II 

116TH CONGRESS 

2D SESSION S. 4469 

To ensure coverage of a COVID–19 vaccine and treatment. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 6, 2020 

Ms. SMITH (for herself, Mr. BENNET, 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 ensure coverage of a COVID–19 vaccine and treatment. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘COVID–19 Treatment Coverage Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Coverage at no cost sharing of COVID–19 vaccine and treatment under 

Medicaid program. 

Sec. 3. Coverage of treatment and vaccines at no cost sharing for the uninsured. 

Sec. 4. Coverage of COVID–19 treatment at no cost sharing under Medicare 

program. 

Sec. 5. Coverage of COVID–19 treatment at no cost sharing under Medicare 

Advantage program. 


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Sec. 6. Coverage of COVID–19 Drugs at no cost sharing under Medicare prescription drug plans. 

Sec. 7. Coverage of COVID–19 treatment at no cost sharing under private 

health insurance. 

Sec. 8. Coverage of COVID–19 treatment at no cost sharing for TRICARE recipients. 

Sec. 9. Coverage of COVID–19 treatment at no cost sharing for veterans. 

Sec. 10. Coverage of COVID–19 treatment at no cost sharing for Federal civilian employees. 

Sec. 11. Coverage of COVID–19 treatment at no cost sharing under Indian 

Health Service. 

Sec. 12. Sense of Congress related to surprise medical bills. 

Sec. 13. Special enrollment period; outreach and enrollment activities. 

1 SEC. 2. COVERAGE AT NO COST SHARING OF COVID–19 VAC2 CINE AND TREATMENT UNDER MEDICAID 

3 PROGRAM. 

4 (a) MEDICAID.— 

5 (1) IN GENERAL.—Section 1905(a)(4) of the 

6 Social Security Act (42 U.S.C. 1396d(a)(4)) is 

7 amended— 

8 (A) by striking ‘‘and (D)’’ and inserting 

9 ‘‘(D)’’; and 

10 (B) by striking the semicolon at the end 

11 and inserting ‘‘; (E) during the portion of the 

12 emergency period described in paragraph (1)(B) 

13 of section 1135(g) beginning on the date of the 

14 enactment of the COVID–19 Treatment Cov15 erage Act, a COVID–19 vaccine licensed under 

16 section 351 of the Public Health Service Act, or 

17 approved or authorized under section 505 or 

18 564 of the Federal Food, Drug, and Cosmetic 

19 Act, and administration of the vaccine; (F) durVerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469

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1 ing such portion of the emergency period de2 scribed in paragraph (1)(B) of section 1135(g), 

3 items or services for the prevention or treat4 ment of COVID–19, including drugs approved 

5 or authorized under such section 505 or such 

6 section 564 or, without regard to the require7 ments of section 1902(a)(10)(B) (relating to 

8 comparability), in the case of an individual who 

9 is diagnosed with or presumed to have COVID– 

10 19, during such portion of such emergency pe11 riod during which such individual is infected (or 

12 presumed infected) with COVID–19, the treat13 ment of a condition that may complicate the 

14 treatment of COVID–19;’’. 

15 (2) PROHIBITION OF COST SHARING.— 

16 (A) IN GENERAL.—Subsections (a)(2) and 

17 (b)(2) of section 1916 of the Social Security 

18 Act (42 U.S.C. 1396o) are each amended— 

19 (i) in subparagraph (F), by striking 

20 ‘‘or’’ at the end; 

21 (ii) in subparagraph (G), by striking 

22 ‘‘; and’’ and inserting ‘‘, or’’; and 

23 (iii) by adding at the end the fol24 lowing subparagraphs: 


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1 ‘‘(H) during the portion of the emergency 

2 period described in paragraph (1)(B) of section 

3 1135(g) beginning on the date of the enactment 

4 of this subparagraph, a COVID–19 vaccine li5 censed under section 351 of the Public Health 

6 Service Act, or approved or authorized under 

7 section 505 or 564 of the Federal Food, Drug, 

8 and Cosmetic Act, and the administration of 

9 such vaccine, or 

10 ‘‘(I) during such portion of the emergency 

11 period described in paragraph (1)(B) of section 

12 1135(g), any item or service furnished for the 

13 treatment of COVID–19, including drugs ap14 proved or authorized under such section 505 or 

15 such section 564 or, in the case of an individual 

16 who is diagnosed with or presumed to have 

17 COVID–19, during the portion of such emer18 gency period during which such individual is in19 fected (or presumed infected) with COVID–19, 

20 the treatment of a condition that may com21 plicate the treatment of COVID–19; and’’. 

22 (B) APPLICATION TO ALTERNATIVE COST

23 SHARING.—Section 1916A(b)(3)(B) of the So24 cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 

25 is amended— 


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1 (i) in clause (xi), by striking ‘‘any 

2 visit’’ and inserting ‘‘any service’’; and 

3 (ii) by adding at the end the following 

4 clauses: 

5 ‘‘(xii) During the portion of the emer6 gency period described in paragraph (1)(B) 

7 of section 1135(g) beginning on the date of 

8 the enactment of this clause, a COVID–19 

9 vaccine licensed under section 351 of the 

10 Public Health Service Act, or approved or 

11 authorized under section 505 or 564 of the 

12 Federal Food, Drug, and Cosmetic Act, 

13 and the administration of such vaccine. 

14 ‘‘(xiii) During such portion of the 

15 emergency period described in paragraph 

16 (1)(B) of section 1135(g), an item or serv17 ice furnished for the treatment of COVID– 

18 19, including drugs approved or authorized 

19 under such section 505 or such section 564 

20 or, in the case of an individual who is diag21 nosed with or presumed to have COVID– 

22 19, during such portion of such emergency 

23 period during which such individual is in24 fected (or presumed infected) with 

25 COVID–19, the treatment of a condition 


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1 that may complicate the treatment of 

2 COVID–19.’’. 

3 (C) CLARIFICATION.—The amendments 

4 made by this subsection shall apply with respect 

5 to a State plan of a territory in the same man6 ner as a State plan of one of the 50 States. 

