Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021

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 PACE programs, and for other purposes. 1. Short title This Act may be cited as the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 2. Requiring the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs (a) In general Section 1853(a)(1) of the Social Security Act ( 42 U.S.C. 1395w–23(a)(1) (J) Inclusion of certain audio-only diagnoses for purposes of risk adjustment (i) In general For purposes of determining the appropriate adjustment for health status under subparagraph (C)(i) for plan years 2020 and 2021 (and for such other plan years determined appropriate by the Secretary), the Secretary, in determining the diseases or conditions of an individual, shall take into account diagnoses obtained through a telehealth encounter, and in the case of a qualified diagnosis (as defined in clause (ii)) made with respect to such individual by a qualified provider (as so defined), shall not require the use of video communications with respect to such telehealth encounter. (ii) Definitions For purposes of this subparagraph: (I) Qualified diagnosis The term qualified diagnosis (II) Qualified provider The term qualified provider (aa) furnished an item or service to such individual during the 3-year period ending on the date such diagnosis was so made; or (bb) is in the same practice (as determined by tax identification number) of a provider of services or supplier who furnished such an item or service to such individual during such period. . (b) PACE program conforming amendment Section 1894(d)(2) of the Social Security Act ( 42 U.S.C. 1395eee(d)(2) For purposes of applying the adjustment under subparagraph (C)(i) of section 1853(a)(1) to such amounts, subparagraph (J) of such section shall be applied as if each reference to plan year plan years 2020 and 2021 year 2020 and 2021 3. Requiring parity in telehealth payments during the COVID–19 emergency Section 1834(m) of the Social Security Act ( 42 U.S.C. 1395m(m) (9) Special rule for telehealth payment parity during the COVID–19 emergency In the case of a telehealth service furnished during the emergency period described in section 1135(g)(1)(B) for which payment may be made under this subsection (including any service for which payment may be so made due to application of a waiver made under section 1135(b)), the amount of such payment shall be equal to the amount that would have been paid for such service had such service been furnished in-person. .

Summary: Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 This bill allows audio-only diagnoses that are made via telehealth to be used for purposes of determining risk adjustments to payments under Medicare Advantage. Additionally, the bill requires payments for Medicare telehealth services that are furnished during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019) to be made in the same amounts as those for in-person services.