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‘‘(3) 
an 
individual 
described 
in 
section 
402(b)(2)(G), but only with respect to the des-
ignated 
Federal 
program 
defined 
in 
section 
402(b)(3)(C).’’. 
(c) DEFINITION
OF QUALIFIED ALIEN.—Section 
431(b) of such Act (8 U.S.C. 1641(b)) is amended— 
(1) in paragraph (6), by striking ‘‘; or’’ at the 
end and inserting a comma; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘, or’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(8) an individual who lawfully resides in the 
United States in accordance with a Compact of Free 
Association referred to in section 402(b)(2)(G), but 
only with respect to the designated Federal program 
defined in section 402(b)(3)(C) (relating to the Med-
icaid program).’’. 
(d) 
APPLICATION
TO
STATE
PLANS.—Section 
1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(i)) is amended by inserting after sub-
clause (IX) the following: 
‘‘(X) who are described in section 
402(b)(2)(G) of the Personal Respon-
sibility and Work Opportunity Rec-
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onciliation Act of 1996 and eligible 
for benefits under this title by reason 
of application of such section;’’. 
(e) CONFORMING AMENDMENTS.—Section 1108 of 
the Social Security Act (42 U.S.C. 1308) is amended— 
(1) in subsection (f), in the matter preceding 
paragraph (1), by striking ‘‘subsections (g) and (h) 
and section 1935(e)(1)(B)’’ and inserting ‘‘sub-
sections (g), (h), and (i) and section 1935(e)(1)(B)’’; 
and 
(2) by adding at the end the following: 
‘‘(i) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI-
TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 
Expenditures for medical assistance provided to an indi-
vidual described in section 431(b)(8) of the Personal Re-
sponsibility and Work Opportunity Reconciliation Act of 
1996 (8 U.S.C. 1641(b)(8)) shall not be taken into ac-
count for purposes of applying payment limits under sub-
sections (f) and (g).’’. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply to benefits for items and services 
furnished on or after the date of the enactment of this 
Act. 
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SEC. 30108. TEMPORARY INCREASE IN MEDICAID DSH AL-
LOTMENTS. 
(a) IN GENERAL.—Section 1923(f)(3) of the Social 
Security Act (42 U.S.C. 1396r–4(f)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘and sub-
paragraph (E)’’ and inserting ‘‘and subparagraphs 
(E) and (F)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) TEMPORARY
INCREASE
IN
ALLOT-
MENTS
DURING
CERTAIN
PUBLIC
HEALTH 
EMERGENCY.—The DSH allotment for any 
State for each of fiscal years 2020 and 2021 is 
equal to 102.5 percent of the DSH allotment 
that would be determined under this paragraph 
for the State for each respective fiscal year 
without application of this subparagraph, not-
withstanding subparagraphs (B) and (C). For 
each fiscal year after fiscal year 2021, the DSH 
allotment for a State for such fiscal year is 
equal to the DSH allotment that would have 
been determined under this paragraph for such 
fiscal year if this subparagraph had not been 
enacted.’’. 
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(b) DSH ALLOTMENT
ADJUSTMENT
FOR
TEN-
NESSEE.—Section 1923(f)(6)(A)(vi) of the Social Security 
Act (42 U.S.C. 1396r–4(f)(6)(A)(vi)) is amended— 
(1) by striking ‘‘Notwithstanding any other pro-
vision of this subsection’’ and inserting the fol-
lowing: 
‘‘(I) 
IN
GENERAL.—Notwith-
standing any other provision of this 
subsection (except as provided in sub-
clause (II) of this clause)’’; and 
(2) by adding at the end the following: 
‘‘(II) TEMPORARY
INCREASE
IN 
ALLOTMENTS.—The DSH allotment 
for Tennessee for each of fiscal years 
2020 and 2021 shall be equal to 
$54,427,500.’’. 
(c) SENSE OF CONGRESS.—It is the sense of Con-
gress that a State should prioritize making payments 
under the State plan of the State under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver 
of such plan) to disproportionate share hospitals that have 
a higher share of COVID–19 patients relative to other 
such hospitals in the State. 
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SEC. 30109. EXTENSION OF EXISTING SECTION 1115 DEM-
ONSTRATIONS. 
(a) APPLICABILITY.—This section shall apply with 
respect to demonstrations operated by States pursuant to 
section 1115(a) of the Social Security Act (42 U.S.C. 
1315(a)) to promote the objectives of title XIX or XXI 
of the Social Security Act with a project term set to end 
on or before February 28, 2021. 
(b) APPROVAL OF EXTENSION.—Upon request by a 
State, the Secretary of Health and Human Services shall 
approve an extension of the demonstration project de-
scribed in subsection (a) for a period up to and including 
December 31, 2021, to ensure continuity of programs and 
funding during the emergency period described in section 
1135(g)(1)(B) of the Social Security Act (42 U.S.C. 
1320b–5(g)(1)(B)). 
(c) EXTENSION TERMS AND CONDITIONS.—(1) The 
approval pursuant to this section shall extend the terms 
and conditions that applied to the demonstration project 
to the extension period. Financial terms and conditions 
shall continue at levels equivalent to the prior demonstra-
tion or program year. All demonstration program compo-
nents shall be extended to operate through the end of the 
extension term. In its request for an extension, the State 
shall identify operational and programmatic changes nec-
essary to continue and stabilize programs into the exten-
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sion period and shall work with the Secretary of Health 
and Human Services to implement such changes. 
(2) Notwithstanding the foregoing, the State may re-
quest, and the Secretary of Health and Human Services 
may approve, modifications to a demonstration project’s 
terms and conditions to address the impact of the federally 
designated public health emergency with respect to 
COVID–19. Such modifications may, at the option of the 
State, become effective retroactive to the start of the cal-
endar quarter in which the first day of the emergency pe-
riod described in paragraph (1)(B) of section 1135(g) of 
the Social Security Act (42 U.S.C. 1320b–5(g)) occurs. 
(d) BUDGET NEUTRALITY.—Budget neutrality for 
extensions under this section shall be deemed to have been 
met at the conclusion of the extension period, and States 
receiving extensions under this section shall not be re-
quired to submit a budget neutrality analysis for the ex-
tension period. 
(e) EXPEDITED APPLICATION PROCESS.—The Fed-
eral and State public notice and comment procedures or 
other time constraints otherwise applicable to demonstra-
tion project amendments shall be waived to expedite a 
State’s extension request pursuant to this section. The 
Secretary of Health and Human Services shall approve the 
extension application within 45 days of a State’s submis-
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sion of its request, or such other timeframe as is mutually 
agreed to with the State. 
(f) CONTINUATION
OF SECRETARIAL AUTHORITY 
UNDER DECLARED EMERGENCY.—This section does not 
restrict the Secretary of Health and Human Services from 
exercising existing flexibilities through demonstration 
projects operated pursuant to section 1115 of the Social 
Security Act (42 U.S.C. 1315) in conjunction with the 
COVID–19 public health emergency. 
(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall authorize the Secretary of Health and Human 
Service to approve or extend a waiver that fails to meet 
the requirements of section 1115 of the Social Security 
Act (42 U.S.C. 1315). 
SEC. 30110. ALLOWING FOR MEDICAL ASSISTANCE UNDER 
MEDICAID FOR INMATES DURING 30-DAY PE-
RIOD PRECEDING RELEASE. 
(a) IN GENERAL.—The subdivision (A) following 
paragraph (30) of section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)) is amended by inserting ‘‘and 
except during the 30-day period preceding the date of re-
lease of such individual from such public institution’’ after 
‘‘medical institution’’. 
(b) REPORT.—Not later than June 30, 2022, the 
Medicaid and CHIP Payment and Access Commission 
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shall submit a report to Congress on the Medicaid inmate 
exclusion under the subdivision (A) following paragraph 
(30) of section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)). Such report may, to the extent prac-
ticable, include the following information: 
(1) The number of incarcerated individuals who 
would otherwise be eligible to enroll for medical as-
sistance under a State plan approved under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) (or a waiver of such a plan). 
(2) Access to health care for incarcerated indi-
viduals, including a description of medical services 
generally available to incarcerated individuals. 
(3) A description of current practices related to 
the discharge of incarcerated individuals, including 
how prisons interact with State Medicaid agencies to 
ensure that such individuals who are eligible to en-
roll for medical assistance under a State plan or 
waiver described in paragraph (1) are so enrolled. 
(4) If determined appropriate by the Commis-
sion, recommendations for Congress, the Depart-
ment of Health and Human Services, or States re-
garding the Medicaid inmate exclusion. 
(5) Any other information that the Commission 
determines would be useful to Congress. 
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SEC. 30111. MEDICAID COVERAGE OF CERTAIN MEDICAL 
TRANSPORTATION. 
(a) CONTINUING REQUIREMENT OF MEDICAID COV-
ERAGE OF NECESSARY TRANSPORTATION.— 
(1) REQUIREMENT.—Section 1902(a)(4) of the 
Social Security Act (42 U.S.C. 1396a(a)(4)) is 
amended— 
(A) by striking ‘‘and including provision 
for utilization’’ and inserting ‘‘including provi-
sion for utilization’’; and 
(B) by inserting after ‘‘supervision of ad-
ministration of the plan’’ the following: ‘‘, and, 
subject to section 1903(i), including a specifica-
tion that the single State agency described in 
paragraph (5) will ensure necessary transpor-
tation for beneficiaries under the State plan to 
and from providers and a description of the 
methods that such agency will use to ensure 
such transportation’’. 
(2) APPLICATION WITH RESPECT TO BENCH-
MARK BENEFIT PACKAGES AND BENCHMARK EQUIV-
ALENT COVERAGE.—Section 1937(a)(1) of the Social 
Security Act (42 U.S.C. 1396u–7(a)(1)) is amend-
ed— 
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(A) in subparagraph (A), by striking ‘‘sub-
section (E)’’ and inserting ‘‘subparagraphs (E) 
and (F)’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) NECESSARY TRANSPORTATION.—The 
State may only exercise the option under sub-
paragraph 
(A)(i) 
if, 
subject 
to 
section 
1903(i)(9) and in accordance with section 
1902(a)(4), the benchmark benefit package or 
benchmark equivalent coverage described in 
such subparagraph (or the State)— 
‘‘(i) ensures necessary transportation 
for individuals enrolled under such package 
or coverage to and from providers; and 
‘‘(ii) provides a description of the 
methods that will be used to ensure such 
transportation.’’. 
(3) LIMITATION ON FEDERAL FINANCIAL PAR-
TICIPATION.—Section 1903(i) of the Social Security 
Act (42 U.S.C. 1396b(i)) is amended by inserting 
after paragraph (8) the following new paragraph: 
‘‘(9) with respect to any amount expended 
for non-emergency transportation described in 
section 1902(a)(4), unless the State plan pro-
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vides for the methods and procedures required 
under section 1902(a)(30)(A); or’’. 
(4) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on the date of the 
enactment of this Act and shall apply to transpor-
tation furnished on or after such date. 
(b) MEDICAID PROGRAM INTEGRITY MEASURES RE-
LATED
TO COVERAGE
OF NONEMERGENCY MEDICAL 
TRANSPORTATION.— 
(1) GAO STUDY.—Not later than two years 
after the date of the enactment of this Act, the 
Comptroller General of the United States shall con-
duct a study, and submit to Congress, a report on 
coverage under the Medicaid program under title 
XIX of the Social Security Act of nonemergency 
transportation to medically necessary services. Such 
study shall take into account the 2009 report of the 
Office of the Inspector General of the Department of 
Health and Human Services, titled ‘‘Fraud and 
Abuse Safeguards for Medicaid Nonemergency Med-
ical Transportation’’ (OEI–06–07–003200). Such 
report shall include the following: 
(A) An examination of the 50 States and 
the District of Columbia to identify safeguards 
to prevent and detect fraud and abuse with re-
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spect to coverage under the Medicaid program 
of nonemergency transportation to medically 
necessary services. 
(B) An examination of transportation bro-
kers to identify the range of safeguards against 
such fraud and abuse to prevent improper pay-
ments for such transportation. 
(C) Identification of the numbers, types, 
and outcomes of instances of fraud and abuse, 
with respect to coverage under the Medicaid 
program of such transportation, that State 
Medicaid Fraud Control Units have investigated 
in recent years. 
(D) Identification of commonalities or 
trends in program integrity, with respect to 
such coverage, to inform risk management 
strategies of States and the Centers for Medi-
care & Medicaid Services. 
(2) STAKEHOLDER WORKING GROUP.— 
(A) IN GENERAL.—Not later than one year 
after the date of the enactment of this Act, the 
Secretary of Health and Human Services, 
through the Centers of Medicare & Medicaid 
Services, shall convene a series of meetings to 
obtain input from appropriate stakeholders to 
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facilitate discussion and shared learning about 
the leading practices for improving Medicaid 
program integrity, with respect to coverage of 
nonemergency transportation to medically nec-
essary services. 
(B) 
TOPICS.—The 
meetings 
convened 
under subparagraph (A) shall— 
(i) focus on ongoing challenges to 
Medicaid program integrity as well as lead-
ing practices to address such challenges; 
and 
(ii) address specific challenges raised 
by stakeholders involved in coverage under 
the Medicaid program of nonemergency 
transportation to medically necessary serv-
ices, including unique considerations for 
specific groups of Medicaid beneficiaries 
meriting particular attention, such as 
American Indians and tribal land issues or 
accommodations for individuals with dis-
abilities. 
(C) 
STAKEHOLDERS.—Stakeholders 
de-
scribed in subparagraph (A) shall include indi-
viduals from State Medicaid programs, brokers 
for nonemergency transportation to medically 
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necessary services that meet the criteria de-
scribed in section 1902(a)(70)(B) of the Social 
Security Act (42 U.S.C. 1396a(a)(70)(B)), pro-
viders (including transportation network compa-
nies), Medicaid patient advocates, and such 
other individuals specified by the Secretary. 
(3) GUIDANCE
REVIEW.—Not later than 18 
months after the date of the enactment of this Act, 
the Secretary of Health and Human Services, 
through the Centers for Medicare & Medicaid Serv-
ices, shall assess guidance issued to States by the 
Centers for Medicare & Medicaid Services relating to 
Federal requirements for nonemergency transpor-
tation to medically necessary services under the 
Medicaid program under title XIX of the Social Se-
curity Act and update such guidance as necessary to 
ensure States have appropriate and current guidance 
in designing and administering coverage under the 
Medicaid program of nonemergency transportation 
to medically necessary services. 
(4) NEMT TRANSPORTATION
PROVIDER
AND 
DRIVER REQUIREMENTS.— 
(A) STATE PLAN REQUIREMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended— 
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(i) by striking ‘‘and’’ at the end of 
paragraph (85); 
(ii) by striking the period at the end 
of paragraph (86) and inserting ‘‘; and’’; 
and 
(iii) by inserting after paragraph (86) 
the following new paragraph: 
‘‘(87) provide for a mechanism, which may in-
clude attestation, that ensures that, with respect to 
any provider (including a transportation network 
company) or individual driver of nonemergency 
transportation to medically necessary services receiv-
ing payments under such plan (but excluding any 
public transit authority), at a minimum— 
‘‘(A) each such provider and individual 
driver is not excluded from participation in any 
Federal health care program (as defined in sec-
tion 1128B(f)) and is not listed on the exclu-
sion list of the Inspector General of the Depart-
ment of Health and Human Services; 
‘‘(B) each such individual driver has a 
valid driver’s license; 
‘‘(C) each such provider has in place a 
process to address any violation of a State drug 
law; and 
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‘‘(D) each such provider has in place a 
process to disclose to the State Medicaid pro-
gram the driving history, including any traffic 
violations, of each such individual driver em-
ployed by such provider, including any traffic 
violations.’’. 