7 (b) STATE PEDIATRIC VACCINE DISTRIBUTION PRO8 GRAM.—Section 1928 of the Social Security Act (42 

9 U.S.C. 1396s) is amended— 

10 (1) in subsection (a)(1)— 

11 (A) in subparagraph (A), by striking ‘‘; 

12 and’’ and inserting a semicolon; 

13 (B) in subparagraph (B), by striking the 

14 period and inserting ‘‘; and’’; and 

15 (C) by adding at the end the following sub16 paragraph: 

17 ‘‘(C) during the portion of the emergency 

18 period described in paragraph (1)(B) of section 

19 1135(g) beginning on the date of the enactment 

20 of this subparagraph, each vaccine-eligible child 

21 (as defined in subsection (b)) is entitled to re22 ceive a COVID–19 vaccine from a program-reg23 istered provider (as defined in subsection 

24 (h)(7)) without charge for— 

25 ‘‘(i) the cost of such vaccine; or 


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1 ‘‘(ii) the administration of such vac2 cine.’’; 

3 (2) in subsection (c)(2)— 

4 (A) in subparagraph (C)(ii), by inserting ‘‘, 

5 but, during the portion of the emergency period 

6 described in paragraph (1)(B) of section 

7 1135(g) beginning on the date of the enactment 

8 of the COVID–19 Treatment Coverage Act, 

9 may not impose a fee for the administration of 

10 a COVID–19 vaccine’’ before the period; and 

11 (B) by adding at the end the following sub12 paragraph: 

13 ‘‘(D) The provider will provide and admin14 ister an approved COVID–19 vaccine to a vac15 cine-eligible child in accordance with the same 

16 requirements as apply under the preceding sub17 paragraphs to the provision and administration 

18 of a qualified pediatric vaccine to such a 

19 child.’’; and 

20 (3) in subsection (d)(1), in the first sentence, 

21 by inserting ‘‘, including, during the portion of the 

22 emergency period described in paragraph (1)(B) of 

23 section 1135(g) beginning on the date of the enact24 ment of the COVID–19 Treatment Coverage Act, 

25 with respect to a COVID–19 vaccine licensed under 


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1 section 351 of the Public Health Service Act, or ap2 proved or authorized under section 505 or 564 of 

3 the Federal Food, Drug, and Cosmetic Act’’ before 

4 the period. 

5 (c) CHIP.— 

6 (1) IN GENERAL.—Section 2103(c) of the So7 cial Security Act (42 U.S.C. 1397cc(c)) is amended 

8 by adding at the end the following paragraph: 

9 ‘‘(11) COVERAGE OF COVID–19 VACCINES AND

10 TREATMENT.—Regardless of the type of coverage 

11 elected by a State under subsection (a), child health 

12 assistance provided under such coverage for targeted 

13 low-income children and, in the case that the State 

14 elects to provide pregnancy-related assistance under 

15 such coverage pursuant to section 2112, such preg16 nancy-related assistance for targeted low-income 

17 pregnant women (as defined in section 2112(d)) 

18 shall include coverage, during the portion of the 

19 emergency period described in paragraph (1)(B) of 

20 section 1135(g) beginning on the date of the enact21 ment of this paragraph, of— 

22 ‘‘(A) a COVID–19 vaccine licensed under 

23 section 351 of the Public Health Service Act, or 

24 approved or authorized under section 505 or 

25 564 of the Federal Food, Drug, and Cosmetic 


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1 Act, and the administration of such vaccine; 

2 and 

3 ‘‘(B) any item or service furnished for the 

4 treatment of COVID–19, including drugs ap5 proved or authorized under such section 505 or 

6 such section 564, or, in the case of an indi7 vidual who is diagnosed with or presumed to 

8 have COVID–19, during the portion of such 

9 emergency period during which such individual 

10 is infected (or presumed infected) with COVID– 

11 19, the treatment of a condition that may com12 plicate the treatment of COVID–19.’’. 

13 (2) PROHIBITION OF COST SHARING.—Section 

14 2103(e)(2) of the Social Security Act (42 U.S.C. 

15 1397cc(e)(2)), as amended by section 6004(b)(3) of 

16 the Families First Coronavirus Response Act, is 

17 amended— 

18 (A) in the paragraph header, by inserting 

19 ‘‘A COVID–19 VACCINE, COVID–19 TREATMENT,’’ 

20 before ‘‘OR PREGNANCY-RELATED ASSISTANCE’’; 

21 and 

22 (B) by striking ‘‘visits described in section 

23 1916(a)(2)(G), or’’ and inserting ‘‘services de24 scribed in section 1916(a)(2)(G), vaccines de25 scribed in section 1916(a)(2)(H) administered 


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1 during the portion of the emergency period de2 scribed in paragraph (1)(B) of section 1135(g) 

3 beginning on the date of the enactment of the 

4 COVID–19 Treatment Coverage Act, items or 

5 services described in section 1916(a)(2)(I) fur6 nished during such emergency period, or’’. 

7 (d) CONFORMING AMENDMENTS.—Section 1937 of 

8 the Social Security Act (42 U.S.C. 1396u–7) is amend9 ed— 

10 (1) in subsection (a)(1)(B), by inserting ‘‘, 

11 under subclause (XXIII) of section 

12 1902(a)(10)(A)(ii),’’ after ‘‘section 

13 1902(a)(10)(A)(i)’’; and 

14 (2) in subsection (b)(5), by adding before the 

15 period the following: ‘‘, and, effective on the date of 

16 the enactment of the COVID–19 Treatment Cov17 erage Act, must comply with subparagraphs (F) 

18 through (I) of subsections (a)(2) and (b)(2) of sec19 tion 1916 and subsection (b)(3)(B) of section 

20 1916A’’. 

