No Cost for Monkeypox Testing Act of 2022

To ensure access to cost-free monkeypox testing services. 1. Short title This Act may be cited as the No Cost for Monkeypox Testing Act of 2022 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. 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 (1) in subsection (a)(1)— (A) by striking and (DD) (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 (12) (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 (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) (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) subclauses (IV) through (VIII) (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) (i) in subparagraph (A), by striking and (ii) in subparagraph (B), by striking the semicolon and inserting ; 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 (I) in subparagraph (H), by striking or (II) in subparagraph (I), by striking ; 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) (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) (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 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)), (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 the emergency period described in such section (II) by striking and testing and treatments testing and treatments (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 (or waiver of such plan) (2) CHIP (A) In general Section 2103(c) of the Social Security Act ( 42 U.S.C. 1397cc(c) (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) (i) in the header, by inserting monkeypox testing, covid–19 treatment (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 , 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 (2) Veterans The Secretary of Veterans Affairs may not require any copayment or other cost sharing under chapter 17 (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 chapter 89 (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 (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 (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 (C) Uninsured individual The term uninsured individual (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 (III) a health plan offered under chapter 89 (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).

Summary: 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.