No Cost for Monkeypox Testing Act of 2022
This bill requires specified public health care programs and private health insurance to cover, through December 31, 2023, testing for monkeypox without imposing cost-sharing, including deductibles, coinsurance, and copayments. (Monkeypox is a viral disease that is endemic to parts of Africa and causes symptoms similar to, but less severe than, smallpox.)
The bill also establishes procedures for uninsured individuals to access such testing at no cost.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8693 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 8693
To ensure access to cost-free monkeypox testing services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 9, 2022
Mr. Sean Patrick Maloney of New York (for himself, Mr. Cicilline, Mr.
Jones, Mr. Takano, Mr. Torres of New York, Mr. Peters, Ms. Underwood,
Mr. Tonko, Mr. Nadler, Mrs. Carolyn B. Maloney of New York, Ms. Jacobs
of California, Mr. Bowman, Mr. Evans, Ms. Bass, Ms. Velazquez, and Mr.
Krishnamoorthi) introduced the following bill; which was referred to
the Committee on Energy and Commerce, and in addition to the Committees
on Ways and Means, Armed Services, Veterans' Affairs, Oversight and
Reform, and Natural Resources, 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 ensure access to cost-free monkeypox testing services.
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 ``No Cost for Monkeypox Testing Act of
2022''.
SEC. 2. ENSURING ACCESS TO COST-FREE MONKEYPOX TESTING SERVICES.
(a) Group Health Plans and Group and Individual Health Insurance
Coverage.--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. COVERAGE OF MONKEYPOX TESTING WITH NO COST SHARING.
``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)) shall provide coverage, and shall not impose
any cost sharing (including deductibles, copayments, and coinsurance)
requirements or prior authorization or other medical management
requirements, for the following items and services furnished during the
period beginning on the date of the enactment of this section and
ending on December 31, 2023:
``(1) Tests for the detection of the monkeypox virus or the
diagnosis of monkeypox (including the administration of such
testing).
``(2) Items and services furnished to an individual during
health care provider office visits (which term in this
paragraph includes in-person visits and telehealth visits),
urgent care center visits, and emergency room visits that
result in an order for or administration of a test described in
paragraph (1), but only to the extent such items and services
relate to the furnishing or administration of such test or to
the evaluation of such individual for purposes of determining
the need of such individual for such test.''.
(b) Medicare.--Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended--
(1) in subsection (a)(1)--
(A) by striking ``and'' before ``(DD)''; and
(B) by inserting before the semicolon at the end
the following: ``and (EE) with respect to a specified
monkeypox testing-related service described in
paragraph (1) of subsection (ee) for which payment may
be made under a specified outpatient payment provision
described in paragraph (2) of such subsection, the
amounts paid shall be 100 percent of the payment amount
otherwise recognized under such respective specified
outpatient payment provision for such service,'';
(2) in subsection (b), in the first sentence--
(A) by striking ``and'' before ``(12)''; and
(B) by inserting before the period at the end the
following: ``, and (13) such deductible shall not apply
with respect to any specified monkeypox testing-related
service described in paragraph (1) of subsection (ee)
for which payment may be made under a specified
outpatient payment provision described in paragraph (2)
of such subsection''; and
(3) by adding at the end the following new subsection:
``(ee) Specified Monkeypox Testing-Related Services.--For purposes
of subsection (a)(1)(EE):
``(1) Description.--
``(A) In general.--A specified monkeypox testing-
related service described in this paragraph is a
medical visit that--
``(i) is in any of the categories of HCPCS
evaluation and management service codes
described in subparagraph (B);
``(ii) is furnished during any portion of
the period that begins on the date of the
enactment of this subsection and ends on
December 31, 2023;
``(iii) results in an order for or
administration of a clinical diagnostic
laboratory test described in section
1852(a)(1)(B)(iv)(IV); and
``(iv) relates to the furnishing or
administration of such test or to the
evaluation of such individual for purposes of
determining the need of such individual for
such test.
``(B) Categories of hcpcs codes.--For purposes of
subparagraph (A), the categories of HCPCS evaluation
and management services codes are the categories
described in subsection (cc)(1)(B).
``(2) Specified outpatient payment provision.--A specified
outpatient payment provision described in this paragraph is any
such provision described in subsection (cc)(2).''.
(c) Medicare Advantage.--Section 1852(a)(1)(B) of the Social
Security Act (42 U.S.C. 1395w-22(a)(1)(B)) is amended--
(1) in clause (iv)--
(A) by redesignating subclause (VII) as subclause
(IX); and
(B) by inserting after subclause (VI) the following
new subclauses:
``(VII) Clinical diagnostic
laboratory tests administered during
the period beginning on the date of the
enactment of this subclause and ending
on December 31, 2023, for the detection
of the monkeypox virus or the diagnosis
of monkeypox and the administration of
such test.