21 (e) EFFECTIVE DATE.—The amendments made by 

22 this section shall take effect on the date of enactment of 

23 this Act and shall apply with respect to a COVID–19 vac24 cine beginning on the date that such vaccine is licensed 

25 under section 351 of the Public Health Service Act (42 


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1 U.S.C. 262), or approved or authorized under section 505 

2 or 564 of the Federal Food, Drug, and Cosmetic Act. 

3 SEC. 3. COVERAGE OF TREATMENT AND VACCINES AT NO 

4 COST SHARING FOR THE UNINSURED. 

5 (a) IN GENERAL.—Section 1902(a)(10) of the Social 

6 Security Act (42 U.S.C. 1396a(a)(10)) is amended, in the 

7 matter following subparagraph (G), by striking ‘‘and any 

8 visit described in section 1916(a)(2)(G)’’ and inserting the 

9 following: ‘‘, any COVID–19 vaccine that is administered 

10 during any such portion (and the administration of such 

11 vaccine), any item or service that is furnished during any 

12 such portion for the treatment of COVID–19, including 

13 drugs approved or authorized under section 505 or 564 

14 of the Federal Food, Drug, and Cosmetic Act, or, in the 

15 case of an individual who is diagnosed with or presumed 

16 to have COVID–19, during the period such individual is 

17 infected (or presumed infected) with COVID–19, the 

18 treatment of a condition that may complicate the treat19 ment of COVID–19, the treatment of a COVID–19-re20 lated condition that follows the treatment of, or hos21 pitalization with, COVID–19, and any services described 

22 in section 1916(a)(2)(G)’’. 

23 (b) DEFINITION OF UNINSURED INDIVIDUAL.— 


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1 (1) IN GENERAL.—Subsection (ss) of section 

2 1902 of the Social Security Act (42 U.S.C. 1396a) 

3 is amended to read as follows: 

4 ‘‘(ss) UNINSURED INDIVIDUAL DEFINED.—For pur5 poses of this section, the term ‘uninsured individual’ 

6 means, notwithstanding any other provision of this title, 

7 any individual who is not covered by minimum essential 

8 coverage (as defined in section 5000A(f)(1) of the Internal 

9 Revenue Code of 1986).’’. 

10 (2) EFFECTIVE DATE.—The amendment made 

11 by paragraph (1) shall take effect and apply as if in12 cluded in the enactment of the Families First 

13 Coronavirus Response Act (Public Law 116–127). 

14 (c) CLARIFICATION REGARDING EMERGENCY SERV15 ICES FOR CERTAIN INDIVIDUALS.—For purposes of apply16 ing section 1903(v)(2)(A) of the Social Security Act (42 

17 U.S.C. 1396b(v)(2)(A)), the care and services described 

18 in such section shall include the following: 

19 (1) In vitro diagnostic products (as defined in 

20 section 809.3(a) of title 21, Code of Federal Regula21 tions), and the administration of such products. 

22 (2) A COVID–19 vaccine (and the administra23 tion of such vaccine). 

24 (3) Any item or service that is furnished for the 

25 treatment of COVID–19 or a condition that may 


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1 complicate the treatment of COVID–19, the treat2 ment of a COVID–19-related condition that follows 

3 the treatment of, or hospitalization with, COVID– 

4 19, and any services described in section 

5 1916(a)(2)(G) of such Act (42 U.S.C. 

6 1396o(a)(2)(G)). 

7 (d) EMERGENCY MEDICAID FOR INDIVIDUALS WITH

8 SUSPECTED COVID–19 INFECTIONS.—For purposes of 

9 applying section 1903(v)(3) of the Social Security Act (42 

10 U.S.C. 1396b(v)(3)), the term ‘‘emergency medical condi11 tion’’ (as defined in such section 1903(v)(3)) shall include, 

12 with respect to an individual, any concern that the indi13 vidual may have contracted COVID–19. 

14 (e) TREATMENT OF ASSISTANCE AND SERVICES PRO15 VIDED.—Beginning on the date of enactment of this Act— 

16 (1) the value of assistance or services provided 

17 to any person under a program with respect to 

18 which a coronavirus response law establishes or ex19 pands eligibility or benefits shall not be considered 

20 income or resources; and 

21 (2)(A) any medical coverage or services pro22 vided to an individual under subsection (v) of section 

23 1903 of the Social Security Act (42 U.S.C. 1396b) 

24 shall be considered treatment for an emergency med25 ical condition (as defined in subsection (v)(3) of 


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1 such section) for any purpose under any Federal, 

2 State, or local law, including law relating to tax3 ation, welfare, and public assistance programs; and 

4 (B) a participating State or political subdivision 

5 of a State shall not decrease any assistance other6 wise provided to an individual because of the receipt 

7 of benefits under the Social Security Act (42 U.S.C. 

8 301 et seq.). 

9 (f) OTHER DEFINITIONS.—In this section: 

10 (1) CORONAVIRUS PUBLIC HEALTH EMER11 GENCY.—The term ‘‘coronavirus public health emer12 gency’’ means— 

13 (A) an emergency involving Federal pri14 mary responsibility determined to exist by the 

15 President under section 501(b) of the Robert T. 

16 Stafford Disaster Relief and Emergency Assist17 ance Act (42 U.S.C. 5191(b)) with respect to 

18 COVID–19 or any other coronavirus with pan19 demic potential; 

20 (B) an emergency declared by a Federal 

21 official with respect to coronavirus (as defined 

22 in section 506 of the Coronavirus Preparedness 

23 and Response Supplemental Appropriations 

24 Act, 2020 (Public Law 116–123)); 


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1 (C) a national emergency declared by the 

2 President under the National Emergencies Act 

3 (50 U.S.C. 1601 et seq.) with respect to 

4 COVID–19 or any other coronavirus with pan5 demic potential; and 

6 (D) a public health emergency declared by 

7 the Secretary of Health and Human Services 

8 pursuant to section 319 of the Public Health 

9 Service Act (42 U.S.C. 247(d)) with respect to 

10 COVID–19 or any other coronavirus with pan11 demic potential. 

12 (2) CORONAVIRUS RESPONSE LAW.—The term 

13 ‘‘coronavirus response law’’ means— 

14 (A) the Coronavirus Preparedness and Re15 sponse Supplemental Appropriations Act, 2020 

16 (Public Law 116–123); 

17 (B) the Families First Coronavirus Re18 sponse Act (Public Law 116–127); 

19 (C) the Coronavirus Aid, Relief, and Eco20 nomic Security Act (Public Law 116–136); and 

21 (D) any subsequent law that appropriates 

22 or otherwise makes available funds, establishes, 

23 amends, or expands a program, or authorizes 

24 activities or assistance for a purpose that is ex25 pressly related to responding to, or mitigating 


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1 the effects of, a coronavirus public health emer2 gency. 