(B) EFFECTIVE DATE.— 
(i) IN GENERAL.—Except as provided 
in clause (ii), the amendments made by 
subparagraph (A) shall take effect on the 
date of the enactment of this Act and shall 
apply to services furnished on or after the 
date that is one year after the date of the 
enactment of this Act. 
(ii) EXCEPTION
IF
STATE
LEGISLA-
TION REQUIRED.—In the case of a State 
plan for medical assistance under title XIX 
of the Social Security Act which the Sec-
retary of Health and Human Services de-
termines requires State legislation (other 
than legislation appropriating funds) in 
order for the plan to meet the additional 
requirement imposed by the amendments 
made by subparagraph (A), the State plan 
shall not be regarded as failing to comply 
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with the requirements of such title solely 
on the basis of its failure to meet this ad-
ditional requirement before the first day of 
the first calendar quarter beginning after 
the close of the first regular session of the 
State legislature that begins after the date 
of the enactment of this Act. For purposes 
of the previous sentence, in the case of a 
State that has a 2-year legislative session, 
each year of such session shall be deemed 
to be a separate regular session of the 
State legislature. 
(5) ANALYSIS
OF
T–MSIS
DATA.—Not later 
than one year after the date of the enactment of this 
Act, the Secretary of Health and Human Services, 
through the Centers for Medicare & Medicaid Serv-
ices, shall analyze, and submit to Congress a report 
on, the nation-wide data set under the Transformed 
Medicaid Statistical Information System to identify 
recommendations relating to coverage under the 
Medicaid program under title XIX of the Social Se-
curity Act of nonemergency transportation to medi-
cally necessary services. 
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TITLE II—MEDICARE 
PROVISIONS 
SEC. 30201. HOLDING MEDICARE BENEFICIARIES HARM-
LESS FOR SPECIFIED COVID–19 TREATMENT 
SERVICES FURNISHED UNDER PART A OR 
PART B OF THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, in the case of a specified COVID–19 treat-
ment service (as defined in subsection (b)) furnished dur-
ing any portion of the emergency period described in para-
graph (1)(B) of section 1135(g) of the Social Security Act 
(42 U.S.C. 1320b-5(g)) beginning on or after the date of 
the enactment of this Act to an individual entitled to bene-
fits under part A or enrolled under part B of title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.) for 
which payment is made under such part A or such part 
B, the Secretary of Health and Human Services (in this 
section referred to as the ‘‘Secretary’’) shall provide 
that— 
(1) any cost-sharing required (including any de-
ductible, copayment, or coinsurance) applicable to 
such individual under such part A or such part B 
with respect to such item or service is paid by the 
Secretary; and 
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(2) the provider of services or supplier (as de-
fined in section 1861 of the Social Security Act (42 
U.S.C. 1395x)) does not hold such individual liable 
for such requirement. 
(b) DEFINITION OF SPECIFIED COVID–19 TREAT-
MENT SERVICES.—For purposes of this section, the term 
‘‘specified COVID–19 treatment service’’ means any item 
or service furnished to an individual for which payment 
may be made under part A or part B of title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.) if such 
item or service is included in a claim with an ICD–10– 
CM code relating to COVID–19 (as described in the docu-
ment entitled ‘‘ICD–10–CM Official Coding Guidelines - 
Supplement Coding encounters related to COVID–19 
Coronavirus Outbreak’’ published on February 20, 2020, 
or as otherwise specified by the Secretary). 
(c) RECOVERY OF COST-SHARING AMOUNTS PAID BY 
THE SECRETARY IN THE CASE OF SUPPLEMENTAL IN-
SURANCE COVERAGE.— 
(1) IN GENERAL.—In the case of any amount 
paid by the Secretary pursuant to subsection (a)(1) 
that the Secretary determines would otherwise have 
been paid by a group health plan or health insurance 
issuer (as such terms are defined in section 2791 of 
the Public Health Service Act (42 U.S.C. 300gg– 
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91)), a private entity offering a medicare supple-
mental policy under section 1882 of the Social Secu-
rity Act (42 U.S.C. 1395ss), any other health plan 
offering supplemental coverage, a State plan under 
title XIX of the Social Security Act, or the Secretary 
of Defense under the TRICARE program, such 
plan, issuer, private entity, other health plan, State 
plan, or Secretary of Defense, as applicable, shall 
pay to the Secretary, not later than 1 year after 
such plan, issuer, private entity, other health plan, 
State plan, or Secretary of Defense receives a notice 
under paragraph (3), such amount in accordance 
with this subsection. 
(2) REQUIRED INFORMATION.—Not later than 
9 months after the date of the enactment of this 
Act, each group health plan, health insurance issuer, 
private entity, other health plan, State plan, and 
Secretary of Defense described in paragraph (1) 
shall submit to the Secretary such information as 
the Secretary determines necessary for purposes of 
carrying out this subsection. Such information so 
submitted shall be updated by such plan, issuer, pri-
vate entity, other health plan, State plan, or Sec-
retary of Defense, as applicable, at such time and in 
such manner as specified by the Secretary. 
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(3) REVIEW OF CLAIMS AND NOTIFICATION.— 
The Secretary shall establish a process under which 
claims for items and services for which the Secretary 
has paid an amount pursuant to subsection (a)(1) 
are reviewed for purposes of identifying if such 
amount would otherwise have been paid by a plan, 
issuer, private entity, other health plan, State plan, 
or Secretary of Defense described in paragraph (1). 
In the case such a claim is so identified, the Sec-
retary shall determine the amount that would have 
been otherwise payable by such plan, issuer, private 
entity, other health plan, State plan, or Secretary of 
Defense and notify such plan, issuer, private entity, 
other health plan, State plan, or Secretary of De-
fense of such amount. 
(4) ENFORCEMENT.—The Secretary may im-
pose a civil monetary penalty in an amount deter-
mined appropriate by the Secretary in the case of a 
plan, issuer, private entity, other health plan, or 
State plan that fails to comply with a provision of 
this section. The provisions of section 1128A of the 
Social Security Act shall apply to a civil monetary 
penalty imposed under the previous sentence in the 
same manner as such provisions apply to a penalty 
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or proceeding under subsection (a) or (b) of such 
section. 
(d) FUNDING.—The Secretary shall provide for the 
transfer to the Centers for Medicare & Medicaid Program 
Management Account from the Federal Hospital Insur-
ance Trust Fund and the Federal Supplementary Trust 
Fund (in such portions as the Secretary determines appro-
priate) $100,000,000 for purposes of carrying out this 
section. 
(e) REPORT.—Not later than 3 years after the date 
of the enactment of this Act, the Inspector General of the 
Department of Health and Human Services shall submit 
to Congress a report containing an analysis of amounts 
paid pursuant to subsection (a)(1) compared to amounts 
paid to the Secretary pursuant to subsection (c). 
(f) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement the provi-
sions of this section by program instruction or otherwise. 
SEC. 30202. ENSURING COMMUNICATIONS ACCESSIBILITY 
FOR RESIDENTS OF SKILLED NURSING FA-
CILITIES DURING THE COVID–19 EMERGENCY 
PERIOD. 
(a) IN GENERAL.—Section 1819(c)(3) of the Social 
Security Act (42 U.S.C. 1395i–3(c)(3)) is amended— 
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(1) in subparagraph (D), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (E), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(F) provide for reasonable access to the 
use of a telephone, including TTY and TDD 
services (as defined for purposes of section 
483.10 of title 42, Code of Federal Regulations 
(or a successor regulation)), and the internet 
(to the extent available to the facility) and in-
form each such resident (or a representative of 
such resident) of such access and any changes 
in policies or procedures of such facility relating 
to limitations on external visitors.’’. 
(b) COVID–19 PROVISIONS.— 
(1) GUIDANCE.—Not later than 15 days after 
the date of the enactment of this Act, the Secretary 
of Health and Human Service shall issue guidance 
on steps skilled nursing facilities may take to ensure 
residents have access to televisitation during the 
emergency period defined in section 1135(g)(1)(B) 
of the Social Security Act (42 U.S.C. 1320b– 
5(g)(1)(B)). Such guidance shall include information 
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on how such facilities will notify residents of such 
facilities, representatives of such residents, and rel-
atives of such residents of the rights of such resi-
dents to such televisitation, and ensure timely and 
equitable access to such televisitation. 
(2) REVIEW OF FACILITIES.—The Secretary of 
Health and Human Services shall take such steps as 
determined appropriate by the Secretary to ensure 
that residents of skilled nursing facilities and rel-
atives of such residents are made aware of the ac-
cess rights described in section 1819(c)(3)(F) of the 
Social Security Act (42 U.S.C. 1395i–3(c)(3)(F)). 
SEC. 30203. MEDICARE HOSPITAL INPATIENT PROSPECTIVE 
PAYMENT SYSTEM OUTLIER PAYMENTS FOR 
COVID–19 PATIENTS DURING CERTAIN EMER-
GENCY PERIOD. 
(a) IN GENERAL.—Section 1886(d)(5)(A) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(A)) is amend-
ed— 
(1) in clause (ii), by striking ‘‘For cases’’ and 
inserting ‘‘Subject to clause (vii), for cases’’; 
(2) in clause (iii), by striking ‘‘The amount’’ 
and inserting ‘‘Subject to clause (vii), the amount’’; 
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(3) in clause (iv), by striking ‘‘The total 
amount’’ and inserting ‘‘Subject to clause (vii), the 
total amount’’; and 
(4) by adding at the end the following new 
clause: 
‘‘(vii) For discharges that have a primary or sec-
ondary diagnosis of COVID–19 and that occur during the 
period beginning on the date of the enactment of this 
clause and ending on the sooner of January 31, 2021, or 
the last day of the emergency period described in section 
1135(g)(1)(B), the amount of any additional payment 
under clause (ii) for a subsection (d) hospital for such a 
discharge shall be determined as if— 
‘‘(I) clause (ii) was amended by striking ‘plus 
a fixed dollar amount determined by the Secretary’; 
‘‘(II) the reference in clause (iii) to ‘approxi-
mate the marginal cost of care beyond the cutoff 
point applicable under clause (i) or (ii)’ were a ref-
erence to ‘approximate the marginal cost of care be-
yond the cutoff point applicable under clause (i), or, 
in the case of an additional payment requested 
under clause (ii), be equal to 100 percent of the 
amount by which the costs of the discharge for 
which such additional payment is so requested ex-
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ceed the applicable DRG prospective payment rate’; 
and 
‘‘(III) clause (iv) does not apply.’’. 
(b) EXCLUSION FROM REDUCTION
IN AVERAGE 
STANDARDIZED AMOUNTS PAYABLE TO HOSPITALS LO-
CATED IN CERTAIN AREAS.—Section 1886(d)(3)(B) of 
the Social Security Act (42 U.S.C. 1395ww(d)(3)(B)) is 
amended by inserting before the period the following: ‘‘, 
other than additional payments described in clause (vii) 
of such paragraph’’. 
(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. 
SEC. 30204. 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 So-
cial Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is 
amended by adding at the end the following new clause: 
‘‘(vii) SPECIAL COVERAGE RULES FOR 
SPECIFIED
COVID–19
TREATMENT
SERV-
ICES.—Notwithstanding clause (i), in the 
case of a specified COVID–19 treatment 
service (as defined in section 30201(b) of 
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The Heroes Act) 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 re-
spect to such service, impose— 
‘‘(I) any cost-sharing require-
ment (including a deductible, copay-
ment, or coinsurance requirement); 
and 
‘‘(II) in the case such service is a 
critical specified COVID–19 treat-
ment 
service 
(including 
ventilator 
services and intensive care unit serv-
ices), 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).’’. 
(b) 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. 
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SEC. 30205. REQUIRING COVERAGE UNDER MEDICARE 
PDPS AND MA–PD PLANS, WITHOUT THE IM-
POSITION OF COST SHARING OR UTILIZA-
TION 
MANAGEMENT 
REQUIREMENTS, 
OF 
DRUGS INTENDED TO TREAT COVID–19 DUR-
ING CERTAIN EMERGENCIES. 
(a) COVERAGE REQUIREMENT.— 
(1) IN
GENERAL.—Section 1860D–4(b)(3) of 
the Social Security Act (42 U.S.C. 1395w– 
104(b)(3)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(I) REQUIRED INCLUSION OF DRUGS IN-
TENDED TO TREAT COVID–19.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
any other provision of law, a PDP sponsor 
offering a prescription drug plan shall, 
with respect to a plan year, any portion of 
which occurs during the period described 
in clause (ii), be required to— 
‘‘(I) include in any formulary— 
‘‘(aa) all covered part D 
drugs with a medically accepted 
indication (as defined in section 
1860D–2(e)(4)) to treat COVID– 
19 that are marketed in the 
United States; and 
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‘‘(bb) all drugs authorized 
under section 564 or 564A of the 
Federal Food, Drug, and Cos-
metic Act to treat COVID–19; 
and 
‘‘(II) not impose any prior au-
thorization or other utilization man-
agement requirement with respect to 
such drugs described in item (aa) or 
(bb) of subclause (I) (other than such 
a requirement that limits the quantity 
of drugs due to safety). 
‘‘(ii) PERIOD DESCRIBED.—For pur-
poses of clause (i), the period described in 
this clause is the period during which there 
exists the public health emergency declared 
by the Secretary pursuant to section 319 
of the Public Health Service Act on Janu-
ary 31, 2020, entitled ‘Determination that 
a Public Health Emergency Exists Nation-
wide as the Result of the 2019 Novel 
Coronavirus’ (including any renewal of 
such declaration pursuant to such sec-
tion).’’. 
(b) ELIMINATION OF COST SHARING.— 
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‘‘(8) ELIMINATION
OF
COST-SHARING
FOR 
DRUGS INTENDED TO TREAT COVID–19.—The cov-
erage does not impose any deductible, copayment, 
coinsurance, or other cost-sharing requirement for 
drugs described in section 1860D–4(b)(3)(I)(i)(I) 
with respect to a plan year, any portion of which oc-
curs during the period during which there exists the 
public health emergency declared by the Secretary 
pursuant to section 319 of the Public Health Service 
Act on January 31, 2020, entitled ‘Determination 
that a Public Health Emergency Exists Nationwide 
as the Result of the 2019 Novel Coronavirus’ (in-
cluding any renewal of such declaration pursuant to 
such section).’’; and 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(4) SAME ELIMINATION OF COST-SHARING FOR 
DRUGS INTENDED TO TREAT COVID–19.—The cov-
erage is in accordance with subsection (b)(8).’’. 
(2) 
ELIMINATION
OF
COST-SHARING
FOR 
DRUGS INTENDED TO TREAT COVID–19 DISPENSED 
TO INDIVIDUALS WHO ARE SUBSIDY ELIGIBLE INDI-
VIDUALS.—Section 1860D–14(a) of the Social Secu-
rity Act (42 U.S.C. 1395w–114(a)) is amended— 
(A) in paragraph (1)— 
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(i) in subparagraph (D)— 
(I) in clause (ii), by striking ‘‘In 
the case of’’ and inserting ‘‘Subject to 
subparagraph (F), in the case of’’; 
and 
(II) in clause (iii), by striking 
‘‘In the case of’’ and inserting ‘‘Sub-
ject to subparagraph (F), in the case 
of’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(F) ELIMINATION OF COST-SHARING FOR 
DRUGS INTENDED TO TREAT COVID–19.—Cov-
erage that is in accordance with section 
1860D–2(b)(8).’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (B), by striking 
‘‘A reduction’’ and inserting ‘‘Subject to 
subparagraph (F), a reduction’’; 
(ii) in subparagraph (D), by striking 
‘‘The substitution’’ and inserting ‘‘Subject 
to subparagraph (F), the substitution’’; 
(iii) in subparagraph (E), by inserting 
after ‘‘Subject to’’ the following: ‘‘subpara-
graph (F) and’’; and 
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(iv) by adding at the end the following 
new subparagraph: 
‘‘(F) ELIMINATION OF COST-SHARING FOR 
DRUGS INTENDED TO TREAT COVID–19.—Cov-
erage that is in accordance with section 
1860D–2(b)(8).’’. 
