I 
116TH CONGRESS 
2D SESSION 
H. R. 6906 
To provide reimbursements for certain costs of health care items and services, 
including prescription drugs, furnished during the public health emer-
gency declared with respect to COVID–19. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2020 
Ms. JAYAPAL (for herself, Ms. BASS, Ms. BONAMICI, Mr. DEFAZIO, Mrs. DIN-
GELL, Mr. ESPAILLAT, Mr. GARCI´A of Illinois, Mr. KENNEDY, Mr. 
KHANNA, Ms. MENG, Ms. NORTON, Ms. OCASIO-CORTEZ, Ms. OMAR, Mr. 
POCAN, Ms. PRESSLEY, Mr. RASKIN, Ms. TLAIB, Mr. COHEN, and Mr. 
BLUMENAUER) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Ways and Means, Veterans’ Affairs, Armed Services, Oversight and 
Reform, and Natural Resources, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To provide reimbursements for certain costs of health care 
items and services, including prescription drugs, fur-
nished during the public health emergency declared with 
respect to COVID–19. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Care Emer-
gency Guarantee Act’’. 
SEC. 
2. 
REIMBURSEMENTS 
FOR 
CERTAIN 
COSTS 
OF 
HEALTH CARE ITEMS AND SERVICES INCLUD-
ING PRESCRIPTION DRUGS FURNISHED DUR-
ING PUBLIC HEALTH EMERGENCY. 
(a) IN GENERAL.—During the period beginning on 
the date of enactment of this Act and ending on the date 
the Secretary certifies to Congress that a vaccine approved 
by the Food and Drug Administration for COVID–19 is 
widely available to the public, the Secretary shall make 
payments to qualified providers with respect to applicable 
health care items and services as defined in subsection (b) 
that are furnished to an applicable individual an amount 
equal to— 
(1) in the case of any portion of such period in 
which an applicable individual is enrolled in a public 
or private health insurance plan, the amount of any 
cost-sharing, including any deductibles, copayments, 
coinsurance or similar charges, that would otherwise 
be applicable under such plan, including with respect 
to prescription drug coverage under the plan; and 
(2) in the case of any portion of such period in 
which an applicable individual is uninsured, an 
amount equal to the amount that would be paid to 
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the qualified provider for the same or equivalent 
items or services, including with respect to any inpa-
tient or physician-administered drugs (and excluding 
outpatient prescription drugs or biologicals with re-
spect to which coverage is provided under subsection 
(e)), under the Medicare program under title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.). 
(b) APPLICABLE HEALTH CARE ITEMS AND SERV-
ICES; APPLICABLE INDIVIDUAL DEFINED.—In this sec-
tion: 
(1) APPLICABLE
HEALTH
CARE
ITEMS
AND 
SERVICES.—The term ‘‘applicable health care items 
and services’’ means, with respect to an applicable 
individual, any health care items and services that 
are medically necessary or appropriate for the main-
tenance of health or for the diagnosis, treatment, or 
rehabilitation of a health condition of the applicable 
individual, including— 
(A) any testing services and treatments for 
COVID–19 or related complications, including 
vaccines, diagnostic tests, drugs and biologicals, 
and therapies; and 
(B) in the case of an applicable individual 
who is enrolled in a public or private health in-
surance plan, any health care items and serv-
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ices covered by such plan as of March 1, 2020, 
or in the case of an applicable individual who 
enrolls in such plan after the date, any health 
care items and services covered by such plan as 
of the date of such enrollment. 
(2) APPLICABLE INDIVIDUAL.—The term ‘‘ap-
plicable individual’’ means an individual who is a 
resident of the United States. 
(c) REQUIREMENTS.— 
(1) NO EFFECT ON APPLICABLE COST-SHARING 
REQUIREMENTS.—Nothing in this section shall af-
fect the application of any requirements applicable 
under Federal or State law with respect to coverage 
of health care items and services without any cost- 
sharing. 
(2) MAINTENANCE OF EFFORT.— 
(A) IN GENERAL.—During the period de-
scribed in subsection (a), a public or private 
health plan shall not increase cost-sharing, de-
crease benefits, or otherwise make coverage less 
generous than the benefits offered on the date 
of enactment of this Act. 
(B) NEW ITEMS AND SERVICES.—During 
such period, a public or private health plan 
shall provide coverage of new items and serv-
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ices, including those related to COVID–19, as 
appropriate, at a minimum, at a level consistent 
with 
the 
prior 
coverage 
practices 
and 
formularies of the plan. 