3 (g) REIMBURSEMENT FOR ADDITIONAL HEALTH

4 SERVICES RELATING TO CORONAVIRUS.—Title V of divi5 sion A of the Families First Coronavirus Response Act 

6 (Public Law 116–127) is amended under the heading 

7 ‘‘Department of Health and Human Services—Office of 

8 the Secretary—Public Health and Social Services Emer9 gency Fund’’ by inserting ‘‘, or treatment related to 

10 SARS–CoV–2 or COVID–19 for uninsured individuals’’ 

11 after ‘‘or visits described in paragraph (2) of such section 

12 for uninsured individuals’’. 

13 (h) RULE OF CONSTRUCTION.—Nothing in this sec14 tion shall be construed to limit— 

15 (1) the types of care and services that are nec16 essary for the treatment of an emergency condition 

17 for purposes of section 1903(v) of the Social Secu18 rity Act (42 U.S.C. 1396b(v)); or 

19 (2) the types of medical conditions that are 

20 ‘‘emergency medical conditions’’ for purposes of such 

21 section. 

22 SEC. 4. COVERAGE OF COVID–19 TREATMENT AT NO COST 

23 SHARING UNDER MEDICARE PROGRAM. 

24 (a) IN GENERAL.—Notwithstanding any other provi25 sion of law, in the case of a specified COVID–19 treatVerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469

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1 ment service (as defined in subsection (b)) furnished dur2 ing any portion of the emergency period described in para3 graph (1)(B) of section 1135(g) of the Social Security Act 

4 (42 U.S.C. 1320b–5(g)) beginning on or after the date 

5 of the enactment of this Act to an individual entitled to 

6 benefits under part A or enrolled under part B of title 

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

8 for which payment is made under such part A or such 

9 part B, the Secretary of Health and Human Services (in 

10 this section referred to as the ‘‘Secretary’’) shall provide 

11 that— 

12 (1) any cost sharing required (including any de13 ductible, copayment, or coinsurance) applicable to 

14 such individual under such part A or such part B 

15 with respect to such item or service is paid by the 

16 Secretary; and 

17 (2) the provider of services or supplier (as de18 fined in section 1861 of the Social Security Act (42 

19 U.S.C. 1395x)) does not hold such individual liable 

20 for such requirement. 

21 (b) DEFINITION OF SPECIFIED COVID–19 TREAT22 MENT SERVICES.—For purposes of this section, the term 

23 ‘‘specified COVID–19 treatment service’’ means any item 

24 or service furnished to an individual for which payment 

25 may be made under part A or part B of title XVIII of 


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1 the Social Security Act (42 U.S.C. 1395 et seq.) if such 

2 item or service is included in a claim with an ICD–10– 

3 CM code relating to COVID–19 (as described in the docu4 ment entitled ‘‘ICD–10–CM Official Coding Guidelines— 

5 Supplement Coding encounters related to COVID–19 

6 Coronavirus Outbreak’’ published on February 20, 2020, 

7 or as otherwise specified by the Secretary). 

8 (c) RECOVERY OF COST-SHARING AMOUNTS PAID BY

9 THE SECRETARY IN THE CASE OF SUPPLEMENTAL IN10 SURANCE COVERAGE.— 

11 (1) IN GENERAL.—In the case of any amount 

12 paid by the Secretary pursuant to subsection (a)(1) 

13 that the Secretary determines would otherwise have 

14 been paid by a group health plan or health insurance 

15 issuer (as such terms are defined in section 2791 of 

16 the Public Health Service Act (42 U.S.C. 300gg– 

17 91)), a private entity offering a medicare supple18 mental policy under section 1882 of the Social Secu19 rity Act (42 U.S.C. 1395ss), any other health plan 

20 offering supplemental coverage, a State plan under 

21 title XIX of the Social Security Act, or the Secretary 

22 of Defense under the TRICARE program, such 

23 plan, issuer, private entity, other health plan, State 

24 plan, or Secretary of Defense, as applicable, shall 

25 pay to the Secretary, not later than 1 year after 


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1 such plan, issuer, private entity, other health plan, 

2 State plan, or Secretary of Defense receives a notice 

3 under paragraph (3), such amount in accordance 

4 with this subsection. 

5 (2) REQUIRED INFORMATION.—Not later than 

6 9 months after the date of the enactment of this 

7 Act, each group health plan, health insurance issuer, 

8 private entity, other health plan, State plan, and 

9 Secretary of Defense described in paragraph (1) 

10 shall submit to the Secretary such information as 

11 the Secretary determines necessary for purposes of 

12 carrying out this subsection. Such information so 

13 submitted shall be updated by such plan, issuer, pri14 vate entity, other health plan, State plan, or Sec15 retary of Defense, as applicable, at such time and in 

16 such manner as specified by the Secretary. 

17 (3) REVIEW OF CLAIMS AND NOTIFICATION.— 

18 The Secretary shall establish a process under which 

19 claims for items and services for which the Secretary 

20 has paid an amount pursuant to subsection (a)(1) 

21 are reviewed for purposes of identifying if such 

22 amount would otherwise have been paid by a plan, 

23 issuer, private entity, other health plan, State plan, 

24 or Secretary of Defense described in paragraph (1). 