(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. 
SEC. 30206. MODIFYING THE ACCELERATED AND ADVANCE 
PAYMENT PROGRAMS UNDER PARTS A AND B 
OF THE MEDICARE PROGRAM DURING THE 
COVID–19 EMERGENCY. 
(a) SPECIAL REPAYMENT RULES.— 
(1) PART A.—Section 1815(f)(2)(C) of the So-
cial Security Act (42 U.S.C. 1395g(f)(2)(C)) is 
amended to read as follows: 
‘‘(C) In the case of an accelerated payment 
made under the program under subsection (e)(3) on 
or after the date of the enactment of the CARES 
Act and so made during the emergency period de-
scribed in section 1135(g)(1)(B)— 
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‘‘(i) such payment shall be treated as if 
such payment were made from the General 
Fund of the Treasury; and 
‘‘(ii) upon request of the hospital, the Sec-
retary shall— 
‘‘(I) provide up to 1 year before 
claims are offset to recoup such payment; 
‘‘(II) provide that any such offset of a 
claim to recoup such payment shall not ex-
ceed 25 percent of the amount of such 
claim; and 
‘‘(III) allow not less than 2 years 
from the date of the first accelerated pay-
ment before requiring that the outstanding 
balance be paid in full.’’. 
(2) PART B.—In carrying out the program de-
scribed in section 421.214 of title 42, Code of Fed-
eral Regulations (or any successor regulation), in the 
case of a payment made under such program on or 
after the date of the enactment of the CARES Act 
(Public Law 116–136) and so made during the 
emergency period described in section 1135(g)(1)(B) 
of the Social Security Act (42 U.S.C. 1320b– 
5(g)(1)(B)), the Secretary of Health and Human 
Services shall— 
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(A) treat such payment as if such payment 
were made from the General Fund of the 
Treasury; and 
(B) upon request of the entity receiving 
such payment— 
(i) provide up to 1 year before claims 
are offset to recoup such payment; 
(ii) provide that any such offset of a 
claim to recoup such payment shall not ex-
ceed 25 percent of the amount of such 
claim; and 
(iii) allow not less than 2 years from 
the date of the first advance payment be-
fore requiring that the outstanding balance 
be paid in full. 
(b) INTEREST RATES.— 
(1) PART A.—Section 1815(d) of the Social Se-
curity Act (42 U.S.C. 1395g(d)) is amended by in-
serting before the period at the end the following: 
‘‘(or, in the case of such a determination made with 
respect to a payment made on or after the date of 
the enactment of the CARES Act and during the 
emergency period described in section 1135(g)(1)(B) 
under the program under subsection (e)(3), at a rate 
of 1 percent)’’. 
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(2) PART B.—Section 1833(j) of the Social Se-
curity Act (42 U.S.C. 1395l(j)) is amended by in-
serting before the period at the end the following: 
‘‘(or, in the case of such a determination made with 
respect to a payment made on or after the date of 
the enactment of the CARES Act and during the 
emergency period described in section 1135(g)(1)(B) 
under the program described in section 421.214 of 
title 42, Code of Federal Regulations (or any suc-
cessor regulation), at a rate of 1 percent)’’. 
(c) REPORT.— 
(1) REPORTS DURING COVID–19 EMERGENCY.— 
Not later than 2 weeks after the date of the enact-
ment of this section, and every 2 weeks thereafter 
during the emergency period described in section 
1135(g)(1)(B) of the Social Security Act (42 U.S.C. 
1320b–5(g)(1)(B)), the Secretary of Health and 
Human Services shall submit to the Committee on 
Ways and Means and the Committee on Energy and 
Commerce of the House of Representatives, and the 
Committee on Finance of the Senate, a report that 
includes the following: 
(A) The total amount of payments made 
under section 1815(e)(3) of the Social Security 
Act (42 U.S.C. 1395g(e)(3)) and under the pro-
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gram described in section 421.214 of title 42, 
Code of Federal Regulations (or any successor 
regulation) during the most recent 2-week pe-
riod for which data is available that precedes 
the date of the submission of such report. 
(B) The number of entities receiving such 
payments during such period. 
(C) A specification of each such entity. 
(2) REPORTS AFTER COVID–19 EMERGENCY.— 
(A) IN
GENERAL.—Not later than 6 
months after the termination of the emergency 
period described in paragraph (1), and every 6 
months thereafter until all specified payments 
(as defined in subparagraph (B)) have been re-
couped or repaid, the Secretary of Health and 
Human Services shall submit to the Committee 
on Ways and Means and the Committee on En-
ergy and Commerce of the House of Represent-
atives, and the Committee on Finance of the 
Senate, a report that includes the following: 
(i) The total amount of all specified 
payments for which claims have been offset 
to recoup such payment or the balance has 
been repaid. 
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(ii) The amount of interest that has 
accrued with respect to all specified pay-
ments. 
(B) SPECIFIED PAYMENTS.—For purposes 
of subparagraph (A), the term ‘‘specified pay-
ments’’ means all payments made under section 
1815(e)(3) of the Social Security Act (42 
U.S.C. 1395g(e)(3)) or under the program de-
scribed in section 421.214 of title 42, Code of 
Federal Regulations (or any successor regula-
tion) made on or after the date of the enact-
ment of the CARES Act (Public Law 116–136) 
during the emergency period described in such 
subparagraph. 
SEC. 30207. MEDICARE SPECIAL ENROLLMENT PERIOD FOR 
INDIVIDUALS RESIDING IN COVID–19 EMER-
GENCY AREAS. 
(a) IN GENERAL.—Section 1837(i) of the Social Se-
curity Act (42 U.S.C. 1395p(i)) is amended by adding at 
the end the following new paragraph: 
‘‘(5)(A) In the case of an individual who— 
‘‘(i) is eligible under section 1836 to enroll 
in the medical insurance program established by 
this part, 
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‘‘(ii) did not enroll (or elected not to be 
deemed enrolled) under this section during an 
enrollment period, and 
‘‘(iii) during the emergency period (as de-
scribed in section 1135(g)(1)(B)), resided in an 
emergency area (as described in such section), 
there shall be a special enrollment period de-
scribed in subparagraph (B). 
‘‘(B) The special enrollment period re-
ferred to in subparagraph (A) is the period that 
begins not later than July 1, 2020, and ends on 
the last day of the month in which the emer-
gency 
period 
(as 
described 
in 
section 
1135(g)(1)(B)) ends.’’. 
(b) 
COVERAGE
PERIOD
FOR
INDIVIDUALS 
TRANSITIONING
FROM
OTHER
COVERAGE.—Section 
1838(e) of the Social Security Act (42 U.S.C. 1395q(e)) 
is amended— 
(1) by striking ‘‘pursuant to section 1837(i)(3) 
or 1837(i)(4)(B)—’’ and inserting the following: 
‘‘pursuant to— 
‘‘(1) section 1837(i)(3) or 1837(i)(4)(B)—’’; 
(2) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively, and mov-
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ing the indentation of each such subparagraph 2 
ems to the right; 
(3) by striking the period at the end of the sub-
paragraph (B), as so redesignated, and inserting ‘‘; 
or’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(2) section 1837(i)(5), the coverage period 
shall begin on the first day of the month following 
the month in which the individual so enrolls.’’. 
(c) FUNDING.—The Secretary of Health and Human 
Services shall provide for the transfer from the Federal 
Hospital Insurance Trust Fund (as described in section 
1817 of the Social Security Act (42 U.S.C. 1395i)) and 
the Federal Supplementary Medical Insurance Trust 
Fund (as described in section 1841 of such Act (42 U.S.C. 
1395t)), in such proportions as determined appropriate by 
the Secretary, to the Social Security Administration, of 
$30,000,000, to remain available until expended, for pur-
poses of carrying out the amendments made by this sec-
tion. 
(d) 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. 
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SEC. 30208. COVID–19 SKILLED NURSING FACILITY PAY-
MENT INCENTIVE PROGRAM. 
(a) IN GENERAL.—Section 1819 of the Social Secu-
rity Act (42 U.S.C. 1395i–3) is amended by adding at the 
end the following new subsection: 
‘‘(k) COVID–19 DESIGNATION PROGRAM.— 
‘‘(1) IN
GENERAL.—Not later than 2 weeks 
after the date of the enactment of this subsection, 
the Secretary shall establish a program under which 
a skilled nursing facility that makes an election de-
scribed in paragraph (2)(A) and meets the require-
ments described in paragraph (2)(B) is designated 
(or a portion of such facility is so designated) as a 
COVID–19 treatment center and receives incentive 
payments under section 1888(e)(13). 
‘‘(2) DESIGNATION.— 
‘‘(A) IN GENERAL.—A skilled nursing fa-
cility may elect to be designated (or to have a 
portion of such facility designated) as a 
COVID–19 treatment center under the program 
established under paragraph (1) if the facility 
submits to the Secretary, at a time and in a 
manner specified by the Secretary, an applica-
tion for such designation that contains such in-
formation as required by the Secretary and 
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demonstrates that such facility meets the re-
quirements described in subparagraph (B). 
‘‘(B) REQUIREMENTS.—The requirements 
described in this subparagraph with respect to 
a skilled nursing facility are the following: 
‘‘(i) The facility has a star rating with 
respect to staffing of 4 or 5 on the Nurs-
ing Home Compare website (as described 
in subsection (i)) and has maintained such 
a rating on such website during the 2-year 
period ending on the date of the submis-
sion of the application described in sub-
paragraph (A). 
‘‘(ii) The facility has a star rating of 
4 or 5 with respect to health inspections on 
such website and has maintained such a 
rating on such website during such period. 
‘‘(iii) During such period, the Sec-
retary or a State has not found a defi-
ciency with such facility relating to infec-
tion control that the Secretary or State de-
termined 
immediately 
jeopardized 
the 
health or safety of the residents of such fa-
cility (as described in paragraph (1) or 
(2)(A) of subsection (h), as applicable). 
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‘‘(A) Notice of such designation. 
‘‘(B) In the case such resident is not an el-
igible individual (and, in the case such designa-
tion is made only with respect to a portion of 
such facility, resides in such portion of such fa-
cility)— 
‘‘(i) a specification of when and where 
such resident will be transferred (or moved 
within such facility); 
‘‘(ii) an explanation that, in lieu of 
such transfer or move, such resident may 
arrange for transfer to such other setting 
(including a home) selected by the resi-
dent; and 
‘‘(iii) if such resident so arranges to 
be transferred to a home, information on 
Internet resources for caregivers who elect 
to care for such resident at home. 
‘‘(C) Contact information for the State 
long-term care ombudsman (established under 
section 307(a)(12) of the Older Americans Act 
of 1965) for the applicable State. 
‘‘(5) REPORTING REQUIREMENT.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (2)(B)(vii), the reporting requirement de-
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scribed in this paragraph is, with respect to a 
skilled nursing facility, that the facility reports 
to the Secretary, weekly and in such manner 
specified by the Secretary, the following (but 
only to the extent the information described in 
clauses (i) through (vii) is not otherwise re-
ported to the Secretary weekly): 
‘‘(i) The number of COVID–19 re-
lated deaths at such facility. 
‘‘(ii) The number of discharges from 
such facility. 
‘‘(iii) The number of admissions to 
such facility. 
‘‘(iv) The number of beds occupied 
and the number of beds available at such 
facility. 
‘‘(v) The number of residents on a 
ventilator at such facility. 
‘‘(vi) The number of clinical and non-
clinical staff providing direct patient care 
at such facility. 
‘‘(vii) Such other information deter-
mined appropriate by the Secretary. 
‘‘(B) NONAPPLICATION
OF
PAPERWORK 
REDUCTION
ACT.—Chapter 35 of title 44, 
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United States Code (commonly known as the 
‘Paperwork Reduction Act’), shall not apply to 
the collection of information under this para-
graph. 
‘‘(6) DEFINITION.—For purposes of this sub-
section, the term ‘eligible individual’ means an indi-
vidual who, during the 30-day period ending on the 
first day on which such individual is a resident of a 
COVID–19 treatment center (on or after the date 
such center is so designated), was furnished a test 
for COVID–19 that came back positive. 
‘‘(7) TERMINATION.—The program established 
under paragraph (1) shall terminate upon the termi-
nation of the emergency period described in section 
1135(g)(1)(B). 
‘‘(8) PROHIBITION
ON
ADMINISTRATIVE
AND 
JUDICIAL REVIEW.—There shall be no administrative 
or judicial review under section 1869, 1878, or oth-
erwise of a designation of a skilled nursing facility 
(or portion of such facility) as a COVID–19 treat-
ment center, or revocation of such a designation, 
under this subsection.’’. 
(b) PAYMENT INCENTIVE.—Section 1888(e) of the 
Social Security Act (42 U.S.C. 1395yy(e)) is amended— 
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(1) in paragraph (1), in the matter preceding 
subparagraph (A), by striking ‘‘and (12)’’ and in-
serting ‘‘(12), and (13)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(13) ADJUSTMENT FOR COVID–19 TREATMENT 
CENTERS.—In the case of a resident of a skilled 
nursing facility that has been designated as a 
COVID–19 treatment center under section 1819(k) 
(or in the case of a resident who resides in a portion 
of such facility that has been so designated), if such 
resident is an eligible individual (as defined in para-
graph (5) of such section), the per diem amount of 
payment for such resident otherwise applicable shall 
be increased by 20 percent to reflect increased costs 
associated with such residents.’’. 
SEC. 30209. FUNDING FOR STATE STRIKE TEAMS FOR RESI-
DENT AND EMPLOYEE SAFETY IN SKILLED 
NURSING FACILITIES AND NURSING FACILI-
TIES. 
(a) IN GENERAL.—Of the amounts made available 
under subsection (c), the Secretary of Health and Human 
Services (referred to in this section as the ‘‘Secretary’’) 
shall allocate such amounts among the States, in a man-
ner that takes into account the percentage of skilled nurs-
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ing facilities and nursing facilities in each State that have 
residents or employees who have been diagnosed with 
COVID–19, for purposes of establishing and implementing 
strike teams in accordance with subsection (b). 
(b) USE OF FUNDS.—A State that receives funds 
under this section shall use such funds to establish and 
implement a strike team that will be deployed to a skilled 
nursing facility or nursing facility in the State with diag-
nosed or suspected cases of COVID–19 among residents 
or staff for the purposes of assisting with clinical care, 
infection control, or staffing. 
(c) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses of carrying out this section, there is authorized to 
be appropriated $500,000,000. 
(d) DEFINITIONS.—In this section: 
(1) NURSING
FACILITY.—The term ‘‘nursing 
facility’’ has the meaning given such term in section 
1919(a) of the Social Security Act (42 U.S.C. 
1396r(a)). 
(2) SKILLED
NURSING
FACILITY.—The term 
‘‘skilled nursing facility’’ has the meaning given such 
term in section 1819(a) of the Social Security Act 
(42 U.S.C. 1395i–3(a)). 
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SEC. 30210. PROVIDING FOR INFECTION CONTROL SUP-
PORT 
TO 
SKILLED 
NURSING 
FACILITIES 
THROUGH CONTRACTS WITH QUALITY IM-
PROVEMENT ORGANIZATIONS. 
