II 

116TH CONGRESS 

2D SESSION S. 4840 

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 for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 21 (legislative day, OCTOBER 19), 2020 

Mr. ROBERTS (for himself, Ms. CORTEZ MASTO, Mr. SCOTT of South Carolina, and Mr. CASEY) introduced the following bill; which was read twice 

and referred to the Committee on Finance 

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 for other purposes. 

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 ‘‘Ensuring Parity in 

5 MA for Audio-Only Telehealth Act of 2020’’. 


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•S 4840 IS

1 SEC. 2. REQUIRING THE INCLUSION OF CERTAIN AUDIO2 ONLY DIAGNOSES IN THE DETERMINATION 

3 OF RISK ADJUSTMENT FOR MEDICARE AD4 VANTAGE PLANS. 

5 Section 1853(a)(1) of the Social Security Act (42 

6 U.S.C. 1395w–23(a)(1)) is amended by adding at the end 

7 the following new subparagraph: 

8 ‘‘(J) INCLUSION OF CERTAIN AUDIO-ONLY

9 DIAGNOSES FOR PURPOSES OF RISK ADJUST10 MENT.— 

11 ‘‘(i) IN GENERAL.—For purposes of 

12 determining the appropriate adjustment 

13 for health status under subparagraph 

14 (C)(i) for plan years 2020 and 2021 (and 

15 for such other plan years determined ap16 propriate by the Secretary), the Secretary, 

17 in determining the diseases or conditions 

18 of an individual, shall take into account a 

19 qualified diagnosis (as defined in clause 

20 (ii)) made with respect to such individual 

21 by a qualified provider (as so defined) via 

22 telehealth regardless of whether such diag23 nosis so made included the use of video 

24 communications. 

25 ‘‘(ii) DEFINITIONS.—For purposes of 

26 this subparagraph: 


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1 ‘‘(I) QUALIFIED DIAGNOSIS.— 

2 The term ‘qualified diagnosis’ means 

3 a diagnosis made with respect to a 

4 chronic disease or condition of an in5 dividual during a plan year if such di6 agnosis was also made with respect to 

7 such individual in one of the last of 

8 the 3 plan years preceding such plan 

9 year. 

10 ‘‘(II) QUALIFIED PROVIDER.— 

11 The term ‘qualified provider’ means, 

12 with respect to a qualified diagnosis 

13 made with respect to an individual 

14 during a plan year, a provider of serv15 ices, clinician or supplier that— 

16 ‘‘(aa) furnished an item or 

17 service to such individual during 

18 the 3-year period ending on the 

19 date such diagnosis was so made; 

20 or 

21 ‘‘(bb) is in the same practice 

22 (as determined by tax identifica23 tion number) of a provider of 

24 services or supplier who fur25 nished such an item or service to 


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•S 4840 IS

1 such individual during such pe2 riod.’’. 

3 SEC. 3. REQUIRING PARITY IN TELEHEALTH PAYMENTS 

4 DURING THE COVID–19 EMERGENCY. 

5 Section 1834(m) of the Social Security Act (42 

6 U.S.C. 1395m(m)) is amended by adding at the end the 

7 following new paragraph: 

8 ‘‘(9) SPECIAL RULE FOR TELEHEALTH PAY9 MENT PARITY DURING THE COVID–19 EMER10 GENCY.—In the case of a telehealth service fur11 nished during the emergency period described in sec12 tion 1135(g)(1)(B) for which payment may be made 

13 under this subsection (including any service for 

14 which payment may be so made due to application 

15 of a waiver made under section 1135(b)), the 

16 amount of such payment shall be equal to the 

17 amount that would have been paid for such service 

18 had such service been furnished in-person.’’. 

Æ 


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