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1 retary shall determine the amount that would have 

2 been otherwise payable by such plan, issuer, private 

3 entity, other health plan, State plan, or Secretary of 

4 Defense and notify such plan, issuer, private entity, 

5 other health plan, State plan, or Secretary of De6 fense of such amount. 

7 (4) ENFORCEMENT.—The Secretary may im8 pose a civil monetary penalty in an amount deter9 mined appropriate by the Secretary in the case of a 

10 plan, issuer, private entity, other health plan, or 

11 State plan that fails to comply with a provision of 

12 this section. The provisions of section 1128A of the 

13 Social Security Act shall apply to a civil monetary 

14 penalty imposed under the previous sentence in the 

15 same manner as such provisions apply to a penalty 

16 or proceeding under subsection (a) or (b) of such 

17 section. 

18 (d) FUNDING.—The Secretary shall provide for the 

19 transfer to the Centers for Medicare & Medicaid Program 

20 Management Account from the Federal Hospital Insur21 ance Trust Fund and the Federal Supplementary Trust 

22 Fund (in such portions as the Secretary determines appro23 priate) $100,000,000 for purposes of carrying out this 

24 section. 


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1 (e) REPORT.—Not later than 3 years after the date 

2 of the enactment of this Act, the Inspector General of the 

3 Department of Health and Human Services shall submit 

4 to Congress a report containing an analysis of amounts 

5 paid pursuant to subsection (a)(1) compared to amounts 

6 paid to the Secretary pursuant to subsection (c). 

7 (f) IMPLEMENTATION.—Notwithstanding any other 

8 provision of law, the Secretary may implement the provi9 sions of this section by program instruction or otherwise. 

10 SEC. 5. COVERAGE OF COVID–19 TREATMENT AT NO COST 

11 SHARING UNDER MEDICARE ADVANTAGE 

12 PROGRAM. 

13 (a) IN GENERAL.—Section 1852(a)(1)(B) of the So14 cial Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is 

15 amended by adding at the end the following new clause: 

16 ‘‘(vii) SPECIAL COVERAGE RULES FOR

17 SPECIFIED COVID–19 TREATMENT SERV18 ICES.—Notwithstanding clause (i), in the 

19 case of a specified COVID–19 treatment 

20 service (as defined in section 4(b) of the 

21 COVID–19 Treatment Coverage Act) that 

22 is furnished during a plan year occurring 

23 during any portion of the emergency period 

24 defined in section 1135(g)(1)(B) beginning 

25 on or after the date of the enactment of 


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1 this clause, a Medicare Advantage plan 

2 may not, with respect to such service, im3 pose— 

4 ‘‘(I) any cost-sharing require5 ment (including a deductible, copay6 ment, or coinsurance requirement); 

7 and 

8 ‘‘(II) in the case such service is a 

9 critical specified COVID–19 treat10 ment service (including ventilator 

11 services and intensive care unit serv12 ices), any prior authorization or other 

13 utilization management requirement. 

14 A Medicare Advantage plan may not take 

15 the application of this clause into account 

16 for purposes of a bid amount submitted by 

17 such plan under section 1854(a)(6).’’. 

18 (b) IMPLEMENTATION.—Notwithstanding any other 

19 provision of law, the Secretary of Health and Human 

20 Services may implement the amendments made by this 

21 section by program instruction or otherwise. 

22 SEC. 6. COVERAGE OF COVID–19 DRUGS AT NO COST SHAR23 ING UNDER MEDICARE PRESCRIPTION DRUG 

24 PLANS. 

25 (a) COVERAGE REQUIREMENT.— 


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1 (1) IN GENERAL.—Section 1860D–4(b)(3) of 

2 the Social Security Act (42 U.S.C. 1395w– 

3 104(b)(3)) is amended by adding at the end the fol4 lowing new subparagraph: 

5 ‘‘(I) REQUIRED INCLUSION OF DRUGS IN6 TENDED TO TREAT COVID–19.— 

7 ‘‘(i) IN GENERAL.—Notwithstanding 

8 any other provision of law, a PDP sponsor 

9 offering a prescription drug plan shall, 

10 with respect to a plan year, any portion of 

11 which occurs during the period described 

12 in clause (ii), be required to— 

13 ‘‘(I) include in any formulary— 

14 ‘‘(aa) all covered part D 

15 drugs with a medically accepted 

16 indication (as defined in section 

17 1860D–2(e)(4)) to treat COVID– 

18 19 that are marketed in the 

19 United States; and 

20 ‘‘(bb) all drugs authorized 

21 under section 564 or 564A of the 

22 Federal Food, Drug, and Cos23 metic Act to treat COVID–19; 

24 and 


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1 ‘‘(II) not impose any prior au2 thorization or other utilization man3 agement requirement with respect to 

4 such drugs described in item (aa) or 

5 (bb) of subclause (I) (other than such 

6 a requirement that limits the quantity 

7 of drugs due to safety). 

8 ‘‘(ii) PERIOD DESCRIBED.—For pur9 poses of clause (i), the period described in 

10 this clause is the period during which there 

11 exists the public health emergency declared 

12 by the Secretary pursuant to section 319 

13 of the Public Health Service Act on Janu14 ary 31, 2020, entitled ‘Determination that 

15 a Public Health Emergency Exists Nation16 wide as the Result of the 2019 Novel 

17 Coronavirus’ (including any renewal of 

18 such declaration pursuant to such sec19 tion).’’. 