``(VIII) Specified monkeypox
testing-related services (as described
in section 1833(ee)(1)) for which
payment would be payable under a
specified outpatient payment provision
described in section 1833(ee)(2).'';
(2) in clause (v), by striking ``subclauses (IV), (V), and
(VI)'' and inserting ``subclauses (IV) through (VIII)''; and
(3) by adding at the end the following new clause:
``(vii) Prohibition of application of
certain requirements for monkeypox testing.--In
the case of a test or service described in
subclause (VII) or (VIII) of clause (iv) that
is administered or furnished during the period
described in such subclause (VII), an MA plan
may not impose any prior authorization or other
utilization management requirements with
respect to the coverage of such a test or
service under such plan.''.
(d) Medicaid and CHIP.--
(1) Medicaid.--
(A) In general.--Section 1905(a)(3) of the Social
Security Act (42 U.S.C. 1396d(a)(3)) is amended--
(i) in subparagraph (A), by striking
``and'' at the end;
(ii) in subparagraph (B), by striking the
semicolon and inserting ``; and''; and
(iii) by adding at the end the following
new subparagraph:
``(C) tests administered during the period beginning on the
date of the enactment of this subparagraph and ending on
December 31, 2023, for the detection of the monkeypox virus or
the diagnosis of monkeypox and the administration of such
tests;''.
(B) No cost sharing.--
(i) In general.--Subsections (a)(2) and
(b)(2) of section 1916 of the Social Security
Act (42 U.S.C. 1396o) are each amended--
(I) in subparagraph (H), by
striking ``or'' at the end;
(II) in subparagraph (I), by
striking ``; and'' and inserting a
comma; and
(III) by adding at the end the
following new subparagraphs:
``(J) any test described in section 1905(a)(3)(C)
that is administered during the period described in
such section (and the administration of such test), or
``(K) monkeypox testing-related services for which
payment may be made under the State plan; and''.
(ii) Application to alternative cost
sharing.--Section 1916A(b)(3)(B) of the Social
Security Act (42 U.S.C. 1396o-1(b)(3)(B)) is
amended by adding at the end the following new
clause:
``(xiv) Any test described in section
1905(a)(3)(C) that is administered during the
period described in such section (and the
administration of such test) and any service
described in section 1916(a)(2)(K) that is
furnished during any such period.''.
(iii) Clarification.--The amendments made
this paragraph shall apply with respect to a
State plan of a territory in the same manner as
a State plan of one of the 50 States.
(C) Expansion of state option to provide coverage
of uninsured individuals to include monkeypox
testing.--Section 1902(a)(10) of the Social Security
Act (42 U.S.C. 1396a(a)(10)) is amended--
(i) in subparagraph (A)(ii)(XXIII), by
striking ``any portion of the emergency period
defined in paragraph (1)(B) of section 1135(g)
beginning on or after the date of the enactment
of this subclause'' and inserting ``the period
beginning on the date of the enactment of this
subclause and ending on December 31, 2022 (or,
if latter, on the last day of the emergency
period described in section 1135(g)(1)(B)),'';
and
(ii) in the matter following subparagraph
(G) designated as subclause (XVIII)--
(I) by striking ``the period at the
end of the emergency sentence described
in such section'' and inserting ``the
emergency period described in such
section'';
(II) by striking ``and testing and
treatments'' and inserting ``testing
and treatments''; and
(III) by inserting ``any test
described in section 1905(a)(3)(C) (and
the administration of such test) that
is administered during the period
beginning on the date of the enactment
of the No Cost for Monkeypox Testing
Act of 2022 and ending on January 1,
2023, and any service described in
section 1916(a)(2)(K) that is furnished
during such period'' after ``(or waiver
of such plan)''.
(2) CHIP.--
(A) In general.--Section 2103(c) of the Social
Security Act (42 U.S.C. 1397cc(c)) is amended by adding
at the end the following paragraph:
``(12) Certain monkeypox testing.--The child health
assistance provided to a targeted low-income child shall
include coverage of any test described in section 1905(a)(3)(C)
that is administered during the period beginning on the date of
the enactment of this paragraph and ending on December 31, 2023
(and the administration of such test).''.
(B) Prohibition of cost sharing.--Section
2103(e)(2) of the Social Security Act (42 U.S.C.
