Telehealth Coverage and Payment Parity Act

I 116TH CONGRESS 2D SESSION H. R. 8308 To amend the Public Health Service Act 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, and for other purposes. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 17, 2020 Mr. PHILLIPS (for himself, Mr. CHABOT, and Mr. MORELLE) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Public Health Service Act to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide cov- erage for services furnished via telehealth if such services would be covered if furnished in-person, and for other purposes. 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 ‘‘Telehealth Coverage 4 and Payment Parity Act’’. 5 VerDate Sep 11 2014 00:10 Oct 04, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8308.IH H8308 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 8308 IH 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. 7 (a) PUBLIC HEALTH SERVICE ACT.—Subpart II of 8 part A of title XXVII of the Public Health Service Act 9 (42 U.S.C. 300gg–11 et seq.) is amended by adding at 10 the end the following new section: 11 ‘‘SEC. 2730. REQUIRED COVERAGE OF TELEHEALTH SERV- 12 ICES. 13 ‘‘(a) IN GENERAL.—A group health plan and a health 14 insurance issuer offering group or individual health insur- 15 ance coverage, including a grandfathered health plan (as 16 defined in section 1251(e) of the Patient Protection and 17 Affordable Care Act (42 U.S.C. 18011(e)))— 18 ‘‘(1) shall— 19 ‘‘(A) provide benefits under such plan or 20 such coverage for any eligible service (as de- 21 fined in subsection (b)), including a mental 22 health and substance use disorder service, fur- 23 nished via a qualifying telecommunications sys- 24 tem (as defined in subsection (b)) by a health 25 care provider to an individual who is a partici- 26 VerDate Sep 11 2014 00:28 Oct 06, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8308.IH H8308 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 8308 IH pant, beneficiary, or enrollee under such plan or 1 such coverage, notwithstanding that such pro- 2 vider furnishing such service is not at the same 3 location as the individual; 4 ‘‘(B) so provide such benefits for such 5 service under the same terms and with applica- 6 tion of the same cost-sharing requirements (in- 7 cluding a deductible, copayment, or coinsur- 8 ance) as would apply if such service were fur- 9 nished by such provider to such individual in- 10 person; 11 ‘‘(C) reimburse such provider for such 12 service in an amount equal to the amount of re- 13 imbursement for such service had such service 14 been furnished by such provider to such indi- 15 vidual in-person; 16 ‘‘(D) not impose any requirement under 17 such plan or coverage that such provider have 18 a prior relationship with such individual; and 19 ‘‘(E) not restrict the ability of any health 20 care provider with a contractual relationship for 21 furnishing an eligible service under such plan or 22 coverage from furnishing such service via a 23 qualifying telecommunications system, and shall 24 not establish incentives or penalties under such 25 VerDate Sep 11 2014 00:10 Oct 04, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8308.IH H8308 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 8308 IH plan or coverage for receiving such an eligible 1 service from such a provider via such a system; 2 and 3 ‘‘(2) may waive any cost-sharing requirement 4 (including application of a deductible, copayment, or 5 coinsurance) for an item or service furnished for 6 purposes of diagnosing or treating COVID-19, in- 7 cluding any such service that is an eligible service 8 furnished via a qualifying telecommunications sys- 9 tem. 10 ‘‘(b) DEFINITIONS.—In this section: 11 ‘‘(1) ELIGIBLE SERVICE.—The term ‘eligible 12 service’ means, with respect to a group health plan 13 and a health insurance issuer offering group or indi- 14 vidual health insurance coverage, a service— 15 ‘‘(A) for which benefits are provided under 16 such plan or such coverage when such service is 17 furnished in-person; 18 ‘‘(B) that is medically necessary (as deter- 19 mined by the health care provider furnishing 20 such service); and 21 ‘‘(C) that is able to be safely and effec- 22 tively furnished via a telecommunications sys- 23 tem. 24 VerDate Sep 11 2014 00:10 Oct 04, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8308.IH H8308 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 8308 IH ‘‘(2) QUALIFYING TELECOMMUNICATIONS SYS- 1 TEM.—The term ‘qualifying telecommunications sys- 2 tem’ means a telecommunications system that in- 3 cludes, at a minimum, audio capabilities permitting 4 two-way, real-time interactive communication be- 5 tween the individual receiving an eligible service via 6 such system and the health care provider furnishing 7 such system, including a telephone, 8 videoconferencing system, internet communications 9 system, streaming media communications system, 10 and such other system as specified by the Secretary 11 of Health and Human Services.’’. 12 (b) APPLICATION.—The amendment made by sub- 13 section (a) shall apply with respect to plan years beginning 14 on or after January 1, 2021. 15 Æ VerDate Sep 11 2014 00:10 Oct 04, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H8308.IH H8308 kjohnson on DSK79L0C42PROD with BILLS