(a) IN GENERAL.—Section 1862(g) of the Social Se-
curity Act (42 U.S.C. 1395y(g)) is amended— 
(1) by striking ‘‘The Secretary’’ and inserting 
‘‘(1) The Secretary’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(2)(A) The Secretary shall ensure that at least 1 
contract with a quality improvement organization de-
scribed in paragraph (1) entered into on or after the date 
of the enactment of this paragraph and before the end 
of 
the 
emergency 
period 
described 
in 
section 
1135(g)(1)(B) (or in effect as of such date) includes the 
requirement that such organization provide to skilled 
nursing facilities with cases of COVID–19 (or facilities at-
tempting to prevent outbreaks of COVID–19) infection 
control support described in subparagraph (B) during 
such period. 
‘‘(B) For purposes of subparagraph (A), the infection 
control support described in this subparagraph is, with re-
spect to skilled nursing facilities described in such sub-
paragraph, the development and dissemination to such fa-
cilities of protocols relating to the prevention or mitigation 
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of COVID–19 at such facilities and the provision of train-
ing materials to such facilities relating to such prevention 
or mitigation.’’. 
(b) FUNDING.—The Secretary of Health and Human 
Services shall provide for the transfer from the Federal 
Supplementary Medical Insurance Trust Fund (as de-
scribed in section 1841 of the Social Security Act (42 
U.S.C. 1395t)) and the Federal Hospital Insurance Trust 
Fund (as described in section 1817 of such Act (42 U.S.C. 
1395i)), in such proportions as determined appropriate by 
the Secretary, to the Centers for Medicare & Medicaid 
Services Program Management Account, of $210,000,000, 
to remain available until expended, for purposes of enter-
ing into contracts with quality improvement organizations 
under part B of title XI of such Act (42 U.S.C. 1320c 
et seq.). Of the amount transferred pursuant to the pre-
vious sentence, not less that $110,000,000 shall be used 
for purposes of entering into such a contract that includes 
the requirement described in section 1862(g)(2)(A) of 
such Act (as added by subsection (a)). 
SEC. 30211. REQUIRING LONG TERM CARE FACILITIES TO 
REPORT CERTAIN INFORMATION RELATING 
TO COVID–19 CASES AND DEATHS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
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retary’’) shall, as soon as practicable, require that the in-
formation described in paragraph (1) of section 483.80(g) 
of title 42, Code of Federal Regulations, or a successor 
regulation, be reported by a facility (as defined for pur-
poses of such section). 
(b) DEMOGRAPHIC INFORMATION.—The Secretary 
shall post the following information with respect to skilled 
nursing facilities (as defined in section 1819(a) of the So-
cial Security Act (42 U.S.C. 1395i–3(a))) and nursing fa-
cilities (as defined in section 1919(a) of such Act (42 
U.S.C. 1396r(a))) on the Nursing Home Compare website 
(as described in section 1819(i) of the Social Security Act 
(42 U.S.C. 1395i–3(i))), or a successor website, aggre-
gated by State: 
(1) The age, race/ethnicity, and preferred lan-
guage of the residents of such skilled nursing facili-
ties and nursing facilities with suspected or con-
firmed COVID–19 infections, including residents 
previously treated for COVID–19. 
(2) The age, race/ethnicity, and preferred lan-
guage relating to total deaths and COVID–19 
deaths among residents of such skilled nursing facili-
ties and nursing facilities. 
(c) CONFIDENTIALITY.—Any information reported 
under this section that is made available to the public shall 
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be made so available in a manner that protects the identity 
of residents of skilled nursing facilities and nursing facili-
ties. 
(d) IMPLEMENTATION.—The Secretary may imple-
ment the provisions of this section be program instruction 
or otherwise. 
SEC. 30212. FLOOR ON THE MEDICARE AREA WAGE INDEX 
FOR HOSPITALS IN ALL-URBAN STATES. 
(a) IN GENERAL.—Section 1886(d)(3)(E) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(3)(E)) is amend-
ed— 
(1) in clause (i), in the first sentence, by strik-
ing ‘‘or (iii)’’ and inserting ‘‘, (iii), or (iv)’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(iv) FLOOR ON AREA WAGE INDEX 
FOR HOSPITALS IN ALL-URBAN STATES.— 
‘‘(I) 
IN
GENERAL.—For 
dis-
charges occurring on or after October 
1, 2021, the area wage index applica-
ble under this subparagraph to any 
hospital in an all-urban State (as de-
fined in subclause (IV)) may not be 
less than the minimum area wage 
index for the fiscal year for hospitals 
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in that State, as established under 
subclause (II). 
‘‘(II) 
MINIMUM
AREA
WAGE 
INDEX.—For purposes of subclause 
(I), the Secretary shall establish a 
minimum area wage index for a fiscal 
year for hospitals in each all-urban 
State using the methodology described 
in section 412.64(h)(4) of title 42, 
Code of Federal Regulations, as in ef-
fect for fiscal year 2018. 
‘‘(III) WAIVING
BUDGET
NEU-
TRALITY.—Pursuant to the fifth sen-
tence of clause (i), this subsection 
shall not be applied in a budget neu-
tral manner. 
‘‘(IV) ALL-URBAN
STATE
DE-
FINED.—In this clause, the term ‘all- 
urban State’ means a State in which 
there are no rural areas (as defined in 
paragraph (2)(D)) or a State in which 
there are no hospitals classified as 
rural under this section.’’. 
(b) WAIVING BUDGET NEUTRALITY.— 
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(1) TECHNICAL AMENDATORY CORRECTION.— 
Section 10324(a)(2) of Public Law 111–148 is 
amended by striking ‘‘third sentence’’ and inserting 
‘‘fifth sentence’’. 
(2) WAIVER.—Section 1886(d)(3)(E)(i) of the 
Social Security Act (42 U.S.C. 1395ww(d)(3)(E)(i)) 
is amended, in the fifth sentence— 
(A) by striking ‘‘and the amendments’’ and 
inserting ‘‘, the amendments’’; and 
(B) by inserting ‘‘, and the amendments 
made by section 30212 of The Heroes Act’’ 
after ‘‘Care Act’’. 
SEC. 30213. RISK CORRIDOR PROGRAM FOR MEDICARE AD-
VANTAGE PLANS. 
(a) IN GENERAL.—Section 1853 of the Social Secu-
rity Act (42 U.S.C. 1395w–23) is amended by adding at 
the end the following new subsection: 
‘‘(p) RISK
CORRIDOR
PROGRAM
DURING
THE 
COVID–19 EMERGENCY.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish and administer a program of risk corridors for 
each plan year, any portion of which occurs during 
the 
emergency 
period 
defined 
in 
section 
1135(g)(1)(B), under which the Secretary shall 
make payments to MA organizations offering a 
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Medicare Advantage plan based on the ratio of the 
allowable costs of the plan to the aggregate pre-
miums of the plan. 
‘‘(2) PAYMENT METHODOLOGY.—The Secretary 
shall provide under the program established under 
paragraph (1) that if the allowable costs for a Medi-
care Advantage plan for any plan year are more 
than 105 percent of the target amount, the Sec-
retary shall pay to the plan an amount equal to 75 
percent of the allowable costs in excess of 105 per-
cent of the target amount. 
‘‘(3) TIMING.— 
‘‘(A) SUBMISSION
OF
INFORMATION
BY 
PLANS.—With respect to a plan year for which 
the program described in paragraph (1) is es-
tablished and administered, not later than July 
1 of the succeeding plan year each MA organi-
zation offering a Medicare Advantage plan shall 
submit to the Secretary such information as the 
Secretary may require for purposes of carrying 
out such program. 
‘‘(B) PAYMENT.—The Secretary shall pay 
to an MA organization offering a Medicare Ad-
vantage plan eligible to receive a payment under 
the program with respect to a plan year the 
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amount provided under paragraph (2) for such 
plan year not later than 60 days after such or-
ganization submits information with respect to 
such plan and plan year under subparagraph 
(A). 
‘‘(4) DEFINITIONS.— 
‘‘(A) ALLOWABLE COSTS.—The amount of 
allowable costs of a MA organization offering a 
Medicare Advantage plan for a plan year is an 
amount equal to the total costs (other than ad-
ministrative costs) of such plan in providing 
benefits covered by such plan, but only to the 
extent that such costs are incurred with respect 
to such benefits for items and services that are 
benefits under the original medicare fee-for- 
service program option. 
‘‘(B) 
TARGET
AMOUNT.—The 
target 
amount described in this paragraph is, with re-
spect to a Medicare Advantage plan and a plan 
year, the total amount of payments paid to the 
MA organization for the plan for benefits under 
the original medicare fee-for-service program 
option for the plan year, taking into account 
amounts paid by the Secretary and enrollees, 
based upon the bid amount submitted under 
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section 1854, reduced by the total amount of 
administrative expenses for the year assumed in 
such bid. 
‘‘(5) FUNDING.—There are appropriated to the 
Centers for Medicare & Medicaid Services Program 
Management Account, out of any monies in the 
Treasury not otherwise obligated, such sums as may 
be necessary for purposes of carrying out this sub-
section.’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Service may implement the amendments made by this sec-
tion by program instruction or otherwise. 
SEC. 30214. RELIEF FOR SMALL RURAL HOSPITALS FROM 
INACCURATE INSTRUCTIONS PROVIDED BY 
CERTAIN MEDICARE ADMINISTRATIVE CON-
TRACTORS. 
Section 1886(d)(5) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)) is amended by adding at the end 
the following new subparagraph: 
‘‘(N)(i) Subject to clause (ii), in the case of a sole 
community hospital or a medicare-dependent, small rural 
hospital with respect to which a medicare administrative 
contractor initially determined and paid a volume decrease 
adjustment under subparagraph (D)(ii) or (G)(iii) for a 
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specified cost reporting period, at the election of the hos-
pital, the Secretary of Health and Human Services shall 
replace the volume decrease adjustment subsequently de-
termined for that specified cost reporting period by the 
medicare administrative contractor with the volume de-
crease adjustment initially determined and paid by the 
medicare administrative contractor for that specified cost 
reporting period. 
‘‘(ii)(I) Clause (i) shall not apply in the case of a sole 
community hospital or a medicare-dependent, small rural 
hospital for which the medicare administrative contractor 
determination of the volume decrease adjustment with re-
spect to a specified cost reporting period of the hospital 
is administratively final before the date that is three years 
before the date of the enactment of this section. 
‘‘(II) For purposes of subclause (I), the date on which 
the medicare administrative contractor determination with 
respect to a volume decrease adjustment for a specified 
cost reporting period is administratively final is the latest 
of the following: 
‘‘(aa) The date of the contractor determination 
(as defined in section 405.1801 of title 42, Code of 
Federal Regulations). 
‘‘(bb) The date of the final outcome of any re-
opening of the medicare administrative contractor 
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determination under section 405.1885 of title 42, 
Code of Federal Regulations. 
‘‘(cc) The date of the final outcome of the final 
appeal filed by such hospital with respect to such 
volume decrease adjustment for such specified cost 
reporting period. 
‘‘(iii) For purposes of this subparagraph, the term 
‘specified cost reporting period’ means a cost reporting pe-
riod of a sole community hospital or a medicare-depend-
ent, small rural hospital, as the case may be, that begins 
during a fiscal year before fiscal year 2018.’’. 
SEC. 30215. DEEMING CERTAIN HOSPITALS TO BE LOCATED 
IN AN URBAN AREA FOR PURPOSES OF PAY-
MENT FOR INPATIENT HOSPITAL SERVICES 
UNDER THE MEDICARE PROGRAM. 
Section 1886(d)(10) of the Social Security Act (42 
U.S.C. 1395ww(d)(10)) is amended by adding at the end 
the following new subparagraph: 
‘‘(G)(i) For purposes of payment under this sub-
section for discharges occurring during the 3-year period 
beginning on October 1, 2020, each hospital located in Al-
bany, Saratoga, Schenectady, Montgomery, or Rensselaer 
County of New York shall be deemed to be located in the 
large urban area of Hartford-West Hartford-East of Hart-
ford, Connecticut (CBSA 25540). 
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‘‘(ii) Any deemed location of a hospital pursuant to 
clause (i) shall be treated as a decision of the Medicare 
Geographic Classification Review Board for purposes of 
paragraph (8)(D).’’. 
TITLE III—PRIVATE INSURANCE 
PROVISIONS 
Subtitle A—Health Plans 
SEC. 30301. SPECIAL ENROLLMENT PERIOD THROUGH EX-
CHANGES; FEDERAL EXCHANGE OUTREACH 
AND EDUCATIONAL ACTIVITIES. 
(a) SPECIAL ENROLLMENT PERIOD THROUGH EX-
CHANGES.—Section 1311(c) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18031(c)) is amended— 
(1) in paragraph (6)— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (D), by striking at 
the end the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(E) subject to subparagraph (B) of para-
graph (8), the special enrollment period de-
scribed in subparagraph (A) of such para-
graph.’’; and 
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(2) by adding at the end the following new 
paragraph: 
‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER-
TAIN PUBLIC HEALTH EMERGENCY.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
subject to subparagraph (B), require an Ex-
change to provide— 
‘‘(i) for a special enrollment period 
during the emergency period described in 
section 1135(g)(1)(B) of the Social Secu-
rity Act— 
‘‘(I) which shall begin on the 
date that is one week after the date of 
the enactment of this paragraph and 
which, in the case of an Exchange es-
tablished or operated by the Secretary 
within a State pursuant to section 
1321(c), shall be an 8-week period; 
and 
‘‘(II) during which any individual 
who is otherwise eligible to enroll in a 
qualified health plan through the Ex-
change may enroll in such a qualified 
health plan; and 
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‘‘(ii) that, in the case of an individual 
who enrolls in a qualified health plan 
through the Exchange during such enroll-
ment period, the coverage period under 
such plan shall begin, at the option of the 
individual, on April 1, 2020, or on the first 
day of the month following the day the in-
dividual selects a plan through such special 
enrollment period. 
‘‘(B) EXCEPTION.—The requirement of 
subparagraph (A) shall not apply to a State-op-
erated or State-established Exchange if such 
Exchange, prior to the date of the enactment of 
this paragraph, established or otherwise pro-
vided for a special enrollment period to address 
access to coverage under qualified health plans 
offered through such Exchange during the 
emergency 
period 
described 
in 
section 
1135(g)(1)(B) of the Social Security Act.’’. 
(b) FEDERAL EXCHANGE OUTREACH
AND EDU-
CATIONAL ACTIVITIES.—Section 1321(c) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18041(c)) 
is amended by adding at the end the following new para-
graph: 
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‘‘(3) OUTREACH
AND
EDUCATIONAL
ACTIVI-
TIES.— 
‘‘(A) IN GENERAL.—In the case of an Ex-
change established or operated by the Secretary 
within a State pursuant to this subsection, the 
Secretary shall carry out outreach and edu-
cational activities for purposes of informing po-
tential enrollees in qualified health plans offered 
through the Exchange of the availability of cov-
erage under such plans and financial assistance 
for coverage under such plans. Such outreach 
and educational activities shall be provided in a 
manner that is culturally and linguistically ap-
propriate to the needs of the populations being 
served by the Exchange (including hard-to- 
reach populations, such as racial and sexual mi-
norities, limited English proficient populations, 
and young adults). 
‘‘(B) LIMITATION ON USE OF FUNDS.—No 
funds appropriated under this paragraph shall 
be used for expenditures for promoting non- 
ACA compliant health insurance coverage. 
‘‘(C) NON-ACA COMPLIANT
HEALTH
IN-
SURANCE
COVERAGE.—For purposes of sub-
paragraph (B): 
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‘‘(i) The term ‘non-ACA compliant 
health insurance coverage’ means health 
insurance coverage, or a group health plan, 
that is not a qualified health plan. 
‘‘(ii) Such term includes the following: 
‘‘(I) An association health plan. 
‘‘(II) Short-term limited duration 
insurance. 
‘‘(D) FUNDING.—There are appropriated, 
out of any funds in the Treasury not otherwise 
appropriated, $25,000,000, to remain available 
until expended— 
‘‘(i) to carry out this paragraph; 
and— 
‘‘(ii) at the discretion of the Sec-
retary, to carry out section 1311(i), with 
respect to an Exchange established or op-
erated by the Secretary within a State pur-
suant to this subsection.’’. 
