II 

116TH CONGRESS 

2D SESSION S. 3790 

To provide reimbursements for certain costs of health care items and services, 

including prescription drugs, furnished during the public health emergency declared with respect to COVID–19. 

IN THE SENATE OF THE UNITED STATES 

MAY 20, 2020 

Mrs. GILLIBRAND (for Mr. SANDERS (for himself, Mrs. GILLIBRAND, Mr. 

MARKEY, Ms. WARREN, Mr. BOOKER, Mr. MERKLEY, and Ms. HARRIS)) 

introduced the following bill; which was read twice and referred to the 

Committee on Health, Education, Labor, and Pensions 

A BILL 

To provide reimbursements for certain costs of health care 

items and services, including prescription drugs, furnished during the public health emergency declared with 

respect to COVID–19. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Care Emer5 gency Guarantee Act’’. 


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1 SEC. 2. REIMBURSEMENTS FOR CERTAIN COSTS OF 

2 HEALTH CARE ITEMS AND SERVICES INCLUD3 ING PRESCRIPTION DRUGS FURNISHED DUR4 ING PUBLIC HEALTH EMERGENCY. 

5 (a) IN GENERAL.—During the period beginning on 

6 the date of enactment of this Act and ending on the date 

7 the Secretary certifies to Congress that a vaccine approved 

8 by the Food and Drug Administration for COVID–19 is 

9 widely available to the public, the Secretary shall make 

10 payments to qualified providers with respect to applicable 

11 health care items and services as defined in subsection (b) 

12 that are furnished to an applicable individual an amount 

13 equal to— 

14 (1) in the case of any portion of such period in 

15 which an applicable individual is enrolled in a public 

16 or private health insurance plan, the amount of any 

17 cost-sharing, including any deductibles, copayments, 

18 coinsurance or similar charges, that would otherwise 

19 be applicable under such plan, including with respect 

20 to prescription drug coverage under the plan; 

21 (2) in the case of any portion of such period in 

22 which an applicable individual is uninsured, an 

23 amount equal to the amount that would be paid to 

24 the qualified provider for the same or equivalent 

25 items or services, including with respect to any inpa26 tient or physician-administered drugs (and excluding 


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1 outpatient prescription drugs or biologicals with re2 spect to which coverage is provided under subsection 

3 (e)), under the Medicare program under title XVIII 

4 of the Social Security Act (42 U.S.C. 1395 et seq.). 

5 (b) APPLICABLE HEALTH CARE ITEMS AND SERV6 ICES; APPLICABLE INDIVIDUAL DEFINED.—In this sec7 tion: 

8 (1) APPLICABLE HEALTH CARE ITEMS AND

9 SERVICES.—The term ‘‘applicable health care items 

10 and services’’ means, with respect to an applicable 

11 individual, any health care items and services that 

12 are medically necessary or appropriate for the main13 tenance of health or for the diagnosis, treatment, or 

14 rehabilitation of a health condition of the applicable 

15 individual, including— 

16 (A) any testing services and treatments for 

17 COVID–19 or related complications, including 

18 vaccines, diagnostic tests, drugs and biologicals, 

19 and therapies; and 

20 (B) in the case of an applicable individual 

21 who is enrolled in a public or private health in22 surance plan, any health care items and serv23 ices covered by such plan as of March 1, 2020, 

24 or in the case of an applicable individual who 

25 enrolls in such plan after the date, any health 


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1 care items and services covered by such plan as 

2 of the date of such enrollment. 

3 (2) APPLICABLE INDIVIDUAL.—The term ‘‘ap4 plicable individual’’ means an individual who is a 

5 resident of the United States. 

6 (c) REQUIREMENTS.— 

7 (1) NO EFFECT ON APPLICABLE COST-SHARING

8 REQUIREMENTS.—Nothing in this section shall af9 fect the application of any requirements applicable 

10 under Federal or State law with respect to coverage 

11 of health care items and services without any cost12 sharing. 

13 (2) MAINTENANCE OF EFFORT.— 

14 (A) IN GENERAL.—During the period de15 scribed in subsection (a), a public or private 

16 health plan shall not increase cost-sharing, de17 crease benefits, or otherwise make coverage less 

18 generous than the benefits offered on the date 

19 of enactment of this Act. 

20 (B) NEW ITEMS AND SERVICES.—During 

21 such period, a public or private health plan 

22 shall provide coverage of new items and serv23 ices, including those related to COVID–19, as 

24 appropriate, at a minimum, at a level consistent 


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1 with the prior coverage practices and 

2 formularies of the plan. 

3 (3) LIMITATION ON OUT-OF-POCKET EX4 PENSES.—During such period, in order to be eligible 

5 to receive payments under this section, a qualified 

6 provider shall agree not to impose on an applicable 

7 individual any charge for applicable health care 

8 items and services furnished to the applicable indi9 vidual. 

