 14 (2) PROHIBITION OF COST SHARING.— 15 (A) IN GENERAL.—Subsections (a)(2) and 16 (b)(2) of section 1916 of the Social Security 17 Act (42 U.S.C. 1396o) are each amended— 18 (i) in subparagraph (F), by striking 19 ‘‘or’’ at the end; 20 (ii) in subparagraph (G), by striking 21 ‘‘; and’’ and inserting ‘‘, or’’; and 22 (iii) by adding at the end the fol- 23 lowing subparagraphs: 24 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 4469 IS ‘‘(H) during the portion of the emergency 1 period described in paragraph (1)(B) of section 2 1135(g) beginning on the date of the enactment 3 of this subparagraph, a COVID–19 vaccine li- 4 censed under section 351 of the Public Health 5 Service Act, or approved or authorized under 6 section 505 or 564 of the Federal Food, Drug, 7 and Cosmetic Act, and the administration of 8 such vaccine, or 9 ‘‘(I) during such portion of the emergency 10 period described in paragraph (1)(B) of section 11 1135(g), any item or service furnished for the 12 treatment of COVID–19, including drugs ap- 13 proved or authorized under such section 505 or 14 such section 564 or, in the case of an individual 15 who is diagnosed with or presumed to have 16 COVID–19, during the portion of such emer- 17 gency period during which such individual is in- 18 fected (or presumed infected) with COVID–19, 19 the treatment of a condition that may com- 20 plicate the treatment of COVID–19; and’’. 21 (B) APPLICATION TO ALTERNATIVE COST 22 SHARING.—Section 1916A(b)(3)(B) of the So- 23 cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 24 is amended— 25 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 4469 IS (i) in clause (xi), by striking ‘‘any 1 visit’’ and inserting ‘‘any service’’; and 2 (ii) by adding at the end the following 3 clauses: 4 ‘‘(xii) During the portion of the emer- 5 gency period described in paragraph (1)(B) 6 of section 1135(g) beginning on the date of 7 the enactment of this clause, a COVID–19 8 vaccine licensed under section 351 of the 9 Public Health Service Act, or approved or 10 authorized under section 505 or 564 of the 11 Federal Food, Drug, and Cosmetic Act, 12 and the administration of such vaccine. 13 ‘‘(xiii) During such portion of the 14 emergency period described in paragraph 15 (1)(B) of section 1135(g), an item or serv- 16 ice furnished for the treatment of COVID– 17 19, including drugs approved or authorized 18 under such section 505 or such section 564 19 or, in the case of an individual who is diag- 20 nosed with or presumed to have COVID– 21 19, during such portion of such emergency 22 period during which such individual is in- 23 fected (or presumed infected) with 24 COVID–19, the treatment of a condition 25 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 4469 IS that may complicate the treatment of 1 COVID–19.’’. 2 (C) CLARIFICATION.—The amendments 3 made by this subsection shall apply with respect 4 to a State plan of a territory in the same man- 5 ner as a State plan of one of the 50 States. 6 (b) STATE PEDIATRIC VACCINE DISTRIBUTION PRO- 7 GRAM.—Section 1928 of the Social Security Act (42 8 U.S.C. 1396s) is amended— 9 (1) in subsection (a)(1)— 10 (A) in subparagraph (A), by striking ‘‘; 11 and’’ and inserting a semicolon; 12 (B) in subparagraph (B), by striking the 13 period and inserting ‘‘; and’’; and 14 (C) by adding at the end the following sub- 15 paragraph: 16 ‘‘(C) during the portion of the emergency 17 period described in paragraph (1)(B) of section 18 1135(g) beginning on the date of the enactment 19 of this subparagraph, each vaccine-eligible child 20 (as defined in subsection (b)) is entitled to re- 21 ceive a COVID–19 vaccine from a program-reg- 22 istered provider (as defined in subsection 23 (h)(7)) without charge for— 24 ‘‘(i) the cost of such vaccine; or 25 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 4469 IS ‘‘(ii) the administration of such vac- 1 cine.’’; 2 (2) in subsection (c)(2)— 3 (A) in subparagraph (C)(ii), by inserting ‘‘, 4 but, during the portion of the emergency period 5 described in paragraph (1)(B) of section 6 1135(g) beginning on the date of the enactment 7 of the COVID–19 Treatment Coverage Act, 8 may not impose a fee for the administration of 9 a COVID–19 vaccine’’ before the period; and 10 (B) by adding at the end the following sub- 11 paragraph: 12 ‘‘(D) The provider will provide and admin- 13 ister an approved COVID–19 vaccine to a vac- 14 cine-eligible child in accordance with the same 15 requirements as apply under the preceding sub- 16 paragraphs to the provision and administration 17 of a qualified pediatric vaccine to such a 18 child.’’; and 19 (3) in subsection (d)(1), in the first sentence, 20 by inserting ‘‘, including, during the portion of the 21 emergency period described in paragraph (1)(B) of 22 section 1135(g) beginning on the date of the enact- 23 ment of the COVID–19 Treatment Coverage Act, 24 with respect to a COVID–19 vaccine licensed under 25 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 4469 IS section 351 of the Public Health Service Act, or ap- 1 proved or authorized under section 505 or 564 of 2 the Federal Food, Drug, and Cosmetic Act’’ before 3 the period. 4 (c) CHIP.