Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021
This bill allows audio-only diagnoses that are made via telehealth to be used for purposes of determining risk adjustments to payments under Medicare Advantage. Additionally, the bill requires payments for Medicare telehealth services that are furnished during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019) to be made in the same amounts as those for in-person services.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2166 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 2166
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 PACE programs, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 23, 2021
Ms. Sewell (for herself, Mr. Bilirakis, Mr. Cardenas, Mrs. Walorski,
Mr. Kind, Mr. Smith of Missouri, Ms. Houlahan, and Mr. Fitzpatrick)
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 require the
inclusion of certain audio-only diagnoses in the determination of risk
adjustment for Medicare Advantage plans and PACE programs, 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 ``Ensuring Parity in MA and PACE for
Audio-Only Telehealth Act of 2021''.
SEC. 2. REQUIRING THE INCLUSION OF CERTAIN AUDIO-ONLY DIAGNOSES IN THE
DETERMINATION OF RISK ADJUSTMENT FOR MEDICARE ADVANTAGE
PLANS AND PACE PROGRAMS.
(a) In General.--Section 1853(a)(1) of the Social Security Act (42
U.S.C. 1395w-23(a)(1)) is amended by adding at the end the following
new subparagraph:
``(J) Inclusion of certain audio-only diagnoses for
purposes of risk adjustment.--
``(i) In general.--For purposes of
determining the appropriate adjustment for
health status under subparagraph (C)(i) for
plan years 2020 and 2021 (and for such other
plan years determined appropriate by the
Secretary), the Secretary, in determining the
diseases or conditions of an individual, shall
take into account diagnoses obtained through a
telehealth encounter, and in the case of a
qualified diagnosis (as defined in clause (ii))
made with respect to such individual by a
qualified provider (as so defined), shall not
require the use of video communications with
respect to such telehealth encounter.
``(ii) Definitions.--For purposes of this
subparagraph:
``(I) Qualified diagnosis.--The
term `qualified diagnosis' means a
diagnosis made with respect to a
chronic disease or condition of an
individual during a plan year if such
diagnosis was also made with respect to
such individual in one of the last of
the 3 plan years preceding such plan
year.
``(II) Qualified provider.--The
term `qualified provider' means, with
respect to a qualified diagnosis made
with respect to an individual during a
plan year, a provider of services,
clinician or supplier that--
``(aa) furnished an item or
service to such individual
during the 3-year period ending
on the date such diagnosis was
so made; or
``(bb) is in the same
practice (as determined by tax
identification number) of a
provider of services or
supplier who furnished such an
item or service to such
individual during such
period.''.
(b) PACE Program Conforming Amendment.--Section 1894(d)(2) of the
Social Security Act (42 U.S.C. 1395eee(d)(2)) is amended by adding at
the end the following new sentence: ``For purposes of applying the
adjustment under subparagraph (C)(i) of section 1853(a)(1) to such
amounts, subparagraph (J) of such section shall be applied as if each
reference to `plan year' and `plan years 2020 and 2021' were instead a
reference to `year' and `2020 and 2021', respectively.''.
SEC. 3. REQUIRING PARITY IN TELEHEALTH PAYMENTS DURING THE COVID-19
EMERGENCY.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is
amended by adding at the end the following new paragraph:
``(9) Special rule for telehealth payment parity during the
covid-19 emergency.--In the case of a telehealth service
furnished during the emergency period described in section
1135(g)(1)(B) for which payment may be made under this
subsection (including any service for which payment may be so
made due to application of a waiver made under section
1135(b)), the amount of such payment shall be equal to the
amount that would have been paid for such service had such
service been furnished in-person.''.
<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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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