10 (4) PERMISSIBLE BILLING OF PLANS; LIMITA11 TION ON BALANCE BILLING.—During such period, in 

12 order to be eligible to receive payments under this 

13 section, a qualified provider shall agree, with respect 

14 to applicable health care items and services fur15 nished to an applicable individual when such indi16 vidual is enrolled in a public or private health insur17 ance plan— 

18 (A) not to impose any charge on the plan 

19 for such items and services beyond the amount 

20 otherwise payable by the plan; and 

21 (B) not to bill the applicable individual for 

22 any amounts in excess of the amount described 

23 in subparagraph (A). 

24 (5) MEDICAL DEBT COLLECTION.—A qualified 

25 provider shall agree— 


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1 (A) to immediately halt all medical debt 

2 collection, including collection activities carried 

3 out by third parties, during such period and 

4 shall not collect medical debt or have third par5 ties collect medical debt for applicable health 

6 care items and services furnished during such 

7 period; and 

8 (B) to refrain from pursuing medical debt 

9 collection, including collection activities carried 

10 out by third parties, after such period with re11 spect to items and services related to the diag12 nosis or treatment of COVID–19 (regardless of 

13 whether such services were furnished before, 

14 during, or after such period) and shall not col15 lect medical debt or have third parties collect 

16 medical debt for such items or services after 

17 such period. 

18 (6) SUBMISSION OF BILLS AND DOCUMENTA19 TION.—A qualified provider shall agree to submit 

20 bills and any required supporting documentation re21 lating to the provision of applicable health care 

22 items and services within 30 days after the date of 

23 providing such services, in such manner as the Sec24 retary determines appropriate. 


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1 (d) WAIVER OF LATE ENROLLMENT PENALTIES

2 UNDER MEDICARE.—During the period described in sub3 section (a), no increase in the monthly premium of an indi4 vidual pursuant to section 1818(c), 1839(b), or 1860D– 

5 13 of the Social Security Act (42 U.S.C. 1395i–2(c), 

6 1395r(b), 1395w–113) shall be effected in the case of any 

7 individual who enrolls for benefits under title XVIII of 

8 such Act with respect to any period prior to the date of 

9 such enrollment. 

10 (e) COVERAGE WITH RESPECT TO OUTPATIENT PRE11 SCRIPTION DRUGS.— 

12 (1) IN GENERAL.—During the period described 

13 in subsection (a), with respect to outpatient pre14 scription drugs or biologicals described in subsection 

15 (b)(1)(A) that are dispensed to uninsured individ16 uals, the Secretary shall establish procedures under 

17 which— 

18 (A) such drugs or biologicals are dispensed 

19 at no cost to such individuals; 

20 (B) pharmacies that dispense such drugs 

21 or biologicals— 

22 (i) are reimbursed by the Secretary 

23 for such drugs or biologicals dispensed to 

24 such individuals at an amount equal to the 

25 price paid by the Secretary of Veterans AfVerDate Sep 11 2014 00:45 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3790.IS S3790

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1 fairs to procure the drug or biological 

2 under the laws administered by the Sec3 retary of Veterans Affairs; and 

4 (ii) agree not to charge such individ5 uals for any difference between the amount 

6 reimbursed under clause (i) and the cost to 

7 the pharmacy for the drug; and 

8 (C) manufacturers of such drugs or 

9 biologicals reimburse pharmacies for any dif10 ference described in subparagraph (B)(ii) with 

11 respect to drugs or biologicals of the manufac12 turer that are dispensed to such individuals. 

13 (2) CONDITION OF COVERAGE UNDER MEDI14 CARE.—During the period described in subsection 

15 (a), no coverage may be provided under part B or 

16 D of title XVIII of the Social Security Act (42 

17 U.S.C. 1395j et seq., 1395w–101 et seq.) with re18 spect to a drug or biological of a manufacturer if the 

19 manufacturer does not enter into an agreement with 

20 the Secretary to carry out the requirements applica21 ble with respect to such manufacturers under this 

22 subsection. 

23 (3) REQUIREMENT FOR PARTICIPATING PHAR24 MACIES.—During the period described in subsection 

25 (a), a prescription drug plan under part D of title 


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1 XVIII of the Social Security Act (42 U.S.C. 1395w– 

2 101 et seq.) may not contract with a pharmacy if 

3 the pharmacy does not enter into an agreement with 

4 the Secretary to carry out the requirements applica5 ble with respect to pharmacies under this subsection. 

6 (f) OTHER DEFINITIONS.— 

7 (1) PUBLIC OR PRIVATE HEALTH INSURANCE

8 PLAN.— 

9 (A) IN GENERAL.—The term ‘‘public or 

10 private health insurance plan’’ means any of 

11 the following: 

12 (i) A group health plan, or group 

13 health insurance coverage, as such terms 

14 are defined in section 2791 of the Public 

15 Health Service Act (42 U.S.C. 300gg–91). 

16 (ii) A qualified health plan, as defined 

17 in section 1301 of the Patient Protection 

18 and Affordable Care Act (42 U.S.C. 

19 18021). 

20 (iii) Subject to subparagraph (B), any 

21 health insurance coverage (other than a 

22 plan described in clause (ii)) offered in the 

23 individual market, as such terms are de24 fined in section 2791 of the Public Health 


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1 Service Act, including any short-term lim2 ited duration insurance. 

