Ensuring Parity in MA for Audio-Only Telehealth Act of 2020

II 116TH CONGRESS 2D SESSION S. 4840 To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans, and for other purposes. IN THE SENATE OF THE UNITED STATES OCTOBER 21 (legislative day, OCTOBER 19), 2020 Mr. ROBERTS (for himself, Ms. CORTEZ MASTO, Mr. SCOTT of South Caro- lina, and Mr. CASEY) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the deter- mination of risk adjustment for Medicare Advantage plans, 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 ‘‘Ensuring Parity in 4 MA for Audio-Only Telehealth Act of 2020’’. 5 VerDate Sep 11 2014 23:46 Oct 28, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4840.IS S4840 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 4840 IS SEC. 2. REQUIRING THE INCLUSION OF CERTAIN AUDIO- 1 ONLY DIAGNOSES IN THE DETERMINATION 2 OF RISK ADJUSTMENT FOR MEDICARE AD- 3 VANTAGE PLANS. 4 Section 1853(a)(1) of the Social Security Act (42 5 U.S.C. 1395w–23(a)(1)) is amended by adding at the end 6 the following new subparagraph: 7 ‘‘(J) INCLUSION OF CERTAIN AUDIO-ONLY 8 DIAGNOSES FOR PURPOSES OF RISK ADJUST- 9 MENT.— 10 ‘‘(i) IN GENERAL.—For purposes of 11 determining the appropriate adjustment 12 for health status under subparagraph 13 (C)(i) for plan years 2020 and 2021 (and 14 for such other plan years determined ap- 15 propriate by the Secretary), the Secretary, 16 in determining the diseases or conditions 17 of an individual, shall take into account a 18 qualified diagnosis (as defined in clause 19 (ii)) made with respect to such individual 20 by a qualified provider (as so defined) via 21 telehealth regardless of whether such diag- 22 nosis so made included the use of video 23 communications. 24 ‘‘(ii) DEFINITIONS.—For purposes of 25 this subparagraph: 26 VerDate Sep 11 2014 23:46 Oct 28, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4840.IS S4840 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 4840 IS ‘‘(I) QUALIFIED DIAGNOSIS.— 1 The term ‘qualified diagnosis’ means 2 a diagnosis made with respect to a 3 chronic disease or condition of an in- 4 dividual during a plan year if such di- 5 agnosis was also made with respect to 6 such individual in one of the last of 7 the 3 plan years preceding such plan 8 year. 9 ‘‘(II) QUALIFIED PROVIDER.— 10 The term ‘qualified provider’ means, 11 with respect to a qualified diagnosis 12 made with respect to an individual 13 during a plan year, a provider of serv- 14 ices, clinician or supplier that— 15 ‘‘(aa) furnished an item or 16 service to such individual during 17 the 3-year period ending on the 18 date such diagnosis was so made; 19 or 20 ‘‘(bb) is in the same practice 21 (as determined by tax identifica- 22 tion number) of a provider of 23 services or supplier who fur- 24 nished such an item or service to 25 VerDate Sep 11 2014 23:46 Oct 28, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4840.IS S4840 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 4840 IS such individual during such pe- 1 riod.’’. 2 SEC. 3. REQUIRING PARITY IN TELEHEALTH PAYMENTS 3 DURING THE COVID–19 EMERGENCY. 4 Section 1834(m) of the Social Security Act (42 5 U.S.C. 1395m(m)) is amended by adding at the end the 6 following new paragraph: 7 ‘‘(9) SPECIAL RULE FOR TELEHEALTH PAY- 8 MENT PARITY DURING THE COVID–19 EMER- 9 GENCY.—In the case of a telehealth service fur- 10 nished during the emergency period described in sec- 11 tion 1135(g)(1)(B) for which payment may be made 12 under this subsection (including any service for 13 which payment may be so made due to application 14 of a waiver made under section 1135(b)), the 15 amount of such payment shall be equal to the 16 amount that would have been paid for such service 17 had such service been furnished in-person.’’. 18 Æ VerDate Sep 11 2014 23:46 Oct 28, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\S4840.IS S4840 pbinns on DSKJLVW7X2PROD with BILLS