(c) IMPLEMENTATION.—The Secretary of Health and 
Human Services may implement the provisions of (includ-
ing amendments made by) this section through subregu-
latory guidance, program instruction, or otherwise. 
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SEC. 30302. EXPEDITED MEETING OF ACIP FOR COVID–19 
VACCINES. 
(a) IN GENERAL.—Notwithstanding section 3091 of 
the 21st Century Cures Act (21 U.S.C. 360bbb–4 note), 
the Advisory Committee on Immunization Practices shall 
meet and issue a recommendation with respect to a vac-
cine that is intended to prevent or treat COVID–19 not 
later than 15 business days after the date on which such 
vaccine is licensed under section 351 of the Public Health 
Service Act (42 U.S.C. 262). 
(b) DEFINITION.—In this section, the term ‘‘Advisory 
Committee on Immunization Practices’’ means the Advi-
sory Committee on Immunization Practices established by 
the Secretary of Health and Human Services pursuant to 
section 222 of the Public Health Service Act (42 U.S.C. 
217a), acting through the Director of the Centers for Dis-
ease Control and Prevention. 
SEC. 30303. COVERAGE OF COVID–19 RELATED TREATMENT 
AT NO COST SHARING. 
(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance 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, copay-
ments, and coinsurance) requirements, for the following 
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items and services furnished during any portion of the 
emergency period defined in paragraph (1)(B) of section 
1135(g) of the Social Security Act (42 U.S.C. 1320b– 
5(g)) beginning on or after the date of the enactment of 
this Act: 
(1) Medically necessary items and services (in-
cluding in-person or telehealth visits in which such 
items and services are furnished) that are furnished 
to an individual who has been diagnosed with (or 
after provision of the items and services is diagnosed 
with) COVID–19 to treat or mitigate the effects of 
COVID–19. 
(2) Medically necessary items and services (in-
cluding in-person or telehealth visits in which such 
items and services are furnished) that are furnished 
to an individual who is presumed to have COVID– 
19 but is never diagnosed as such, if the following 
conditions are met: 
(A) Such items and services are furnished 
to the individual to treat or mitigate the effects 
of COVID–19 or to mitigate the impact of 
COVID–19 on society. 
(B) Health care providers have taken ap-
propriate steps under the circumstances to 
make a diagnosis, or confirm whether a diag-
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nosis was made, with respect to such individual, 
for COVID–19, if possible. 
(b) ITEMS
AND SERVICES RELATED
TO COVID– 
19.—For purposes of this section— 
(1) not later than one week after the date of 
the enactment of this section, the Secretary of 
Health and Human Services, Secretary of Labor, 
and Secretary of the Treasury shall jointly issue 
guidance specifying applicable diagnoses and medi-
cally necessary items and services related to 
COVID–19; and 
(2) such items and services shall include all 
items or services that are relevant to the treatment 
or mitigation of COVID–19, regardless of whether 
such items or services are ordinarily covered under 
the terms of a group health plan or group or indi-
vidual health insurance coverage offered by a health 
insurance issuer. 
(c) ENFORCEMENT.— 
(1) APPLICATION
WITH
RESPECT
TO
PHSA, 
ERISA, AND
IRC.—The provisions of this section 
shall be applied by the Secretary of Health and 
Human Services, Secretary of Labor, and Secretary 
of the Treasury to group health plans and health in-
surance issuers offering group or individual health 
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insurance coverage as if included in the provisions of 
part A of title XXVII of the Public Health Service 
Act, part 7 of the Employee Retirement Income Se-
curity Act of 1974, and subchapter B of chapter 100 
of the Internal Revenue Code of 1986, as applicable. 
(2) PRIVATE RIGHT OF ACTION.—An individual 
with respect to whom an action is taken by a group 
health plan or health insurance issuer offering group 
or individual health insurance coverage in violation 
of subsection (a) may commence a civil action 
against the plan or issuer for appropriate relief. The 
previous sentence shall not be construed as limiting 
any enforcement mechanism otherwise applicable 
pursuant to paragraph (1). 
(d) IMPLEMENTATION.—The Secretary of Health and 
Human Services, Secretary of Labor, and Secretary of the 
Treasury may implement the provisions of this section 
through sub-regulatory guidance, program instruction or 
otherwise. 
(e) TERMS.—The terms ‘‘group health plan’’; ‘‘health 
insurance issuer’’; ‘‘group health insurance coverage’’, and 
‘‘individual health insurance coverage’’ have the meanings 
given such terms in section 2791 of the Public Health 
Service Act (42 U.S.C. 300gg–91), section 733 of the Em-
ployee Retirement Income Security Act of 1974 (29 
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U.S.C. 1191b), and section 9832 of the Internal Revenue 
Code of 1986, as applicable. 
SEC. 30304. REQUIRING PRESCRIPTION DRUG REFILL NOTI-
FICATIONS DURING EMERGENCIES. 
(a) ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185 et seq.) is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 716. PROVISION OF PRESCRIPTION DRUG REFILL NO-
TIFICATIONS DURING EMERGENCIES. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering health insurance coverage 
in connection with a group health plan, that provides bene-
fits for prescription drugs under such plan or such cov-
erage shall provide to each participant or beneficiary 
under such plan or such coverage who resides in an emer-
gency area during an emergency period— 
‘‘(1) not later than 5 business days after the 
date of the beginning of such period with respect to 
such area (or, the case of the emergency period de-
scribed in section 30304(d)(2) of The Heroes Act, 
not later than 5 business days after the date of the 
enactment of this section), a notification (written in 
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a manner that is clear and understandable to the av-
erage participant or beneficiary)— 
‘‘(A) of whether such plan or coverage will 
waive, during such period with respect to such 
a participant or beneficiary, any time restric-
tions under such plan or coverage on any au-
thorized refills for such drugs to enable such re-
fills in advance of when such refills would oth-
erwise have been permitted under such plan or 
coverage; and 
‘‘(B) in the case that such plan or coverage 
will waive such restrictions during such period 
with respect to such a participant or bene-
ficiary, that contains information on how such 
a participant or beneficiary may obtain such a 
refill; and 
‘‘(2) in the case such plan or coverage elects to 
so waive such restrictions during such period with 
respect to such a participant or beneficiary after the 
notification described in paragraph (1) has been pro-
vided with respect to such period, not later than 5 
business days after such election, a notification of 
such election that contains the information described 
in subparagraph (B) of such paragraph. 
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‘‘(b) EMERGENCY AREA; EMERGENCY PERIOD.—For 
purposes of this section, an ‘emergency area’ is a geo-
graphical area in which, and an ‘emergency period’ is the 
period during which, there exists— 
‘‘(1) an emergency or disaster declared by the 
President pursuant to the National Emergencies Act 
or the Robert T. Stafford Disaster Relief and Emer-
gency Assistance Act; and 
‘‘(2) a public health emergency declared by the 
Secretary pursuant to section 319 of the Public 
Health Service Act.’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents of the Employee Retirement Income Security 
Act of 1974 is amended by inserting after the item 
relating to section 714 the following: 
‘‘Sec. 715. Additional market reforms. 
‘‘Sec. 716. Provision of prescription drug refill notifications during emer-
gencies.’’. 
(b) PHSA.—Subpart II of part A of title XXVII of 
the Public Health Service Act (42 U.S.C. 300gg–11 et 
seq.) is amended by adding at the end the following new 
section: 
‘‘SEC. 2730. PROVISION OF PRESCRIPTION DRUG REFILL 
NOTIFICATIONS DURING EMERGENCIES. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group or individual health 
insurance coverage, that provides benefits for prescription 
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drugs under such plan or such coverage shall provide to 
each participant, beneficiary, or enrollee enrolled under 
such plan or such coverage who resides in an emergency 
area during an emergency period— 
‘‘(1) not later than 5 business days after the 
date of the beginning of such period with respect to 
such area (or, the case of the emergency period de-
scribed in section 30304(d)(2) of The Heroes Act, 
not later than 5 business days after the date of the 
enactment of this section), a notification (written in 
a manner that is clear and understandable to the av-
erage participant, beneficiary, or enrollee)— 
‘‘(A) of whether such plan or coverage will 
waive, during such period with respect to such 
a participant, beneficiary, or enrollee, any time 
restrictions under such plan or coverage on any 
authorized refills for such drugs to enable such 
refills in advance of when such refills would 
otherwise have been permitted under such plan 
or coverage; and 
‘‘(B) in the case that such plan or coverage 
will waive such restrictions during such period 
with respect to such a participant, beneficiary, 
or enrollee, that contains information on how 
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such a participant, beneficiary, or enrollee may 
obtain such a refill; and 
‘‘(2) in the case such plan or coverage elects to 
so waive such restrictions during such period with 
respect to such a participant, beneficiary, or enrollee 
after the notification described in paragraph (1) has 
been provided with respect to such period, not later 
than 5 business days after such election, a notifica-
tion of such election that contains the information 
described in subparagraph (B) of such paragraph. 
‘‘(b) EMERGENCY AREA; EMERGENCY PERIOD.—For 
purposes of this section, an ‘emergency area’ is a geo-
graphical area in which, and an ‘emergency period’ is the 
period during which, there exists— 
‘‘(1) an emergency or disaster declared by the 
President pursuant to the National Emergencies Act 
or the Robert T. Stafford Disaster Relief and Emer-
gency Assistance Act; and 
‘‘(2) a public health emergency declared by the 
Secretary pursuant to section 319.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following new section: 
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‘‘SEC. 9816. PROVISION OF PRESCRIPTION DRUG REFILL 
NOTIFICATIONS DURING EMERGENCIES. 
‘‘(a) IN GENERAL.—A group health plan that pro-
vides benefits for prescription drugs under such plan shall 
provide to each participant or beneficiary enrolled under 
such plan who resides in an emergency area during an 
emergency period, not later than 5 business days after the 
date of the beginning of such period with respect to such 
area (or, the case of the emergency period described in 
section 30304(d)(2) of The Heroes Act, not later than 5 
business days after the date of the enactment of this sec-
tion)— 
‘‘(1) a notification (written in a manner that is 
clear and understandable to the average participant 
or beneficiary)— 
‘‘(A) of whether such plan will waive, dur-
ing such period with respect to such a partici-
pant or beneficiary, any time restrictions under 
such plan on any authorized refills for such 
drugs to enable such refills in advance of when 
such refills would otherwise have been per-
mitted under such plan; and 
‘‘(B) in the case that such plan will waive 
such restrictions during such period with re-
spect to such a participant or beneficiary, that 
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contains information on how such a participant 
or beneficiary may obtain such a refill; and 
‘‘(2) in the case such plan elects to so waive 
such restrictions during such period with respect to 
such a participant or beneficiary after the notifica-
tion described in paragraph (1) has been provided 
with respect to such period, not later than 5 busi-
ness days after such election, a notification of such 
election that contains the information described in 
subparagraph (B) of such paragraph. 
‘‘(b) EMERGENCY AREA; EMERGENCY PERIOD.—For 
purposes of this section, an ‘emergency area’ is a geo-
graphical area in which, and an ‘emergency period’ is the 
period during which, there exists— 
‘‘(1) an emergency or disaster declared by the 
President pursuant to the National Emergencies Act 
or the Robert T. Stafford Disaster Relief and Emer-
gency Assistance Act; and 
‘‘(2) a public health emergency declared by the 
Secretary pursuant to section 319 of the Public 
Health Service Act.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new item: 
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‘‘Sec. 9816. Provision of prescription drug refill notifications during emer-
gencies.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to— 
(1) emergency periods beginning on or after the 
date of the enactment of this Act; and 
(2) the emergency period relating to the public 
health emergency declared by the Secretary of 
Health and Human Services pursuant to section 319 
of the Public Health Service Act on January 31, 
2020, entitled ‘‘Determination that a Public Health 
Emergency Exists Nationwide as the Result of the 
2019 Novel Coronavirus’’. 
SEC. 30305. IMPROVEMENT OF CERTAIN NOTIFICATIONS 
PROVIDED TO QUALIFIED BENEFICIARIES BY 
GROUP HEALTH PLANS IN THE CASE OF 
QUALIFYING EVENTS. 
(a) EMPLOYEE RETIREMENT INCOME SECURITY ACT 
OF 1974.— 
(1) IN GENERAL.—Section 606 of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 
1166) is amended— 
(A) in subsection (a)(4), in the matter fol-
lowing subparagraph (B), by striking ‘‘under 
this subsection’’ and inserting ‘‘under this part 
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in accordance with the notification requirements 
under subsection (c)’’; and 
(B) in subsection (c)— 
(i) by striking ‘‘For purposes of sub-
section (a)(4), any notification’’ and insert-
ing ‘‘For purposes of subsection (a)(4)— 
‘‘(1) any notification’’; 
(ii) by striking ‘‘, whichever is applica-
ble, and any such notification’’ and insert-
ing ‘‘of subsection (a), whichever is appli-
cable; 
‘‘(2) any such notification’’; and 
(iii) by striking ‘‘such notification is 
made’’ and inserting ‘‘such notification is 
made; and 
‘‘(3) any such notification shall, with respect to 
each qualified beneficiary with respect to whom such 
notification is made, include information regarding 
any Exchange established under title I of the Pa-
tient Protection and Affordable Care Act through 
which such a qualified beneficiary may be eligible to 
enroll in a qualified health plan (as defined in sec-
tion 1301 of the Patient Protection and Affordable 
Care Act), including— 
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‘‘(A) 
the 
publicly 
accessible 
Internet 
website address for such Exchange; 
‘‘(B) 
the 
publicly 
accessible 
Internet 
website address for the Find Local Help direc-
tory maintained by the Department of Health 
and Human Services on the healthcare.gov 
Internet website (or a successor website); 
‘‘(C) a clear explanation that— 
‘‘(i) an individual who is eligible for 
continuation coverage may also be eligible 
to enroll, with financial assistance, in a 
qualified health plan offered through such 
Exchange, but, in the case that such indi-
vidual elects to enroll in such continuation 
coverage and subsequently elects to termi-
nate such continuation coverage before the 
period of such continuation coverage ex-
pires, such individual will not be eligible to 
enroll in a qualified health plan offered 
through such Exchange during a special 
enrollment period; and 
‘‘(ii) an individual who elects to enroll 
in continuation coverage will remain eligi-
ble to enroll in a qualified health plan of-
fered through such Exchange during an 
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open enrollment period and may be eligible 
for financial assistance with respect to en-
rolling in such a qualified health plan; 
‘‘(D) information on consumer protections 
with respect to enrolling in a qualified health 
plan offered through such Exchange, including 
the requirement for such a qualified health plan 
to provide coverage for essential health benefits 
(as defined in section 1302(b) of the Patient 
Protection and Affordable Care Act) and the re-
quirements applicable to such a qualified health 
plan under part A of title XXVII of the Public 
Health Service Act; and 
‘‘(E) information on the availability of fi-
nancial assistance with respect to enrolling in a 
qualified health plan, including the maximum 
income limit for eligibility for a premium tax 
credit under section 36B of the Internal Rev-
enue Code of 1986.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply with respect to quali-
fying events occurring on or after the date that is 
14 days after the date of the enactment of this Act. 
