Medicare Advantage COVID Treatment Act
This bill requires Medicare Advantage (MA) plans to cover specified treatment services relating to COVID-19 (i.e., coronavirus disease 2019) without cost-sharing during the public health emergency declared on January 31, 2020. The CMS must reimburse MA plans for cost-sharing amounts that would otherwise have been received, in accordance with a specified timeline.
MA plans are also prohibited from instituting prior authorization or other utilization management requirements with respect to coverage of specified critical treatment services (e.g., ventilator services and intensive care unit services).
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6640 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 6640
To amend title XVIII of the Social Security Act to provide coverage for
COVID-19 at no cost sharing under the medicare advantage program, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 28, 2020
Ms. Mucarsel-Powell (for herself and Mr. Kind) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Energy and Commerce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide coverage for
COVID-19 at no cost sharing under the medicare advantage program, and
for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Advantage COVID Treatment
Act''.
SEC. 2. COVERAGE OF TREATMENTS FOR COVID-19 AT NO COST SHARING UNDER
THE MEDICARE ADVANTAGE PROGRAM.
(a) In General.--Section 1852(a)(1)(B) of the Social Security Act
(42 U.S.C. 1395w-22(a)(1)(B)) is amended by adding at the end the
following new clause:
``(vii) Special coverage rules for
specified covid-19 treatment services.--
``(I) In general.--Notwithstanding
clause (i), in the case of a specified
COVID-19 treatment service that is
furnished during a plan year occurring
during any portion of the emergency
period defined in section 1135(g)(1)(B)
beginning on or after the date of the
enactment of this clause, a Medicare
Advantage plan may not, with respect to
such service, impose--
``(aa) any cost-sharing
requirement (including a
deductible, copayment, or
coinsurance requirement); and
``(bb) in the case such
service is a critical specified
COVID-19 treatment service
(including ventilator services
and intensive care unit
services), any prior
authorization or other
utilization management
requirement.
A Medicare Advantage plan may not take
the application of this clause into
account for purposes of a bid amount
submitted by such plan under section
1854(a)(6).
``(II) Specified covid-19 treatment
service defined.--For purposes of this
clause, the term `specified COVID-19
treatment service' means any item or
service furnished to an individual for
which payment may be made under part A
or part B of title XVIII of the Social
Security Act if such item or service is
included in a claim with an ICD-10-CM
code relating to COVID-19 (as described
in the document entitled `ICD-10-CM
Official Coding Guidelines--Supplement
Coding encounters related to COVID-19
Coronavirus Outbreak' published on
February 20, 2020, or as otherwise
specified by the Secretary).''.
(b) Reimbursement of Medicare Advantage Plans for Elimination of
Cost Sharing.--Section 1853 of the Social Security Act (42 U.S.C.
1395w-23) is amended by adding at the end the following new subsection:
``(p) Additional Payment to Account for Cost Sharing Elimination
for COVID-19 Treatment Services.--
``(1) In general.--A Medicare Advantage plan shall notify
the Secretary of the total dollar amount of cost sharing that,
but for the application of section 1852(a)(1)(B)(vii), would
have been required under such plan for specified COVID-19
treatment services (as defined in subclause (II) of such
section) furnished during a plan year described in such section
to individuals enrolled in the plan. The Secretary shall make
periodic and timely payments in accordance with this subsection
to such plan that, in the aggregate, equal such total dollar
amount.
``(2) Timing of payment.--Payments by the Secretary under
this subsection shall be made beginning March 1, 2021, for
amounts described in such paragraph that would have been
required under such plan for specified COVID-19 treatment
services furnished during plan year 2020. Payments by the
Secretary under this subsection for such amounts that would
have been so required under such plan for such services
furnished during a plan year subsequent to plan year 2020 shall
be made beginning March 1 of the plan year following such
subsequent plan year.
``(3) Non-application.--Section 1853(c)(7) shall not apply
with respect to the application of this subsection.
``(4) Appropriation.--There are transferred to the Centers
for Medicare & Medicaid Program Management Fund, out of any
monies in the Treasury not otherwise obligated, such sums as
may be necessary to the Secretary for purposes of making
payments under this subsection.''.
(c) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by this section by program instruction or otherwise.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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