1397cc(e)(2)) is amended--
(i) in the header, by inserting ``monkeypox
testing,'' after ``covid-19 treatment''; and
(ii) by inserting ``tests described in
subsection (c)(12) (and administration of such
tests) furnished during the period described in
such section, services described in section
1916(a)(2)(K) furnished during such period''
before ``, or for pregnancy-related
assistance''.
(e) Application With Respect to Tricare, Coverage for Veterans, and
Coverage for Federal Civilians.--
(1) Tricare.--The Secretary of Defense may not require any
copayment or other cost sharing under chapter 55 of title 10,
United States Code, for tests described in paragraph (1) of
section 2730 of the Public Health Service Act (or the
administration of such tests) or item and services described in
paragraph (2) of such section furnished during the period
beginning on the date of the enactment of this Act and ending
on December 31, 2023.
(2) Veterans.--The Secretary of Veterans Affairs may not
require any copayment or other cost sharing under chapter 17 of
title 38, United States Code, for tests described in paragraph
(1) of section 2730 of the Public Health Service Act (or the
administration of such tests) or items and services described
in paragraph (2) of such section furnished during the period
described in paragraph (1).
(3) Federal civilians.--No copayment or other cost sharing
may be required for any individual occupying a position in the
civil service (as that term is defined in section 2101(1) of
title 5, United States Code) enrolled in a health benefits
plan, including any plan under chapter 89 of title 5, United
States Code, or for any other individual currently enrolled in
any plan under chapter 89 of title 5 for tests described in
paragraph (1) of section 2730 of the Public Health Service Act
(or the administration of such tests) or items and services
described in paragraph (2) of such section furnished during the
period described in paragraph (1).
(f) Coverage of Testing for Monkeypox at No Cost Sharing for
Indians Receiving Purchased/Referred Care.--The Secretary of Health and
Human Services shall cover, without the imposition of any cost sharing
requirements, the cost of providing any test described in paragraph (1)
of section 2730 of the Public Health Service Act (or the administration
of such tests) or items and services described in paragraph (2) of such
section furnished during the period described in subsection (e)(1) to
Indians (as defined in section 4 of the Indian Health Care Improvement
Act (25 U.S.C. 1603)) receiving health services through the Indian
Health Service, including through an Urban Indian Organization,
regardless of whether such items or services have been authorized under
the purchased/referred care system funded by the Indian Health Service
or is covered as a health service of the Indian Health Service.
(g) Access for Certain Uninsured Individuals.--
(1) In general.--The Secretary of Health and Human Services
shall establish a program under which--
(A) program-registered providers submit claims to
the Secretary with respect to the furnishing, during
the period described in subsection (e)(1), of tests
described in paragraph (1) of section 2730 of the
Public Health Service Act (or the administration of
such tests) or items and services described in
paragraph (2) of such section furnished to uninsured
individuals; and
(B) the Secretary, subject to the availability of
appropriations, pays each such provider for such tests,
items, and services in an amount determined appropriate
by the Secretary.
(2) Definitions.--In this section:
(A) Program-registered provider.--The term
``program-registered provider'' means a health care
provider that--
(i) enters into an agreement with the
Secretary under which the provider agrees not
to hold an uninsured individual liable for the
cost of tests, items, and services described in
paragraph (1) with respect to which a payment
is made under subparagraph (B) of such
paragraph; and
(ii) meets such other requirements as the
Secretary may specify.
(B) Secretary.--The term ``Secretary'' means the
Secretary of Health and Human Services.
(C) Uninsured individual.--The term ``uninsured
individual'' means, with respect to an individual and a
test, item, or service described in paragraph (1), an
individual who--
(i) is not enrolled in--
(I) a Federal health care program
(as defined in section 1128B(f) of the
Social Security Act (42 U.S.C. 1320a-
7b(f)));
(II) a group health plan or health
insurance coverage offered by a health
insurance issuer in the group or
individual market (as such terms are
defined in section 2791 of the Public
Health Service Act (42 U.S.C. 300gg-
91)); or
(III) a health plan offered under
chapter 89 of title 5, United States
Code; or
(ii) is enrolled in a program, plan, or
coverage described in subparagraph (A) that
does not provide any benefits for such test,
item, or service under such program, plan, or
coverage (as applicable).
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, Veterans' Affairs, Oversight and Reform, and Natural Resources, 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 Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, Veterans' Affairs, Oversight and Reform, and Natural Resources, 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 Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, Veterans' Affairs, Oversight and Reform, and Natural Resources, 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 Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, Veterans' Affairs, Oversight and Reform, and Natural Resources, 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 Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, Veterans' Affairs, Oversight and Reform, and Natural Resources, 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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Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, Veterans' Affairs, Oversight and Reform, and Natural Resources, 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.