Telehealth Coverage and Payment Parity Act
This bill requires private health insurance plans to cover certain services provided via telecommunications systems (i.e., telehealth). Specifically, the telehealth services must be deemed medically necessary by a health care provider and covered under the plan if provided in person. Plans must apply the same cost-sharing and reimbursement amounts that would otherwise apply to such services and may waive cost-sharing requirements for any services to diagnose or treat COVID-19, including via telehealth.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8308 Introduced in House (IH)]
<DOC>
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 coverage 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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Telehealth Coverage and Payment
Parity Act''.
SEC. 2. REQUIRING 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.
(a) Public Health Service Act.--Subpart II of part A of title XXVII
of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is
amended by adding at the end the following new section:
``SEC. 2730. REQUIRED COVERAGE OF TELEHEALTH SERVICES.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage,
including a grandfathered health plan (as defined in section 1251(e) of
the Patient Protection and Affordable Care Act (42 U.S.C. 18011(e)))--
``(1) shall--
``(A) provide benefits under such plan or such
coverage for any eligible service (as defined in
subsection (b)), including a mental health and
substance use disorder service, furnished via a
qualifying telecommunications system (as defined in
subsection (b)) by a health care provider to an
individual who is a participant, beneficiary, or
enrollee under such plan or such coverage,
notwithstanding that such provider furnishing such
service is not at the same location as the individual;
``(B) so provide such benefits for such service
under the same terms and with application of the same
cost-sharing requirements (including a deductible,
copayment, or coinsurance) as would apply if such
service were furnished by such provider to such
individual in-person;
``(C) reimburse such provider for such service in
an amount equal to the amount of reimbursement for such
service had such service been furnished by such
provider to such individual in-person;
``(D) not impose any requirement under such plan or
coverage that such provider have a prior relationship
with such individual; and
``(E) not restrict the ability of any health care
provider with a contractual relationship for furnishing
an eligible service under such plan or coverage from
furnishing such service via a qualifying
telecommunications system, and shall not establish
incentives or penalties under such plan or coverage for
receiving such an eligible service from such a provider
via such a system; and
``(2) may waive any cost-sharing requirement (including
application of a deductible, copayment, or coinsurance) for an
item or service furnished for purposes of diagnosing or
treating COVID-19, including any such service that is an
eligible service furnished via a qualifying telecommunications
system.
``(b) Definitions.--In this section:
``(1) Eligible service.--The term `eligible service' means,
with respect to a group health plan and a health insurance
issuer offering group or individual health insurance coverage,
a service--
``(A) for which benefits are provided under such
plan or such coverage when such service is furnished
in-person;
``(B) that is medically necessary (as determined by
the health care provider furnishing such service); and
``(C) that is able to be safely and effectively
furnished via a telecommunications system.
``(2) Qualifying telecommunications system.--The term
`qualifying telecommunications system' means a
telecommunications system that includes, at a minimum, audio
capabilities permitting two-way, real-time interactive
communication between the individual receiving an eligible
service via such system and the health care provider furnishing
such system, including a telephone, videoconferencing system,
internet communications system, streaming media communications
system, and such other system as specified by the Secretary of
Health and Human Services.''.
(b) Application.--The amendment made by subsection (a) shall apply
with respect to plan years beginning on or after January 1, 2021.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
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