(3) 
LIMITATION
ON
OUT-OF-POCKET
EX-
PENSES.—During such period, in order to be eligible 
to receive payments under this section, a qualified 
provider shall agree not to impose on an applicable 
individual any charge for applicable health care 
items and services furnished to the applicable indi-
vidual. 
(4) PERMISSIBLE BILLING OF PLANS; LIMITA-
TION ON BALANCE BILLING.—During such period, in 
order to be eligible to receive payments under this 
section, a qualified provider shall agree, with respect 
to applicable health care items and services fur-
nished to an applicable individual when such indi-
vidual is enrolled in a public or private health insur-
ance plan— 
(A) not to impose any charge on the plan 
for such items and services beyond the amount 
otherwise payable by the plan; and 
(B) not to bill the applicable individual for 
any amounts in excess of the amount described 
in subparagraph (A). 
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(5) MEDICAL DEBT COLLECTION.—A qualified 
provider shall agree— 
(A) to immediately halt all medical debt 
collection, including collection activities carried 
out by third parties, during such period and 
shall not collect medical debt or have third par-
ties collect medical debt for applicable health 
care items and services furnished during such 
period; and 
(B) to refrain from pursuing medical debt 
collection, including collection activities carried 
out by third parties, after such period with re-
spect to items and services related to the diag-
nosis or treatment of COVID–19 (regardless of 
whether such services were furnished before, 
during, or after such period) and shall not col-
lect medical debt or have third parties collect 
medical debt for such items or services after 
such period. 
(6) SUBMISSION OF BILLS AND DOCUMENTA-
TION.—A qualified provider shall agree to submit 
bills and any required supporting documentation re-
lating to the provision of applicable health care 
items and services within 30 days after the date of 
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providing such services, in such manner as the Sec-
retary determines appropriate. 
(d) WAIVER
OF LATE ENROLLMENT PENALTIES 
UNDER MEDICARE.—During the period described in sub-
section (a), no increase in the monthly premium of an indi-
vidual pursuant to section 1818(c), 1839(b), or 1860D– 
13 of the Social Security Act (42 U.S.C. 1395i–2(c), 
1395r(b), 1395w–113) shall be effected in the case of any 
individual who enrolls for benefits under title XVIII of 
such Act with respect to any period prior to the date of 
such enrollment. 
(e) COVERAGE WITH RESPECT TO OUTPATIENT PRE-
SCRIPTION DRUGS.— 
(1) IN GENERAL.—During the period described 
in subsection (a), with respect to outpatient pre-
scription drugs or biologicals described in subsection 
(b)(1)(A) that are dispensed to uninsured individ-
uals, the Secretary shall establish procedures under 
which— 
(A) such drugs or biologicals are dispensed 
at no cost to such individuals; 
(B) pharmacies that dispense such drugs 
or biologicals— 
(i) are reimbursed by the Secretary 
for such drugs or biologicals dispensed to 
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such individuals at an amount equal to the 
price paid by the Secretary of Veterans Af-
fairs to procure the drug or biological 
under the laws administered by the Sec-
retary of Veterans Affairs; and 
(ii) agree not to charge such individ-
uals for any difference between the amount 
reimbursed under clause (i) and the cost to 
the pharmacy for the drug; and 
(C) manufacturers of such drugs or 
biologicals reimburse pharmacies for any dif-
ference described in subparagraph (B)(ii) with 
respect to drugs or biologicals of the manufac-
turer that are dispensed to such individuals. 
(2) CONDITION
OF
COVERAGE
UNDER
MEDI-
CARE.—During the period described in subsection 
(a), no coverage may be provided under part B or 
D of title XVIII of the Social Security Act (42 
U.S.C. 1395j et seq., 1395w–101 et seq.) with re-
spect to a drug or biological of a manufacturer if the 
manufacturer does not enter into an agreement with 
the Secretary to carry out the requirements applica-
ble with respect to such manufacturers under this 
subsection. 
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(3) REQUIREMENT FOR PARTICIPATING PHAR-
MACIES.—During the period described in subsection 
(a), a prescription drug plan under part D of title 
XVIII of the Social Security Act (42 U.S.C. 1395w– 
101 et seq.) may not contract with a pharmacy if 
the pharmacy does not enter into an agreement with 
the Secretary to carry out the requirements applica-
ble with respect to pharmacies under this subsection. 
(f) OTHER DEFINITIONS.— 
(1) PUBLIC OR PRIVATE HEALTH INSURANCE 
PLAN.— 
(A) IN
GENERAL.—The term ‘‘public or 
private health insurance plan’’ means any of 
the following: 
(i) A group health plan, or group 
health insurance coverage, as such terms 
are defined in section 2791 of the Public 
Health Service Act (42 U.S.C. 300gg–91). 