— 5 (1) IN GENERAL.—Section 2103(c) of the So- 6 cial Security Act (42 U.S.C. 1397cc(c)) is amended 7 by adding at the end the following paragraph: 8 ‘‘(11) COVERAGE OF COVID–19 VACCINES AND 9 TREATMENT.—Regardless of the type of coverage 10 elected by a State under subsection (a), child health 11 assistance provided under such coverage for targeted 12 low-income children and, in the case that the State 13 elects to provide pregnancy-related assistance under 14 such coverage pursuant to section 2112, such preg- 15 nancy-related assistance for targeted low-income 16 pregnant women (as defined in section 2112(d)) 17 shall include coverage, during the portion of the 18 emergency period described in paragraph (1)(B) of 19 section 1135(g) beginning on the date of the enact- 20 ment of this paragraph, of— 21 ‘‘(A) a COVID–19 vaccine licensed under 22 section 351 of the Public Health Service Act, or 23 approved or authorized under section 505 or 24 564 of the Federal Food, Drug, and Cosmetic 25 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 4469 IS Act, and the administration of such vaccine; 1 and 2 ‘‘(B) any item or service furnished for the 3 treatment of COVID–19, including drugs ap- 4 proved or authorized under such section 505 or 5 such section 564, or, in the case of an indi- 6 vidual who is diagnosed with or presumed to 7 have COVID–19, during the portion of such 8 emergency period during which such individual 9 is infected (or presumed infected) with COVID– 10 19, the treatment of a condition that may com- 11 plicate the treatment of COVID–19.’’. 12 (2) PROHIBITION OF COST SHARING.—Section 13 2103(e)(2) of the Social Security Act (42 U.S.C. 14 1397cc(e)(2)), as amended by section 6004(b)(3) of 15 the Families First Coronavirus Response Act, is 16 amended— 17 (A) in the paragraph header, by inserting 18 ‘‘A COVID–19 VACCINE, COVID–19 TREATMENT,’’ 19 before ‘‘OR PREGNANCY-RELATED ASSISTANCE’’; 20 and 21 (B) by striking ‘‘visits described in section 22 1916(a)(2)(G), or’’ and inserting ‘‘services de- 23 scribed in section 1916(a)(2)(G), vaccines de- 24 scribed in section 1916(a)(2)(H) administered 25 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 4469 IS during the portion of the emergency period de- 1 scribed in paragraph (1)(B) of section 1135(g) 2 beginning on the date of the enactment of the 3 COVID–19 Treatment Coverage Act, items or 4 services described in section 1916(a)(2)(I) fur- 5 nished during such emergency period, or’’. 6 (d) CONFORMING AMENDMENTS.—Section 1937 of 7 the Social Security Act (42 U.S.C. 1396u–7) is amend- 8 ed— 9 (1) in subsection (a)(1)(B), by inserting ‘‘, 10 under subclause (XXIII) of section 11 1902(a)(10)(A)(ii),’’ after ‘‘section 12 1902(a)(10)(A)(i)’’; and 13 (2) in subsection (b)(5), by adding before the 14 period the following: ‘‘, and, effective on the date of 15 the enactment of the COVID–19 Treatment Cov- 16 erage Act, must comply with subparagraphs (F) 17 through (I) of subsections (a)(2) and (b)(2) of sec- 18 tion 1916 and subsection (b)(3)(B) of section 19 1916A’’. 20 (e) EFFECTIVE DATE.—The amendments made by 21 this section shall take effect on the date of enactment of 22 this Act and shall apply with respect to a COVID–19 vac- 23 cine beginning on the date that such vaccine is licensed 24 under section 351 of the Public Health Service Act (42 25 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 4469 IS U.S.C. 262), or approved or authorized under section 505 1 or 564 of the Federal Food, Drug, and Cosmetic Act. 2 SEC. 3. COVERAGE OF TREATMENT AND VACCINES AT NO 3 COST SHARING FOR THE UNINSURED. 4 (a) IN GENERAL.—Section 1902(a)(10) of the Social 5 Security Act (42 U.S.C. 1396a(a)(10)) is amended, in the 6 matter following subparagraph (G), by striking ‘‘and any 7 visit described in section 1916(a)(2)(G)’’ and inserting the 8 following: ‘‘, any COVID–19 vaccine that is administered 9 during any such portion (and the administration of such 10 vaccine), any item or service that is furnished during any 11 such portion for the treatment of COVID–19, including 12 drugs approved or authorized under section 505 or 564 13 of the Federal Food, Drug, and Cosmetic Act, or, in the 14 case of an individual who is diagnosed with or presumed 15 to have COVID–19, during the period such individual is 16 infected (or presumed infected) with COVID–19, the 17 treatment of a condition that may complicate the treat- 18 ment of COVID–19, the treatment of a COVID–19-re- 19 lated condition that follows the treatment of, or hos- 20 pitalization with, COVID–19, and any services described 21 in section 1916(a)(2)(G)’’. 22 (b) DEFINITION OF UNINSURED INDIVIDUAL.— 23 VerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 4469 IS (1) IN GENERAL.—Subsection (ss) of section 1 1902 of the Social Security Act (42 U.S.C. 1396a) 2 is amended to read as follows: 3 ‘‘(ss) UNINSURED INDIVIDUAL DEFINED.—For pur- 4 poses of this section, the term ‘uninsured individual’ 5 means, notwithstanding any other provision of this title, 6 any individual who is not covered by minimum essential 7 coverage (as defined in se [Text truncated for display. 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