Medicare Advantage COVID Treatment Act

To amend title XVIII of the Social Security Act to provide coverage for COVID–19 at no cost sharing under the medicare advantage program, and for other purposes. 1. Short title This Act may be cited as the Medicare Advantage COVID Treatment Act 2. Coverage of treatments for COVID–19 at no cost sharing under the medicare advantage program (a) In general Section 1852(a)(1)(B) of the Social Security Act ( 42 U.S.C. 1395w–22(a)(1)(B) (vii) Special coverage rules for specified COVID–19 treatment services (I) In general Notwithstanding clause (i), in the case of a specified COVID-19 treatment service that is furnished during a plan year occurring during any portion of the emergency period defined in section 1135(g)(1)(B) beginning on or after the date of the enactment of this clause, a Medicare Advantage plan may not, with respect to such service, impose— (aa) any cost-sharing requirement (including a deductible, copayment, or coinsurance requirement); and (bb) in the case such service is a critical specified COVID-19 treatment service (including ventilator services and intensive care unit services), any prior authorization or other utilization management requirement. A Medicare Advantage plan may not take the application of this clause into account for purposes of a bid amount submitted by such plan under section 1854(a)(6). (II) Specified COVID-19 treatment service defined For purposes of this clause, the term specified COVID-19 treatment service ICD–10–CM Official Coding Guidelines—Supplement Coding encounters related to COVID-19 Coronavirus Outbreak . (b) Reimbursement of medicare advantage plans for elimination of cost sharing Section 1853 of the Social Security Act ( 42 U.S.C. 1395w–23 (p) Additional payment to account for cost sharing elimination for COVID-19 treatment services (1) In general A Medicare Advantage plan shall notify the Secretary of the total dollar amount of cost sharing that, but for the application of section 1852(a)(1)(B)(vii), would have been required under such plan for specified COVID-19 treatment services (as defined in subclause (II) of such section) furnished during a plan year described in such section to individuals enrolled in the plan. The Secretary shall make periodic and timely payments in accordance with this subsection to such plan that, in the aggregate, equal such total dollar amount. (2) Timing of payment Payments by the Secretary under this subsection shall be made beginning March 1, 2021, for amounts described in such paragraph that would have been required under such plan for specified COVID-19 treatment services furnished during plan year 2020. Payments by the Secretary under this subsection for such amounts that would have been so required under such plan for such services furnished during a plan year subsequent to plan year 2020 shall be made beginning March 1 of the plan year following such subsequent plan year. (3) Non-application Section 1853(c)(7) shall not apply with respect to the application of this subsection. (4) Appropriation There are transferred to the Centers for Medicare & Medicaid Program Management Fund, out of any monies in the Treasury not otherwise obligated, such sums as may be necessary to the Secretary for purposes of making payments under this subsection. . (c) Implementation Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section by program instruction or otherwise.

Summary: Medicare Advantage COVID Treatment Act This bill requires Medicare Advantage (MA) plans to cover specified treatment services relating to COVID-19 (i.e., coronavirus disease 2019) without cost-sharing during the public health emergency declared on January 31, 2020. The CMS must reimburse MA plans for cost-sharing amounts that would otherwise have been received, in accordance with a specified timeline. MA plans are also prohibited from instituting prior authorization or other utilization management requirements with respect to coverage of specified critical treatment services (e.g., ventilator services and intensive care unit services).