3 (iv) A health plan offered under chap4 ter 89 of title 5, United States Code. 

5 (v) A Federal health care program (as 

6 defined under section 1128B(f) of the So7 cial Security Act (42 U.S.C. 1320a–7b(f)), 

8 including— 

9 (I) health benefits furnished 

10 under the TRICARE program (as de11 fined in section 1072 of title 10, 

12 United States Code); 

13 (II) health benefits furnished to 

14 veterans under the laws administered 

15 by the Secretary of Veterans Affairs; 

16 and 

17 (III) health benefits furnished to 

18 Indians (as defined in section 4 of the 

19 Indian Health Care Improvement Act 

20 (25 U.S.C. 1603)) receiving health 

21 services through the Indian Health 

22 Service, including through an Urban 

23 Indian Organization, regardless of 

24 whether such benefits are for items or 

25 services that have been authorized 


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1 under the purchased/referred care sys2 tem funded by the Indian Health 

3 Service or are covered as a health 

4 service of the Indian Health Service. 

5 (B) LIMITATION ON INDIVIDUAL HEALTH

6 INSURANCE COVERAGE.—The term ‘‘public or 

7 private health insurance coverage’’ includes the 

8 health insurance coverage described in clause 

9 (iii) of subparagraph (A) only with respect to 

10 an individual who is enrolled in such coverage 

11 on March 1, 2020. 

12 (2) QUALIFIED PROVIDER.—The term ‘‘quali13 fied provider’’ means a health care provider who is 

14 a participating provider under the Medicare program 

15 under title XVIII of the Social Security Act (42 

16 U.S.C. 1395 et seq.). Such term includes a health 

17 care provider who is not a participating provider 

18 under such program if the health care provider 

19 would meet the criteria for such participation and, 

20 if the State requires the health care provider to be 

21 licensed by the State, is licensed by the State in 

22 which the items or services are furnished. 

23 (3) SECRETARY.—The term ‘‘Secretary’’ means 

24 the Secretary of Health and Human Services. 

25 (g) IMPLEMENTATION.— 


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1 (1) IN GENERAL.—The Secretary, in coordina2 tion with the Secretary of the Treasury, the Com3 missioner of Social Security, and the Secretary of 

4 Labor, shall implement the provisions of this section 

5 not later than the date that is 7 days after the date 

6 of the enactment of this Act. 

7 (2) ENSURING TIMELY PAYMENT.—The Sec8 retary shall establish a process and issue such guid9 ance as is necessary to ensure a qualified provider 

10 receives payments under this section in a timely 

11 manner. 

12 (3) ENSURING COLLECTION OF DATA ON DIS13 PARITIES.—The Secretary shall implement this sec14 tion in a manner and issue such guidance as is nec15 essary to allow for the ongoing, accurate, and timely 

16 collection and analysis of data on disparities in ac17 cordance with subsection (h). 

18 (h) COLLECTION OF DATA ON DISPARITIES.— 

19 (1) IN GENERAL.—During the period described 

20 in subsection (a), the Secretary shall collect data on 

21 disparities across race, ethnicity, primary language, 

22 gender, sexual orientation, disability status, age, ge23 ographic area, insurance status, and socioeconomic 

24 status— 


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1 (A) in health outcomes and access to 

2 health care related to the COVID–19 outbreak, 

3 including data on COVID–19 cases, treatment, 

4 and deaths; and 

5 (B) in patient access to applicable health 

6 care items and services under this section. 

7 (2) PUBLIC AVAILABILITY.—The Secretary 

8 shall— 

9 (A) make data collected under this sub10 section publicly available on the internet website 

11 of the Department of Health and Human Serv12 ices as soon as is practicable, but not later than 

13 30 days after the date of enactment of this Act, 

14 in a manner that allows researchers, scholars, 

15 health care providers, and others to access and 

16 analyze such data, without compromising pa17 tient privacy; and 

18 (B) update such data on a weekly basis 

19 thereafter for the duration of the period de20 scribed in subsection (a). 

21 (i) WEEKLY REPORTS TO CONGRESS.— 

22 (1) IN GENERAL.—On a weekly basis during 

23 the period described in subsection (a), the Secretary 

24 shall report to Congress on— 


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1 (A) the implementation of this section, in2 cluding information on the amount, type, and 

3 geographic distribution of payments to qualified 

4 providers under this section; and 

5 (B) any disparities in health and access to 

6 health care related to the COVID–19 outbreak 

7 or patient access to applicable health care items 

8 and services under this section, as identified 

9 through the collection and analysis of data col10 lected under subsection (h). 

11 (2) PUBLIC AVAILABILITY.—The Secretary 

12 shall make each report submitted under paragraph 

13 (1) publicly available on the internet website of the 

14 Department of Health and Human Services. 

15 (j) FUNDING.—There are authorized to be appro16 priated such sums as are necessary to carry out this sec17 tion. 

Æ 


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