(b) PUBLIC HEALTH SERVICE ACT.— 
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(1) IN GENERAL.—Section 2206 of the Public 
Health Service Act (42 U.S.C. 300bb–6) is amend-
ed— 
(A) by striking ‘‘In accordance’’ and in-
serting the following: 
‘‘(a) IN GENERAL.—In accordance’’; 
(B) by striking ‘‘of such beneficiary’s 
rights under this subsection’’ and inserting ‘‘of 
such beneficiary’s rights under this title in ac-
cordance with the notification requirements 
under subsection (b)’’; and 
(C) by striking ‘‘For purposes of para-
graph (4),’’ and all that follows through ‘‘such 
notification is made.’’ and inserting the fol-
lowing: 
‘‘(b) RULES RELATING TO NOTIFICATION OF QUALI-
FIED BENEFICIARIES
BY PLAN ADMINISTRATOR.—For 
purposes of subsection (a)(4)— 
‘‘(1) any notification shall be made within 14 
days of the date on which the plan administrator is 
notified under paragraph (2) or (3) of subsection 
(a), whichever is applicable; 
‘‘(2) any such notification to an individual who 
is a qualified beneficiary as the spouse of the cov-
ered employee shall be treated as notification to all 
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other qualified beneficiaries residing with such 
spouse at the time such notification is made; and 
‘‘(3) any such notification shall, with respect to 
each qualified beneficiary with respect to whom such 
notification is made, include information regarding 
any Exchange established under title I of the Pa-
tient Protection and Affordable Care Act through 
which such a qualified beneficiary may be eligible to 
enroll in a qualified health plan (as defined in sec-
tion 1301 of the Patient Protection and Affordable 
Care Act), including— 
‘‘(A) 
the 
publicly 
accessible 
Internet 
website address for such Exchange; 
‘‘(B) 
the 
publicly 
accessible 
Internet 
website address for the Find Local Help direc-
tory maintained by the Department of Health 
and Human Services on the healthcare.gov 
Internet website (or a successor website); 
‘‘(C) a clear explanation that— 
‘‘(i) an individual who is eligible for 
continuation coverage may also be eligible 
to enroll, with financial assistance, in a 
qualified health plan offered through such 
Exchange, but, in the case that such indi-
vidual elects to enroll in such continuation 
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coverage and subsequently elects to termi-
nate such continuation coverage before the 
period of such continuation coverage ex-
pires, such individual will not be eligible to 
enroll in a qualified health plan offered 
through such Exchange during a special 
enrollment period; and 
‘‘(ii) an individual who elects to enroll 
in continuation coverage will remain eligi-
ble to enroll in a qualified health plan of-
fered through such Exchange during an 
open enrollment period and may be eligible 
for financial assistance with respect to en-
rolling in such a qualified health plan; 
‘‘(D) information on consumer protections 
with respect to enrolling in a qualified health 
plan offered through such Exchange, including 
the requirement for such a qualified health plan 
to provide coverage for essential health benefits 
(as defined in section 1302(b) of the Patient 
Protection and Affordable Care Act) and the re-
quirements applicable to such a qualified health 
plan under part A of title XXVII; and 
‘‘(E) information on the availability of fi-
nancial assistance with respect to enrolling in a 
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qualified health plan, including the maximum 
income limit for eligibility for a premium tax 
credit under section 36B of the Internal Rev-
enue Code of 1986.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply with respect to quali-
fying events occurring on or after the date that is 
14 days after the date of the enactment of this Act. 
(c) INTERNAL REVENUE CODE OF 1986.— 
(1) IN GENERAL.—Section 4980B(f)(6) of the 
Internal Revenue Code of 1986 is amended— 
(A) in subparagraph (D)— 
(i) in clause (ii), by striking ‘‘under 
subparagraph (C)’’ and inserting ‘‘under 
clause (iii)’’; and 
(ii) by redesignating clauses (i) and 
(ii) as subclauses (I) and (II), respectively, 
and moving the margin of each such sub-
clause, as so redesignated, 2 ems to the 
right; 
(B) by redesignating subparagraphs (A) 
through (D) as clauses (i) through (iv), respec-
tively, and moving the margin of each such 
clause, as so redesignated, 2 ems to the right; 
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(C) by striking ‘‘In accordance’’ and in-
serting the following: 
‘‘(A) IN GENERAL.—In accordance’’; 
(D) by inserting after ‘‘of such bene-
ficiary’s rights under this subsection’’ the fol-
lowing: ‘‘in accordance with the notification re-
quirements under subparagraph (C)’’; and 
(E) by striking ‘‘The requirements of sub-
paragraph (B)’’ and all that follows through 
‘‘such notification is made.’’ and inserting the 
following: 
‘‘(B) ALTERNATIVE
MEANS
OF
COMPLI-
ANCE WITH REQUIREMENT FOR NOTIFICATION 
OF MULTIEMPLOYER PLANS BY EMPLOYERS.— 
The requirements of subparagraph (A)(ii) shall 
be considered satisfied in the case of a multiem-
ployer plan in connection with a qualifying 
event described in paragraph (3)(B) if the plan 
provides that the determination of the occur-
rence of such qualifying event will be made by 
the plan administrator. 
‘‘(C) RULES RELATING TO NOTIFICATION 
OF QUALIFIED BENEFICIARIES BY PLAN ADMIN-
ISTRATOR.—For 
purposes 
of 
subparagraph 
(A)(iv)— 
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‘‘(i) any notification shall be made 
within 14 days (or, in the case of a group 
health plan which is a multiemployer plan, 
such longer period of time as may be pro-
vided in the terms of the plan) of the date 
on which the plan administrator is notified 
under clause (ii) or (iii) of subparagraph 
(A), whichever is applicable; 
‘‘(ii) any such notification to an indi-
vidual who is a qualified beneficiary as the 
spouse of the covered employee shall be 
treated as notification to all other qualified 
beneficiaries residing with such spouse at 
the time such notification is made; and 
‘‘(iii) any such notification shall, with 
respect to each qualified beneficiary with 
respect to whom such notification is made, 
include information regarding any Ex-
change established under title I of the Pa-
tient Protection and Affordable Care Act 
through which such a qualified beneficiary 
may be eligible to enroll in a qualified 
health plan (as defined in section 1301 of 
the Patient Protection and Affordable Care 
Act), including— 
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‘‘(I) the publicly accessible Inter-
net website address for such Ex-
change; 
‘‘(II) 
the 
publicly 
accessible 
Internet website address for the Find 
Local Help directory maintained by 
the 
Department 
of 
Health 
and 
Human Services on the healthcare.gov 
Internet website (or a successor 
website); 
‘‘(III) a clear explanation that— 
‘‘(aa) an individual who is 
eligible for continuation coverage 
may also be eligible to enroll, 
with financial assistance, in a 
qualified 
health 
plan 
offered 
through such Exchange, but, in 
the case that such individual 
elects to enroll in such continu-
ation coverage and subsequently 
elects to terminate such continu-
ation coverage before the period 
of such continuation coverage ex-
pires, such individual will not be 
eligible to enroll in a qualified 
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health plan offered through such 
Exchange during a special enroll-
ment period; and 
‘‘(bb) an individual who 
elects to enroll in continuation 
coverage will remain eligible to 
enroll in a qualified health plan 
offered through such Exchange 
during an open enrollment period 
and may be eligible for financial 
assistance with respect to enroll-
ing in such a qualified health 
plan; 
‘‘(IV) information on consumer 
protections with respect to enrolling in 
a 
qualified 
health 
plan 
offered 
through such Exchange, including the 
requirement for such a qualified 
health plan to provide coverage for es-
sential health benefits (as defined in 
section 1302(b) of the Patient Protec-
tion and Affordable Care Act) and the 
requirements applicable to such a 
qualified health plan under part A of 
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title XXVII of the Public Health 
Service Act; and 
‘‘(V) information on the avail-
ability of financial assistance with re-
spect to enrolling in a qualified health 
plan, including the maximum income 
limit for eligibility for a premium tax 
credit under section 36B.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply with respect to quali-
fying events occurring on or after the date that is 
14 days after the date of the enactment of this Act. 
(d) MODEL NOTICES.—Not later than 14 days after 
the date of the enactment of this Act, the Secretary of 
the Labor, in consultation with the Secretary of the Treas-
ury and the Secretary of Health and Human Services, 
shall— 
(1) update the model Consolidated Omnibus 
Budget Reconciliation Act of 1985 (referred to in 
this subsection as ‘‘COBRA’’) continuation coverage 
general notice and the model COBRA continuation 
coverage election notice developed by the Secretary 
of Labor for purposes of facilitating compliance of 
group health plans with the notification require-
ments under section 606 of the Employee Retire-
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ment Income Security Act of 1974 (29 U.S.C. 1166) 
to include the information described in paragraph 
(3) of subsection (c) of such section 606, as added 
by subsection (a)(1); 
(2) provide an opportunity for consumer testing 
of each such notice, as so updated, to ensure that 
each such notice is clear and understandable to the 
average participant or beneficiary of a group health 
plan; and 
(3) rename the model COBRA continuation 
coverage general notice and the model COBRA con-
tinuation coverage election notice as the ‘‘model 
COBRA continuation coverage and Affordable Care 
Act coverage general notice’’ and the ‘‘model 
COBRA continuation coverage and Affordable Care 
Act coverage election notice’’, respectively. 
SEC. 30306. SOONER COVERAGE OF TESTING FOR COVID–19. 
Section 6001(a) of division F of the Families First 
Coronavirus Response Act (42 U.S.C. 1320b–5 note) is 
amended by striking ‘‘beginning on or after’’ and inserting 
‘‘beginning before, on, or after’’. 
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SEC. 30307. RISK CORRIDOR PROGRAM FOR HEALTH IN-
SURANCE COVERAGE OFFERED IN THE INDI-
VIDUAL OR SMALL GROUP MARKET. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish and administer a program of risk 
corridors for plan years 2020 and 2021 under which the 
Secretary shall make payments to health insurance issuers 
offering health insurance coverage in the individual or 
small group market based on the ratio of the allowable 
costs of the coverage to the aggregate premiums of the 
coverage. 
(b) PAYMENT METHODOLOGY.—The Secretary shall 
provide under the program established under subsection 
(a) that if the allowable costs for a health insurance issuer 
offering health insurance coverage in the individual or 
small group market for any plan year are more than 105 
percent of the target amount, the Secretary shall pay to 
the issuer an amount equal to 75 percent of the allowable 
costs in excess of 105 percent of the target amount. 
(c) INFORMATION COLLECTION.—The Secretary shall 
establish a process under which information is collected 
from health insurance issuers offering health insurance 
coverage in the individual or small group market for pur-
poses of carrying out this section. 
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(d) NON-APPLICATION.—The provisions of this sec-
tion shall not apply with respect to any group or individual 
health insurance coverage in relation to its provision of 
excepted benefits described in section 2791(c)(1) of the 
Public Health Service Act (42 U.S.C. 300gg–91(c)). 
(e) DEFINITIONS.—In this section: 
(1) ALLOWABLE COSTS.— 
(A) IN GENERAL.—The amount of allow-
able costs of a health insurance issuer offering 
health insurance coverage in the individual or 
small group market for any year is an amount 
equal to the total costs (other than administra-
tive costs) of such issuer in providing benefits 
covered by such coverage. 
(B) 
CERTAIN
REDUCTIONS.—Allowable 
costs shall reduced by any— 
(i) risk adjustment payments received 
under section 1343 of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 
18063); and 
(ii) reinsurance payments received 
pursuant to a waiver approved under sec-
tion 1332 of such Act (42 U.S.C. 18052). 
(2) ADDITIONAL
TERMS.—The terms ‘‘health 
insurance issuer’’, ‘‘health insurance coverage’’, ‘‘in-
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dividual market’’, and ‘‘small group market’’ have 
the meanings given such terms in section 2791 of 
the Public Health Service Act (42 U.S.C. 300gg– 
91). 
(3) TARGET AMOUNT.—The target amount of 
health insurance coverage offered in the individual 
or small group market for any year is an amount 
equal to the total premiums (including any premium 
subsidies under any governmental program), reduced 
by the administrative costs of the coverage. 
(f) TREATMENT FOR MLR.—Payments made under 
this section with respect to an applicable plan year to a 
health insurance issuer offering health insurance coverage 
in the individual or small group market shall for purposes 
of section 2718(b) of the Public Health Service Act (42 
U.S.C. 300gg–18(b)) be included in the calculation of the 
premium revenue with respect to such issuer and year. 
(g) IMPLEMENTATION.—The Secretary of Health and 
Human Services may implement the provisions of this sec-
tion by subregulatory guidance, program instruction, or 
otherwise. 
(h) APPROPRIATION.—There are appropriated, out of 
any monies in the Treasury not otherwise appropriated, 
such sums as may be necessary to carry out this section. 
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SEC. 30308. RISK CORRIDOR PROGRAM FOR SELF-INSURED 
GROUP HEALTH PLANS AND HEALTH INSUR-
ANCE COVERAGE OFFERED IN THE LARGE 
GROUP MARKET. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’), in coordination with the Secretary of Labor and 
the Secretary of the Treasury, shall establish and admin-
ister a program of risk corridors for plan years 2020 and 
2021 under which the Secretary, in coordination with the 
Secretary of Labor and the Secretary of the Treasury, 
shall make payments in accordance with subsection (b) to 
self-insured group health plans and health insurance 
issuers offering health insurance coverage in the large 
group market. 
(b) PAYMENT METHODOLOGY.—The Secretary, in 
coordination with the Secretary of Labor and the Sec-
retary of the Treasury, shall provide under the program 
established under subsection (a) that if the allowable costs 
for a self-insured group health plan or health insurance 
coverage offered in the large group market for any plan 
year are more than 105 percent of the target amount, the 
Secretary shall pay to the plan, or issuer of such coverage, 
an amount equal to 75 percent of the allowable costs in 
excess of 105 percent of the target amount. 
(c) INFORMATION COLLECTION.— 
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(1) IN GENERAL.—The Secretary, the Secretary 
of Labor, and the Secretary of the Treasury may re-
quire self-insured group health plans and health in-
surance issuers of health insurance coverage offered 
in the large group market to report to the applicable 
Secretary, in a form, manner, and timeframe speci-
fied by the Secretaries, information necessary for 
purposes of carrying out this section in accordance 
with the process established under paragraph (2). 
(2) PROCESS.—The Secretary, the Secretary of 
Labor, and the Secretary of the Treasury shall joint-
ly establish a process prescribing the form and man-
ner under which information is collected from self- 
insured group health plans and health insurance 
issuers offering health insurance coverage in the 
large group market for purposes of carrying out this 
section. 
(d) DEFINITIONS.— 
(1) ALLOWABLE COSTS.— 
(A) IN GENERAL.—The amount of allow-
able costs of a self-insured group health plan or 
health insurance coverage offered in the large 
group market for any plan year is an amount 
equal to the total costs (other than administra-
tive costs) of such plan or the issuer of such 
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coverage in covering items and services fur-
nished during such plan year under such plan 
or such coverage. 
(B) 
CERTAIN
REDUCTIONS.—Allowable 
costs of a self-insured group health plan or 
health insurance coverage offered in the large 
group market for a plan year shall be reduced 
by any— 
(i) reinsurance payments received by 
such plan or coverage pursuant to a waiver 
approved under section 1332 of such Act 
(42 U.S.C. 18052) for such plan year; and 
(ii) other payments received by such 
plan or coverage (as specified by the Sec-
retary) for such plan year. 
(2) ADDITIONAL TERMS.—For purposes of this 
section, the terms ‘‘excepted benefits’’, ‘‘health in-
surance issuer’’, ‘‘health insurance coverage’’, and 
‘‘large group market’’ have the meanings given such 
terms in section 2791 of the Public Health Service 
Act (42 U.S.C. 300gg–91), section 733 of the Em-
ployee Retirement Income Security Act of 1974 (29 
U.S.C. 1191b), and section 9832 of the Internal 
Revenue Code of 1986, as applicable, and the term 
‘‘self-insured group health plan’’ has the meaning 
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given such term for purposes of section 2701(a)(5) 
of the Public Health Service Act (42 U.S.C. 
300gg(a)(5)). 