(ii) A qualified health plan, as defined 
in section 1301 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 
18021). 
(iii) Subject to subparagraph (B), any 
health insurance coverage (other than a 
plan described in clause (ii)) offered in the 
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individual market, as such terms are de-
fined in section 2791 of the Public Health 
Service Act, including any short-term lim-
ited duration insurance. 
(iv) A health plan offered under chap-
ter 89 of title 5, United States Code. 
(v) A Federal health care program (as 
defined under section 1128B(f) of the So-
cial Security Act (42 U.S.C. 1320a–7b(f)), 
including— 
(I) 
health 
benefits 
furnished 
under the TRICARE program (as de-
fined in section 1072 of title 10, 
United States Code); 
(II) health benefits furnished to 
veterans under the laws administered 
by the Secretary of Veterans Affairs; 
and 
(III) health benefits furnished to 
Indians (as defined in section 4 of the 
Indian Health Care Improvement Act 
(25 U.S.C. 1603)) receiving health 
services through the Indian Health 
Service, including through an Urban 
Indian Organization, regardless of 
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whether such benefits are for items or 
services that have been authorized 
under the purchased/referred care sys-
tem funded by the Indian Health 
Service or are covered as a health 
service of the Indian Health Service. 
(B) LIMITATION ON INDIVIDUAL HEALTH 
INSURANCE COVERAGE.—The term ‘‘public or 
private health insurance coverage’’ includes the 
health insurance coverage described in clause 
(iii) of subparagraph (A) only with respect to 
an individual who is enrolled in such coverage 
on March 1, 2020. 
(2) QUALIFIED PROVIDER.—The term ‘‘quali-
fied provider’’ means a health care provider who is 
a participating provider under the Medicare program 
under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). Such term includes a health 
care provider who is not a participating provider 
under such program if the health care provider 
would meet the criteria for such participation and, 
if the State requires the health care provider to be 
licensed by the State, is licensed by the State in 
which the items or services are furnished. 
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(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(g) IMPLEMENTATION.— 
(1) IN GENERAL.—The Secretary, in coordina-
tion with the Secretary of the Treasury, the Com-
missioner of Social Security, and the Secretary of 
Labor, shall implement the provisions of this section 
not later than the date that is 7 days after the date 
of the enactment of this Act. 
(2) ENSURING
TIMELY
PAYMENT.—The Sec-
retary shall establish a process and issue such guid-
ance as is necessary to ensure a qualified provider 
receives payments under this section in a timely 
manner. 
(3) ENSURING COLLECTION OF DATA ON DIS-
PARITIES.—The Secretary shall implement this sec-
tion in a manner and issue such guidance as is nec-
essary to allow for the ongoing, accurate, and timely 
collection and analysis of data on disparities in ac-
cordance with subsection (h). 
(h) COLLECTION OF DATA ON DISPARITIES.— 
(1) IN GENERAL.—During the period described 
in subsection (a), the Secretary shall collect data on 
disparities across race, ethnicity, primary language, 
gender, sexual orientation, disability status, age, ge-
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ographic area, insurance status, and socioeconomic 
status— 
(A) in health outcomes and access to heath 
care related to the COVID–19 outbreak, includ-
ing data on COVID–19 cases, treatment, and 
deaths; and 
(B) in patient access to applicable health 
care items and services under this section. 
(2) 
PUBLIC
AVAILABILITY.—The 
Secretary 
shall— 
(A) make data collected under this sub-
section publicly available on the internet website 
of the Department of Health and Human Serv-
ices as soon as is practicable, but not later than 
30 days after the date of enactment of this Act, 
in a manner that allows researchers, scholars, 
health care providers, and others to access and 
analyze such data, without compromising pa-
tient privacy; and 
(B) update such data on a weekly basis 
thereafter for the duration of the period de-
scribed in subsection (a). 
(i) WEEKLY REPORTS TO CONGRESS.— 
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(1) IN GENERAL.—On a weekly basis during 
the period described in subsection (a), the Secretary 
shall report to Congress on— 
(A) the implementation of this section, in-
cluding information on the amount, type, and 
geographic distribution of payments to qualified 
providers under this section; and 
(B) any disparities in health and access to 
health care related to the COVID–19 outbreak 
or patient access to applicable health care items 
and services under this section, as identified 
through the collection and analysis of data col-
lected under subsection (h). 
(2) 
PUBLIC
AVAILABILITY.—The 
Secretary 
shall make each report submitted under paragraph 
(1) publicly available on the internet website of the 
Department of Health and Human Services. 
(j) FUNDING.—There are authorized to be appro-
priated such sums as are necessary to carry out this sec-
tion. 
Æ 
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