20 (b) ELIMINATION OF COST SHARING.— 

21 (1) ELIMINATION OF COST SHARING FOR

22 DRUGS INTENDED TO TREAT COVID–19 UNDER

23 STANDARD AND ALTERNATIVE PRESCRIPTION DRUG

24 COVERAGE.—Section 1860D–2 of the Social Security 

25 Act (42 U.S.C. 1395w–102) is amended— 


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1 (A) in subsection (b)— 

2 (i) in paragraph (1)(A), by striking 

3 ‘‘The coverage’’ and inserting ‘‘Subject to 

4 paragraph (8), the coverage’’; 

5 (ii) in paragraph (2)— 

6 (I) in subparagraph (A), by in7 serting after ‘‘Subject to subpara8 graphs (C) and (D)’’ the following: 

9 ‘‘and paragraph (8)’’; 

10 (II) in subparagraph (C)(i), by 

11 striking ‘‘paragraph (4)’’ and insert12 ing ‘‘paragraphs (4) and (8)’’; and 

13 (III) in subparagraph (D)(i), by 

14 striking ‘‘paragraph (4)’’ and insert15 ing ‘‘paragraphs (4) and (8)’’; 

16 (iii) in paragraph (4)(A)(i), by strik17 ing ‘‘The coverage’’ and inserting ‘‘Subject 

18 to paragraph (8), the coverage’’; and 

19 (iv) by adding at the end the following 

20 new paragraph: 

21 ‘‘(8) ELIMINATION OF COST-SHARING FOR

22 DRUGS INTENDED TO TREAT COVID–19.—The cov23 erage does not impose any deductible, copayment, 

24 coinsurance, or other cost-sharing requirement for 

25 drugs described in section 1860D–4(b)(3)(I)(i)(I) 


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1 with respect to a plan year, any portion of which oc2 curs during the period during which there exists the 

3 public health emergency declared by the Secretary 

4 pursuant to section 319 of the Public Health Service 

5 Act on January 31, 2020, entitled ‘Determination 

6 that a Public Health Emergency Exists Nationwide 

7 as the Result of the 2019 Novel Coronavirus’ (in8 cluding any renewal of such declaration pursuant to 

9 such section).’’; and 

10 (B) in subsection (c), by adding at the end 

11 the following new paragraph: 

12 ‘‘(4) SAME ELIMINATION OF COST-SHARING FOR

13 DRUGS INTENDED TO TREAT COVID–19.—The cov14 erage is in accordance with subsection (b)(8).’’. 

15 (2) ELIMINATION OF COST SHARING FOR

16 DRUGS INTENDED TO TREAT COVID–19 DISPENSED

17 TO INDIVIDUALS WHO ARE SUBSIDY ELIGIBLE INDI18 VIDUALS.—Section 1860D–14(a) of the Social Secu19 rity Act (42 U.S.C. 1395w–114(a)) is amended— 

20 (A) in paragraph (1)— 

21 (i) in subparagraph (D)— 

22 (I) in clause (ii), by striking ‘‘In 

23 the case of’’ and inserting ‘‘Subject to 

24 subparagraph (F), in the case of’’; 

25 and 


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1 (II) in clause (iii), by striking 

2 ‘‘In the case of’’ and inserting ‘‘Sub3 ject to subparagraph (F), in the case 

4 of’’; and 

5 (ii) by adding at the end the following 

6 new subparagraph: 

7 ‘‘(F) ELIMINATION OF COST-SHARING FOR

8 DRUGS INTENDED TO TREAT COVID–19.—Cov9 erage that is in accordance with section 

10 1860D–2(b)(8).’’; and 

11 (B) in paragraph (2)— 

12 (i) in subparagraph (B), by striking 

13 ‘‘A reduction’’ and inserting ‘‘Subject to 

14 subparagraph (F), a reduction’’; 

15 (ii) in subparagraph (D), by striking 

16 ‘‘The substitution’’ and inserting ‘‘Subject 

17 to subparagraph (F), the substitution’’; 

18 (iii) in subparagraph (E), by inserting 

19 after ‘‘Subject to’’ the following: ‘‘subpara20 graph (F) and’’; and 

21 (iv) by adding at the end the following 

22 new subparagraph: 

23 ‘‘(F) ELIMINATION OF COST-SHARING FOR

24 DRUGS INTENDED TO TREAT COVID–19.—CovVerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469

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1 erage that is in accordance with section 

2 1860D–2(b)(8).’’. 

3 (c) IMPLEMENTATION.—Notwithstanding any other 

4 provision of law, the Secretary of Health and Human 

5 Services may implement the amendments made by this 

6 section by program instruction or otherwise. 

7 SEC. 7. COVERAGE OF COVID–19 TREATMENT AT NO COST 

8 SHARING UNDER PRIVATE HEALTH INSUR9 ANCE. 

10 (a) IN GENERAL.—A group health plan and a health 

11 insurance issuer offering group or individual health insur12 ance coverage (including a grandfathered health plan (as 

13 defined in section 1251(e) of the Patient Protection and 

14 Affordable Care Act)) shall provide coverage, and shall not 

15 impose any cost sharing (including deductibles, copay16 ments, and coinsurance) requirements, for the following 

17 items and services furnished during any portion of the 

18 emergency period defined in paragraph (1)(B) of section 

19 1135(g) of the Social Security Act (42 U.S.C. 1320b– 

20 5(g)) beginning on or after the date of the enactment of 

21 this Act: 

22 (1) Medically necessary items and services (in23 cluding in-person or telehealth visits in which such 

24 items and services are furnished) that are furnished 

25 to an individual who has been diagnosed with (or 


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1 after provision of the items and services is diagnosed 

2 with) COVID–19 to treat or mitigate the effects of 

3 COVID–19. 

4 (2) Medically necessary items and services (in5 cluding in-person or telehealth visits in which such 

6 items and services are furnished) that are furnished 

7 to an individual who is presumed to have COVID– 

8 19 but is never diagnosed as such, if the following 

9 conditions are met: 

10 (A) Such items and services are furnished 

11 to the individual to treat or mitigate the effects 

12 of COVID–19 or to mitigate the impact of 

13 COVID–19 on society. 

14 (B) Health care providers have taken ap15 propriate steps under the circumstances to 

16 make a diagnosis, or confirm whether a diag17 nosis was made, with respect to such individual, 

18 for COVID–19, if possible. 