(3) TARGET AMOUNT.— 
(A) IN
GENERAL.—The target amount 
of— 
(i) a self-insured group health plan for 
an applicable plan year is— 
(I) in the case such plan was of-
fered during the preceding plan year 
and was subject to the requirement of 
section 601(a) of the Employee Re-
tirement Income Security Act of 1974 
(29 U.S.C. 1161(a)) during such pre-
ceding plan year, the expected cost to 
the plan for all individuals covered 
under such plan for such preceding 
plan year (without regard to whether 
such cost is paid by the employer or 
employee), taking into account appli-
cable premiums (as defined in section 
604(a) of such Act (29 U.S.C. 
1164(1))) for such plan and preceding 
plan year, reduced by any administra-
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tive costs for such preceding plan year 
and increased by 5 percent; or 
(II) in the case such plan is not 
described in subclause (I), the ex-
pected cost to the plan for all individ-
uals covered under such plan for such 
applicable plan year (as determined 
under a methodology specified by the 
Secretary), reduced by any adminis-
trative costs for such plan year; and 
(ii) health insurance coverage offered 
in the large group market for an applicable 
plan year is an amount equal to the total 
premiums (including any premium sub-
sidies under any governmental program), 
as defined by the Secretary, for such plan 
year, reduced by the administrative costs 
of the coverage for such plan year. 
(B) APPLICABLE PLAN YEAR.—The term 
‘‘applicable plan year’’ means plan year 2020 or 
plan year 2021, as applicable. 
(e) APPLICATION.— 
(1) IN GENERAL.—The provisions of subsection 
(c) shall be applied by the Secretary of Health and 
Human Services, the Secretary of Labor, and the 
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Secretary of the Treasury to group health plans and 
health insurance issuers offering health insurance 
coverage in the large group market as if such sub-
section were included in the provisions of part A of 
title XXVII of the Public Health Service Act (42 
U.S.C. 300gg et seq.), part 7 of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 
1181 et seq.), and subchapter B of chapter 100 of 
the Internal Revenue Code of 1986, as applicable. 
(2) TREATMENT
FOR
MLR.—Payments made 
under this section with respect to an applicable plan 
year to a self-insured group health plan or health in-
surance issuer offering health insurance coverage in 
the large group market shall for purposes of section 
2718(b) of the Public Health Service Act (42 U.S.C. 
300gg–18(b)) be included in the calculation of the 
premium revenue with respect to such plan or issuer, 
respectively, and year. 
(f) NON-APPLICATION.—The provisions of this sec-
tion shall not apply with respect to— 
(1) any group health plan or group or indi-
vidual health insurance coverage in relation to its 
provision of excepted benefits; or 
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(2) a grandfathered health plan, as defined in 
section 1251(e) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18011(e)). 
(g) IMPLEMENTATION.—The Secretary, the Sec-
retary of Labor, and the Secretary of the Treasury may 
implement the provisions of this section by subregulatory 
guidance, program instruction, or otherwise. 
(h) APPROPRIATION.—There are appropriated, out of 
any monies in the Treasury not otherwise appropriated, 
such sums as may be necessary to carry out this section. 
Subtitle B—Worker Health 
Coverage Protection 
SEC. 30311. SHORT TITLE. 
This subtitle may be cited as the ‘‘Worker Health 
Coverage Protection Act’’. 
SEC. 30312. PRESERVING HEALTH BENEFITS FOR WORK-
ERS. 
(a) PREMIUM ASSISTANCE FOR COBRA CONTINU-
ATION COVERAGE
AND FURLOUGHED CONTINUATION 
COVERAGE FOR INDIVIDUALS AND THEIR FAMILIES.— 
(1) PROVISION OF PREMIUM ASSISTANCE.— 
(A) 
REDUCTION
OF
PREMIUMS
PAY-
ABLE.— 
(i) 
COBRA 
CONTINUATION
COV-
ERAGE.—In the case of any premium for a 
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period of coverage during the period begin-
ning on March 1, 2020, and ending on 
January 31, 2021 for COBRA continu-
ation coverage with respect to any assist-
ance eligible individual described in para-
graph (3)(A), such individual shall be 
treated for purposes of any COBRA con-
tinuation provision as having paid the 
amount of such premium if such individual 
pays (and any person other than such indi-
vidual’s employer pays on behalf of such 
individual) 0 percent of the amount of 
such premium owed by such individual (as 
determined without regard to this sub-
section). 
(ii) 
FURLOUGHED
CONTINUATION 
COVERAGE.—In the case of any premium 
for a period of coverage during the period 
beginning on March 1, 2020, and ending 
on January 31, 2021 for coverage under a 
group health plan with respect to any as-
sistance eligible individual described in 
paragraph (3)(B), such individual shall be 
treated for purposes of coverage under the 
plan offered by the plan sponsor in which 
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the individual is enrolled as having paid 
the amount of such premium if such indi-
vidual pays (and any person other than 
such individual’s employer pays on behalf 
of such individual) 0 percent of the 
amount of such premium owed by such in-
dividual (as determined without regard to 
this subsection). 
(B) PLAN ENROLLMENT OPTION.— 
(i) IN
GENERAL.—Notwithstanding 
the COBRA continuation provisions, any 
assistance eligible individual who is en-
rolled in a group health plan offered by a 
plan sponsor may, not later than 90 days 
after the date of notice of the plan enroll-
ment option described in this subpara-
graph, elect to enroll in coverage under a 
plan offered by such plan sponsor that is 
different than coverage under the plan in 
which such individual was enrolled at the 
time— 
(I) in the case of any assistance 
eligible individual described in para-
graph (3)(A), the qualifying event 
specified in section 603(2) of the Em-
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ployee Retirement Income Security 
Act of 1974, section 4980B(f)(3)(B) 
of the Internal Revenue Code of 1986, 
section 2203(2) of the Public Health 
Service Act, or section 8905a of title 
5, United States Code (except for the 
voluntary termination of such individ-
ual’s employment by such individual), 
occurred, and such coverage shall be 
treated as COBRA continuation cov-
erage for purposes of the applicable 
COBRA continuation coverage provi-
sion; or 
(II) in the case of any assistance 
eligible individual described in para-
graph (3)(B), the furlough period 
began with respect to such individual. 
(ii) REQUIREMENTS.—Any assistance 
eligible individual may elect to enroll in 
different coverage as described in clause (i) 
only if— 
(I) the employer involved has 
made a determination that such em-
ployer will permit such assistance eli-
gible individual to enroll in different 
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coverage as provided under this sub-
paragraph; 
(II) the premium for such dif-
ferent coverage does not exceed the 
premium for coverage in which such 
individual was enrolled at the time 
such qualifying event occurred or im-
mediately before such furlough began; 
(III) the different coverage in 
which the individual elects to enroll is 
coverage that is also offered to the ac-
tive employees of the employer, who 
are not in a furlough period, at the 
time at which such election is made; 
and 
(IV) the different coverage in 
which the individual elects to enroll is 
not— 
(aa) coverage that provides 
only dental, vision, counseling, or 
referral services (or a combina-
tion of such services); 
(bb) a qualified small em-
ployer health reimbursement ar-
rangement (as defined in section 
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9831(d)(2) of the Internal Rev-
enue Code of 1986); 
(cc) a flexible spending ar-
rangement (as defined in section 
106(c)(2) of the Internal Rev-
enue Code of 1986); or 
(dd) benefits that provide 
coverage for services or treat-
ments furnished in an on-site 
medical facility maintained by 
the employer and that consists 
primarily of first-aid services, 
prevention and wellness care, or 
similar care (or a combination of 
such care). 
(C) PREMIUM REIMBURSEMENT.—For pro-
visions providing the payment of such premium, 
see section 6432 of the Internal Revenue Code 
of 1986, as added by paragraph (14). 
(2) LIMITATION OF PERIOD OF PREMIUM AS-
SISTANCE.— 
(A) ELIGIBILITY
FOR
ADDITIONAL
COV-
ERAGE.—Paragraph (1)(A) shall not apply with 
respect to— 
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(i) any assistance eligible individual 
described in paragraph (3)(A) for months 
of coverage beginning on or after the ear-
lier of— 
(I) the first date that such indi-
vidual is eligible for coverage under 
any other group health plan (other 
than coverage consisting of only den-
tal, vision, counseling, or referral serv-
ices (or a combination thereof), cov-
erage under a flexible spending ar-
rangement (as defined in section 
106(c)(2) of the Internal Revenue 
Code of 1986), coverage of treatment 
that is furnished in an on-site medical 
facility maintained by the employer 
and that consists primarily of first-aid 
services, prevention and wellness care, 
or similar care (or a combination 
thereof)), or eligible for benefits under 
the Medicare program under title 
XVIII of the Social Security Act; or 
(II) the earliest of— 
(aa) the date following the 
expiration of the maximum pe-
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riod of continuation coverage re-
quired 
under 
the 
applicable 
COBRA continuation coverage 
provision; or 
(bb) the date following the 
expiration of the period of con-
tinuation coverage allowed under 
paragraph (4)(B)(ii); or 
(ii) any assistance eligible individual 
described in paragraph (3)(B) for months 
of coverage beginning on or after the ear-
lier of— 
(I) the first date that such indi-
vidual is eligible for coverage under 
any other group health plan (other 
than coverage consisting of only den-
tal, vision, counseling, or referral serv-
ices (or a combination thereof), cov-
erage under a flexible spending ar-
rangement (as defined in section 
106(c)(2) of the Internal Revenue 
Code of 1986), coverage of treatment 
that is furnished in an on-site medical 
facility maintained by the employer 
and that consists primarily of first-aid 
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services, prevention and wellness care, 
or similar care (or a combination 
thereof)), or eligible for benefits under 
the Medicare program under title 
XVIII of the Social Security Act; or 
(II) the first date that such indi-
vidual is no longer in the furlough pe-
riod. 
(B) NOTIFICATION
REQUIREMENT.—Any 
assistance eligible individual shall notify the 
group health plan with respect to which para-
graph (1)(A) applies if such paragraph ceases 
to apply by reason of clause (i)(I) or (ii)(I) of 
subparagraph (A) (as applicable). Such notice 
shall be provided to the group health plan in 
such time and manner as may be specified by 
the Secretary of Labor. 
(C) SPECIAL ENROLLMENT PERIOD FOL-
LOWING
EXPIRATION
OF
PREMIUM
ASSIST-
ANCE.—Notwithstanding section 1311 of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18031), the expiration of premium as-
sistance pursuant to a limitation specified 
under subparagraph (A) shall be treated as a 
qualifying event for which any assistance eligi-
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ble individual is eligible to enroll in a qualified 
health plan offered through an Exchange under 
title I of such Act (42 U.S.C. 18001 et seq.) 
during a special enrollment period. 
(3) ASSISTANCE
ELIGIBLE
INDIVIDUAL.—For 
purposes of this section, the term ‘‘assistance eligible 
individual’’ means, with respect to a period of cov-
erage during the period beginning on March 1, 
2020, and ending on January 31, 2021— 
(A) any individual that is a qualified bene-
ficiary that— 
(i) is eligible for COBRA continuation 
coverage by reason of a qualifying event 
specified in section 603(2) of the Employee 
Retirement Income Security Act of 1974, 
section 4980B(f)(3)(B) of the Internal 
Revenue Code of 1986, section 2203(2) of 
the Public Health Service Act, or section 
8905a of title 5, United States Code (ex-
cept for the voluntary termination of such 
individual’s employment by such indi-
vidual); and 
(ii) elects such coverage; or 
(B) any covered employee that is in a fur-
lough period that remains eligible for coverage 
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under a group health plan offered by the em-
ployer of such covered employee. 
(4) EXTENSION OF ELECTION PERIOD AND EF-
FECT ON COVERAGE.— 
(A) IN GENERAL.—For purposes of apply-
ing section 605(a) of the Employee Retirement 
Income 
Security 
Act 
of 
1974, 
section 
4980B(f)(5)(A) of the Internal Revenue Code 
of 1986, section 2205(a) of the Public Health 
Service Act, and section 8905a(c)(2) of title 5, 
United States Code, in the case of— 
(i) an individual who does not have an 
election of COBRA continuation coverage 
in effect on the date of the enactment of 
this Act but who would be an assistance el-
igible individual described in paragraph 
(3)(A) if such election were so in effect; or 
(ii) an individual who elected COBRA 
continuation coverage on or after March 1, 
2020, and discontinued from such coverage 
before the date of the enactment of this 
Act, 
such individual may elect the COBRA continu-
ation coverage under the COBRA continuation 
coverage provisions containing such provisions 
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during the period beginning on the date of the 
enactment of this Act and ending 60 days after 
the date on which the notification required 
under paragraph (7)(C) is provided to such in-
dividual. 
(B) COMMENCEMENT OF COBRA CONTINU-
ATION COVERAGE.—Any COBRA continuation 
coverage elected by a qualified beneficiary dur-
ing an extended election period under subpara-
graph (A)— 
(i) shall apply as if such qualified ben-
eficiary had been covered as of the date of 
a qualifying event specified in section 
603(2) of the Employee Retirement In-
come Security Act of 1974, section 
4980B(f)(3)(B) of the Internal Revenue 
Code of 1986, section 2203(2) of the Pub-
lic Health Service Act, or section 8905a of 
title 5, United States Code, except for the 
voluntary termination of such beneficiary’s 
employment by such beneficiary, that oc-
curs no earlier than March 1, 2020 (in-
cluding the treatment of premium pay-
ments under paragraph (1)(A) and any 
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cost-sharing requirements for items and 
services under a group health plan); and 
(ii) shall not extend beyond the period 
of COBRA continuation coverage that 
would have been required under the appli-
cable COBRA continuation coverage provi-
sion if the coverage had been elected as re-
quired under such provision. 
(5) EXPEDITED REVIEW OF DENIALS OF PRE-
MIUM ASSISTANCE.—In any case in which an indi-
vidual requests treatment as an assistance eligible 
individual described in subparagraph (A) or (B) of 
paragraph (3) and is denied such treatment by the 
group health plan, the Secretary of Labor (or the 
Secretary of Health and Human Services in connec-
tion with COBRA continuation coverage which is 
provided other than pursuant to part 6 of subtitle B 
of title I of the Employee Retirement Income Secu-
rity Act of 1974), in consultation with the Secretary 
of the Treasury, shall provide for expedited review of 
such denial. An individual shall be entitled to such 
review upon application to such Secretary in such 
form and manner as shall be provided by such Sec-
retary, in consultation with the Secretary of Treas-
ury. Such Secretary shall make a determination re-
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garding such individual’s eligibility within 15 busi-
ness days after receipt of such individual’s applica-
tion for review under this paragraph. Either Sec-
retary’s determination upon review of the denial 
shall be de novo and shall be the final determination 
of such Secretary. A reviewing court shall grant def-
erence to such Secretary’s determination. The provi-
sions of this paragraph, paragraphs (1) through (4), 
and paragraphs (7) through (9) shall be treated as 
provisions of title I of the Employee Retirement In-
come Security Act of 1974 for purposes of part 5 of 
subtitle B of such title. 
(6) DISREGARD OF SUBSIDIES FOR PURPOSES 
OF
FEDERAL
AND
STATE
PROGRAMS.—Notwith-
standing any other provision of law, any premium 
assistance with respect to an assistance eligible indi-
vidual under this subsection shall not be considered 
income, in-kind support, or resources for purposes of 
determining the eligibility of the recipient (or the re-
cipient’s spouse or family) for benefits or assistance, 
or the amount or extent of benefits or assistance, or 
any other benefit provided under any Federal pro-
gram or any program of a State or political subdivi-
sion thereof financed in whole or in part with Fed-
eral funds. 