19 (b) ITEMS AND SERVICES RELATED TO COVID– 

20 19.—For purposes of this section— 

21 (1) not later than one week after the date of 

22 the enactment of this section, the Secretary of 

23 Health and Human Services, the Secretary of Labor, 

24 and the Secretary of the Treasury shall jointly issue 

25 guidance specifying applicable diagnoses and mediVerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469

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1 cally necessary items and services related to 

2 COVID–19; and 

3 (2) such items and services shall include all 

4 items or services that are relevant to the treatment 

5 or mitigation of COVID–19, regardless of whether 

6 such items or services are ordinarily covered under 

7 the terms of a group health plan or group or indi8 vidual health insurance coverage offered by a health 

9 insurance issuer. 

10 (c) ENFORCEMENT.— 

11 (1) APPLICATION WITH RESPECT TO PHSA, 

12 ERISA, AND IRC.—The provisions of this section 

13 shall be applied by the Secretary of Health and 

14 Human Services, the Secretary of Labor, and the 

15 Secretary of the Treasury to group health plans and 

16 health insurance issuers offering group or individual 

17 health insurance coverage as if included in the provi18 sions of part A of title XXVII of the Public Health 

19 Service Act (42 U.S.C. 300gg et seq.), part 7 of sub20 title B of title I of the Employee Retirement Income 

21 Security Act of 1974 (29 U.S.C. 1181 et seq.), and 

22 subchapter B of chapter 100 of the Internal Rev23 enue Code of 1986, as applicable. 

24 (2) PRIVATE RIGHT OF ACTION.—An individual 

25 with respect to whom an action is taken by a group 


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1 health plan or health insurance issuer offering group 

2 or individual health insurance coverage in violation 

3 of subsection (a) may commence a civil action 

4 against the plan or issuer for appropriate relief. The 

5 previous sentence shall not be construed as limiting 

6 any enforcement mechanism otherwise applicable 

7 pursuant to paragraph (1). 

8 (d) IMPLEMENTATION.—The Secretary of Health and 

9 Human Services, the Secretary of Labor, and the Sec10 retary of the Treasury may implement the provisions of 

11 this section through sub-regulatory guidance, program in12 struction or otherwise. 

13 (e) TERMS.—The terms ‘‘group health plan’’, ‘‘health 

14 insurance issuer’’, ‘‘group health insurance coverage’’, and 

15 ‘‘individual health insurance coverage’’ have the meanings 

16 given such terms in section 2791 of the Public Health 

17 Service Act (42 U.S.C. 300gg–91), section 733 of the Em18 ployee Retirement Income Security Act of 1974 (29 

19 U.S.C. 1191b), and section 9832 of the Internal Revenue 

20 Code of 1986, as applicable. 

21 SEC. 8. COVERAGE OF COVID–19 TREATMENT AT NO COST 

22 SHARING FOR TRICARE RECIPIENTS. 

23 (a) IN GENERAL.—Section 6006(a) of the Families 

24 First Coronavirus Response Act (Public Law 116–127; 38 

25 U.S.C. 1074 note) is amended by striking ‘‘or visits deVerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469

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1 scribed in paragraph (2) of such section’’ and inserting 

2 ‘‘, visits described in paragraph (2) of such section, or 

3 medical care to treat COVID–19’’. 

4 (b) EFFECTIVE DATE.—The amendment made by 

5 subsection (a) shall apply with respect to medical care fur6 nished on or after the date of the enactment of this Act. 

7 SEC. 9. COVERAGE OF COVID–19 TREATMENT AT NO COST 

8 SHARING FOR VETERANS. 

9 (a) IN GENERAL.—Section 6006(b) of the Families 

10 First Coronavirus Response Act (Public Law 116–127; 38 

11 U.S.C. 1701 note) is amended by striking ‘‘or visits de12 scribed in paragraph (2) of such section’’ and inserting 

13 ‘‘, visits described in paragraph (2) of such section, or hos14 pital care or medical services to treat COVID–19’’. 

15 (b) EFFECTIVE DATE.—The amendment made by 

16 subsection (a) shall apply with respect to hospital care and 

17 medical services furnished on or after the date of the en18 actment of this Act. 

19 SEC. 10. COVERAGE OF COVID–19 TREATMENT AT NO COST 

20 SHARING FOR FEDERAL CIVILIAN EMPLOY21 EES. 

22 (a) IN GENERAL.—Section 6006(c) of the Families 

23 First Coronavirus Response Act (Public Law 116–127; 5 

24 U.S.C. 8904 note) is amended by striking ‘‘or visits de25 scribed in paragraph (2) of such section’’ and inserting 


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1 ‘‘, visits described in paragraph (2) of such section, or hos2 pital care or medical services to treat COVID–19’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 subsection (a) shall apply with respect to hospital care and 

5 medical services furnished on or after the date of the en6 actment of this Act. 

7 SEC. 11. COVERAGE OF COVID–19 TREATMENT AT NO COST 

8 SHARING UNDER INDIAN HEALTH SERVICE. 

9 The Secretary of Health and Human Services shall 

10 cover, without the imposition of any cost sharing require11 ments, the cost of the following on or after the date of 

12 the enactment of this Act to Indians (as defined in section 

13 4 of the Indian Health Care Improvement Act (25 U.S.C. 

14 1603)) receiving health services through the Indian Health 

15 Service, regardless of whether such items or services are 

16 authorized under the Contract Health Services program 

17 funded by the Indian Health Service and operated by the 

18 Indian Health Service or operated by an Indian tribe or 

19 tribal organization under a contract or compact with the 

20 Indian Health Service under the Indian Self-Determina21 tion and Education Assistance Act (25 U.S.C. 5301 et 

22 seq.), or are provided as a health service of the Indian 

23 Health Service: 

24 (1) A COVID–19 vaccine licensed under section 

25 351 of the Public Health Service Act, or approved 


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1 or authorized under section 505 or 564 of the Fed2 eral Food, Drug, and Cosmetic Act, and the admin3 istration of such vaccine. 

4 (2) Any item or service furnished for the treat5 ment of COVID–19, including drugs approved or au6 thorized under such section 505 or such section 564, 

7 or, in the case of an individual who is diagnosed 

8 with or presumed to have COVID–19, during the 

9 portion of such emergency period during which such 

10 individual is infected (or presumed infected) with 

11 COVID–19, the treatment of a condition that may 

12 complicate the treatment of COVID–19. 

13 SEC. 12. SENSE OF CONGRESS RELATED TO SURPRISE MED14 ICAL BILLS. 

15 It is the sense of Congress that no individual should 

16 receive a medical bill, including a balance bill, for the cost 

17 of COVID–19 treatment, office visits related to COVID– 

18 19 treatment, COVID–19 vaccines, or the administration 

19 of those vaccines. 

20 SEC. 13. SPECIAL ENROLLMENT PERIOD; OUTREACH AND 

21 ENROLLMENT ACTIVITIES. 

22 (a) SPECIAL ENROLLMENT PERIOD THROUGH EX23 CHANGES.—Section 1311(c) of the Patient Protection and 

24 Affordable Care Act (42 U.S.C. 18031(c)) is amended— 

25 (1) in paragraph (6)— 


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1 (A) in subparagraph (C), by striking at the 

2 end ‘‘and’’; 

3 (B) in subparagraph (D), by striking at 

4 the end the period and inserting ‘‘; and’’; and 

5 (C) by adding at the end the following new 

6 subparagraph: 

7 ‘‘(E) subject to subparagraph (B) of para8 graph (8), the special enrollment period de9 scribed in subparagraph (A) of such para10 graph.’’; and 

11 (2) by adding at the end the following new 

12 paragraph: 

13 ‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER14 TAIN PUBLIC HEALTH EMERGENCY.— 

15 ‘‘(A) IN GENERAL.—The Secretary shall, 

16 subject to subparagraph (B), require an Ex17 change to provide— 

18 ‘‘(i) for a special enrollment period 

19 during the emergency period described in 

20 section 1135(g)(1)(B) of the Social Secu21 rity Act— 

22 ‘‘(I) which shall begin on the 

23 date that is one week after the date of 

24 the enactment of this paragraph and 

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1 tablished or operated by the Secretary 

2 within a State pursuant to section 

3 1321(c), shall be an 8-week period; 

4 and 

5 ‘‘(II) during which any individual 

6 who is otherwise eligible to enroll in a 

7 qualified health plan through the Ex8 change may enroll in such a qualified 

9 health plan; and 

10 ‘‘(ii) that, in the case of an individual 

11 who enrolls in a qualified health plan 

12 through the Exchange during such enroll13 ment period, the coverage period under 

14 such plan shall begin, at the option of the 

15 individual, on April 1, 2020, or on the first 

16 day of the month following the day the in17 dividual selects a plan through such special 

18 enrollment period. 

19 ‘‘(B) EXCEPTION.—The requirement of 

20 subparagraph (A) shall not apply to a State-op21 erated or State-established Exchange if such 

22 Exchange, prior to the date of the enactment of 

23 this paragraph, established or otherwise pro24 vided for a special enrollment period to address 

25 access to coverage under qualified health plans 


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1 offered through such Exchange during the 

2 emergency period described in section 

3 1135(g)(1)(B) of the Social Security Act.’’. 

4 (b) FEDERAL EXCHANGE OUTREACH AND EDU5 CATIONAL ACTIVITIES.—Section 1321(c) of the Patient 

6 Protection and Affordable Care Act (42 U.S.C. 18041(c)) 

7 is amended by adding at the end the following new para8 graph: 

9 ‘‘(3) OUTREACH AND EDUCATIONAL ACTIVI10 TIES.— 

11 ‘‘(A) IN GENERAL.—In the case of an Ex12 change established or operated by the Secretary 

13 within a State pursuant to this subsection, the 

14 Secretary shall carry out outreach and edu15 cational activities for purposes of informing po16 tential enrollees in qualified health plans offered 

17 through the Exchange of the availability of cov18 erage under such plans and financial assistance 

19 for coverage under such plans. Such outreach 

20 and educational activities shall be provided in a 

21 manner that is culturally and linguistically ap22 propriate to the needs of the populations being 

23 served by the Exchange (including hard-to24 reach populations, such as racial and sexual miVerDate Sep 11 2014 17:25 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S4469.IS S4469

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1 norities, limited English proficient populations, 

2 and young adults). 

3 ‘‘(B) LIMITATION ON USE OF FUNDS.—No 

4 funds appropriated under this paragraph shall 

5 be used for expenditures for promoting non6 ACA compliant health insurance coverage. 

7 ‘‘(C) NON-ACA COMPLIANT HEALTH IN8 SURANCE COVERAGE.—For purposes of sub9 paragraph (B): 

10 ‘‘(i) The term ‘non-ACA compliant 

11 health insurance coverage’ means health 

12 insurance coverage, or a group health plan, 

13 that is not a qualified health plan. 

14 ‘‘(ii) Such term includes the following: 

15 ‘‘(I) An association health plan. 

16 ‘‘(II) Short-term limited duration 

17 insurance. 

18 ‘‘(D) FUNDING.—There are appropriated, 

19 out of any funds in the Treasury not otherwise 

20 appropriated, $25,000,000, to remain available 

21 until expended— 

22 ‘‘(i) to carry out this paragraph; and 

23 ‘‘(ii) at the discretion of the Sec24 retary, to carry out section 1311(i), with 

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1 erated by the Secretary within a State pur2 suant to this subsection.’’. 

3 (c) IMPLEMENTATION.—The Secretary of Health and 

4 Human Services may implement the provisions of (includ5 ing amendments made by) this section through subregu6 latory guidance, program instruction, or otherwise. 

Æ 


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