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(7) COBRA-SPECIFIC NOTICE.— 
(A) GENERAL NOTICE.— 
(i) IN GENERAL.—In the case of no-
tices provided under section 606(a)(4) of 
the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1166(4)), section 
4980B(f)(6)(D) of the Internal Revenue 
Code of 1986, section 2206(4) of the Pub-
lic Health Service Act (42 U.S.C. 300bb– 
6(4)), or section 8905a(f)(2)(A) of title 5, 
United States Code, with respect to indi-
viduals who, during the period described in 
paragraph (3), become entitled to elect 
COBRA continuation coverage, the re-
quirements of such provisions shall not be 
treated as met unless such notices include 
an additional notification to the recipient a 
written notice in clear and understandable 
language of— 
(I) the availability of premium 
assistance with respect to such cov-
erage under this subsection; and 
(II) the option to enroll in dif-
ferent coverage if the employer per-
mits assistance eligible individuals de-
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scribed in paragraph (3)(A) to elect 
enrollment in different coverage (as 
described in paragraph (1)(B)). 
(ii) ALTERNATIVE
NOTICE.—In the 
case of COBRA continuation coverage to 
which the notice provision under such sec-
tions does not apply, the Secretary of 
Labor, in consultation with the Secretary 
of the Treasury and the Secretary of 
Health and Human Services, shall, in con-
sultation with administrators of the group 
health plans (or other entities) that provide 
or administer the COBRA continuation 
coverage involved, provide rules requiring 
the provision of such notice. 
(iii) FORM.—The requirement of the 
additional notification under this subpara-
graph may be met by amendment of exist-
ing notice forms or by inclusion of a sepa-
rate document with the notice otherwise 
required. 
(B) SPECIFIC REQUIREMENTS.—Each ad-
ditional notification under subparagraph (A) 
shall include— 
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(i) the forms necessary for estab-
lishing eligibility for premium assistance 
under this subsection; 
(ii) the name, address, and telephone 
number necessary to contact the plan ad-
ministrator and any other person main-
taining relevant information in connection 
with such premium assistance; 
(iii) a description of the extended elec-
tion period provided for in paragraph 
(4)(A); 
(iv) a description of the obligation of 
the qualified beneficiary under paragraph 
(2)(B) and the penalty provided under sec-
tion 6720C of the Internal Revenue Code 
of 1986 for failure to carry out the obliga-
tion; 
(v) a description, displayed in a 
prominent manner, of the qualified bene-
ficiary’s right to a reduced premium and 
any conditions on entitlement to the re-
duced premium; 
(vi) a description of the option of the 
qualified beneficiary to enroll in different 
coverage if the employer permits such ben-
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eficiary to elect to enroll in such different 
coverage under paragraph (1)(B); and 
(vii) information regarding any Ex-
change established under title I of the Pa-
tient Protection and Affordable Care Act 
(42 U.S.C. 18001 et seq.) through which a 
qualified beneficiary may be eligible to en-
roll in a qualified health plan, including— 
(I) the publicly accessible inter-
net website address for such Ex-
change; 
(II) the publicly accessible inter-
net website address for the Find 
Local Help directory maintained by 
the 
Department 
of 
Health 
and 
Human Services on the healthcare.gov 
internet 
website 
(or 
a 
successor 
website); 
(III) a clear explanation that— 
(aa) an individual who is eli-
gible for continuation coverage 
may also be eligible to enroll, 
with financial assistance, in a 
qualified 
health 
plan 
offered 
through such Exchange, but, in 
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the case that such individual 
elects to enroll in such continu-
ation coverage and subsequently 
elects to terminate such continu-
ation coverage before the period 
of such continuation coverage ex-
pires, such termination does not 
initiate a special enrollment pe-
riod (absent a qualifying event 
specified in section 603(2) of the 
Employee Retirement Income Se-
curity 
Act 
of 
1974, 
section 
4980B(f)(3)(B) of the Internal 
Revenue Code of 1986, section 
2203(2) of the Public Health 
Service Act, or section 8905a of 
title 5, United States Code, with 
respect to such individual); and 
(bb) an individual who elects 
to enroll in continuation coverage 
will remain eligible to enroll in a 
qualified 
health 
plan 
offered 
through such Exchange during 
an open enrollment period and 
may be eligible for financial as-
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sistance with respect to enrolling 
in such a qualified health plan; 
(IV) information on consumer 
protections with respect to enrolling in 
a 
qualified 
health 
plan 
offered 
through such Exchange, including the 
requirement for such a qualified 
health plan to provide coverage for es-
sential health benefits (as defined in 
section 1302(b) of such Act (42 
U.S.C. 18022(b))) and the require-
ments applicable to such a qualified 
health plan under part A of title 
XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.); 
(V) information on the avail-
ability of financial assistance with re-
spect to enrolling in a qualified health 
plan, including the maximum income 
limit for eligibility for the premium 
tax credit under section 36B of the 
Internal Revenue Code of 1986; and 
(VI) information on any special 
enrollment periods during which any 
assistance eligible individual described 
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in paragraph (3)(A)(i) may be eligible 
to enroll, with financial assistance, in 
a 
qualified 
health 
plan 
offered 
through such Exchange (including a 
special enrollment period for which an 
individual may be eligible due to the 
expiration of premium assistance pur-
suant to a limitation specified under 
paragraph (2)(A)). 
(C) NOTICE
IN
CONNECTION
WITH
EX-
TENDED ELECTION PERIODS.—In the case of 
any assistance eligible individual described in 
paragraph (3)(A) (or any individual described 
in paragraph (4)(A)) who became entitled to 
elect COBRA continuation coverage before the 
date of the enactment of this Act, the adminis-
trator of the applicable group health plan (or 
other entity) shall provide (within 60 days after 
the date of enactment of this Act) for the addi-
tional notification required to be provided under 
subparagraph (A) and failure to provide such 
notice shall be treated as a failure to meet the 
notice 
requirements 
under 
the 
applicable 
COBRA continuation provision. 
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(D) MODEL NOTICES.—Not later than 30 
days after the date of enactment of this Act, 
with respect to any assistance eligible individual 
described in paragraph (3)(A)— 
(i) the Secretary of Labor, in con-
sultation with the Secretary of the Treas-
ury and the Secretary of Health and 
Human Services, shall prescribe models for 
the additional notification required under 
this paragraph (other than the additional 
notification described in clause (ii)); and 
(ii) in the case of any additional noti-
fication provided pursuant to subpara-
graph (A) under section 8905a(f)(2)(A) of 
title 5, United States Code, the Office of 
Personnel Management shall prescribe a 
model for such additional notification. 
(8) FURLOUGH-SPECIFIC NOTICE.— 
(A) IN GENERAL.—With respect to any as-
sistance eligible individual described in para-
graph (3)(B) who, during the period described 
in such paragraph, becomes eligible for assist-
ance pursuant to paragraph (1)(A)(ii), the re-
quirements of section 606(a)(4) of the Em-
ployee Retirement Income Security Act of 1974 
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443 
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(29 U.S.C. 1166(4)), section 4980B(f)(6)(D) of 
the Internal Revenue Code of 1986, section 
2206(4) of the Public Health Service Act (42 
U.S.C. 300bb–6(4)), or section 8905a(f)(2)(A) 
of title 5, United States Code, shall not be 
treated as met unless the group health plan ad-
ministrator, in accordance with the timing re-
quirement specified under subparagraph (B), 
provides to the individual a written notice in 
clear and understandable language of— 
(i) the availability of premium assist-
ance with respect to such coverage under 
this subsection; 
(ii) the option of the qualified bene-
ficiary to enroll in different coverage if the 
employer permits such beneficiary to elect 
to enroll in such different coverage under 
paragraph (1)(B); and 
(iii) the information specified under 
paragraph (7)(B) (as applicable). 
(B) TIMING SPECIFIED.—For purposes of 
subparagraph (A), the timing requirement spec-
ified in this subparagraph is— 
(i) with respect to such an individual 
who is within a furlough period during the 
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period beginning on March 1, 2020, and 
ending on the date of the enactment of this 
Act, 30 days after the date of such enact-
ment; and 
(ii) with respect to such an individual 
who is within a furlough period during the 
period beginning on the first day after the 
date of the enactment of this Act and end-
ing on January 31, 2021, 30 days after 
the date of the beginning of such furlough 
period. 
(C) MODEL NOTICES.—Not later than 30 
days after the date of enactment of this Act, 
with respect to any assistance eligible individual 
described in paragraph (3)(B)— 
(i) the Secretary of Labor, in con-
sultation with the Secretary of the Treas-
ury and the Secretary of Health and 
Human Services, shall prescribe models for 
the notification required under this para-
graph (other than the notification de-
scribed in clause (ii)); and 
(ii) in the case of any notification pro-
vided pursuant to subparagraph (A) under 
section 8905a(f)(2)(A) of title 5, United 
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States Code, the Office of Personnel Man-
agement shall prescribe a model for such 
notification. 
(9) NOTICE
OF
EXPIRATION
OF
PERIOD
OF 
PREMIUM ASSISTANCE.— 
(A) IN GENERAL.—With respect to any as-
sistance eligible individual, subject to subpara-
graph 
(B), 
the 
requirements 
of 
section 
606(a)(4) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1166(4)), sec-
tion 4980B(f)(6)(D) of the Internal Revenue 
Code of 1986, section 2206(4) of the Public 
Health Service Act (42 U.S.C. 300bb–6(4)), or 
section 8905a(f)(2)(A) of title 5, United States 
Code, shall not be treated as met unless the 
employer of the individual, during the period 
specified under subparagraph (C), provides to 
such individual a written notice in clear and un-
derstandable language— 
(i) that the premium assistance for 
such individual will expire soon and the 
prominent identification of the date of 
such expiration; 
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(ii) that such individual may be eligi-
ble for coverage without any premium as-
sistance through— 
(I) COBRA continuation cov-
erage; or 
(II) coverage under a group 
health plan; 
(iii) that the expiration of premium 
assistance is treated as a qualifying event 
for which any assistance eligible individual 
is eligible to enroll in a qualified health 
plan offered through an Exchange under 
title I of such Act (42 U.S.C. 18001 et 
seq.) during a special enrollment period; 
and 
(iv) the information specified in para-
graph (7)(B)(vii). 
(B) EXCEPTION.—The requirement for the 
group health plan administrator to provide the 
written notice under subparagraph (A) shall be 
waived in the case the premium assistance for 
such individual expires pursuant to clause (i)(I) 
or (ii)(I) of paragraph (2)(A). 
(C) PERIOD SPECIFIED.—For purposes of 
subparagraph (A), the period specified in this 
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subparagraph is, with respect to the date of ex-
piration of premium assistance for any assist-
ance eligible individual pursuant to a limitation 
requiring a notice under this paragraph, the pe-
riod beginning on the day that is 45 days before 
the date of such expiration and ending on the 
day that is 15 days before the date of such ex-
piration. 
(D) MODEL NOTICES.—Not later than 30 
days after the date of enactment of this Act, 
with respect to any assistance eligible indi-
vidual— 
(i) the Secretary of Labor, in con-
sultation with the Secretary of the Treas-
ury and the Secretary of Health and 
Human Services, shall prescribe models for 
the notification required under this para-
graph (other than the notification de-
scribed in clause (ii)); and 
(ii) in the case of any notification pro-
vided pursuant to subparagraph (A) under 
section 8905a(f)(2)(A) of title 5, United 
States Code, the Office of Personnel Man-
agement shall prescribe a model for such 
notification. 
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(10) REGULATIONS.—The Secretary of the 
Treasury and the Secretary of Labor may jointly 
prescribe such regulations or other guidance as may 
be necessary or appropriate to carry out the provi-
sions of this subsection, including the prevention of 
fraud and abuse under this subsection, except that 
the Secretary of Labor and the Secretary of Health 
and Human Services may prescribe such regulations 
(including interim final regulations) or other guid-
ance as may be necessary or appropriate to carry 
out the provisions of paragraphs (5), (7), (8), (9), 
and (11). 
(11) OUTREACH.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Labor, in consultation with the Secretary of the 
Treasury and the Secretary of Health and 
Human Services, shall provide outreach con-
sisting of public education and enrollment as-
sistance relating to premium assistance pro-
vided under this subsection. Such outreach shall 
target employers, group health plan administra-
tors, public assistance programs, States, insur-
ers, and other entities as determined appro-
priate by such Secretaries. Such outreach shall 
include an initial focus on those individuals 
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electing continuation coverage who are referred 
to in paragraph (7)(C). Information on such 
premium assistance, including enrollment, shall 
also be made available on websites of the De-
partments of Labor, Treasury, and Health and 
Human Services. 
(B) ENROLLMENT
UNDER
MEDICARE.— 
The Secretary of Health and Human Services 
shall provide outreach consisting of public edu-
cation. Such outreach shall target individuals 
who lose health insurance coverage. Such out-
reach shall include information regarding en-
rollment for benefits under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.) for 
purposes of preventing mistaken delays of such 
enrollment by such individuals, including life-
time penalties for failure of timely enrollment. 
(12) DEFINITIONS.—For purposes of this sec-
tion: 
(A) ADMINISTRATOR.—The term ‘‘admin-
istrator’’ has the meaning given such term in 
section 3(16)(A) of the Employee Retirement 
Income Security Act of 1974. 
(B) COBRA CONTINUATION COVERAGE.— 
The term ‘‘COBRA continuation coverage’’ 
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means continuation coverage provided pursuant 
to part 6 of subtitle B of title I of the Em-
ployee Retirement Income Security Act of 1974 
(other than under section 609), title XXII of 
the Public Health Service Act, section 4980B of 
the Internal Revenue Code of 1986 (other than 
subsection (f)(1) of such section insofar as it 
relates to pediatric vaccines), or section 8905a 
of title 5, United States Code, or under a State 
program that provides comparable continuation 
coverage. Such term does not include coverage 
under a health flexible spending arrangement 
under a cafeteria plan within the meaning of 
section 125 of the Internal Revenue Code of 
1986. 
(C) COBRA CONTINUATION PROVISION.— 
The term ‘‘COBRA continuation provision’’ 
means the provisions of law described in sub-
paragraph (B). 
(D) 
COVERED
EMPLOYEE.—The 
term 
‘‘covered employee’’ has the meaning given such 
term in section 607(2) of the Employee Retire-
ment Income Security Act of 1974. 
(E) QUALIFIED BENEFICIARY.—The term 
‘‘qualified beneficiary’’ has the meaning given 
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such term in section 607(3) of the Employee 
Retirement Income Security Act of 1974. 
(F) GROUP
HEALTH
PLAN.—The term 
‘‘group health plan’’ has the meaning given 
such term in section 607(1) of the Employee 
Retirement Income Security Act of 1974. 
(G) STATE.—The term ‘‘State’’ includes 
the District of Columbia, the Commonwealth of 
Puerto Rico, the Virgin Islands, Guam, Amer-
ican Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
(H) PERIOD
OF
COVERAGE.—Any ref-
erence in this subsection to a period of coverage 
shall be treated as a reference to a monthly or 
shorter period of coverage with respect to which 
premiums are charged with respect to such cov-
erage. 
(I) PLAN
SPONSOR.—The term ‘‘plan 
sponsor’’ has the meaning given such term in 
section 3(16)(B) of the Employee Retirement 
Income Security Act of 1974. 
(J) FURLOUGH PERIOD.— 
(i) IN GENERAL.—The term ‘‘furlough 
period’’ means, with respect to an indi-
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(I) such individual’s work hours 
in the month prior (or in the case 
such individual had no work hours in 
the month prior and had work hours 
in the 3 months prior, the last month 
with work hours within the prior 3 
months); and 
(II) such individual’s work hours 
during the period beginning January 
1, 2020 and ending January 31, 
2020. 
(13) REPORTS.— 
(A) INTERIM REPORT.—The Secretary of 
the Treasury and the Secretary of Labor shall 
jointly submit an interim report to the Com-
mittee on Education and Labor, the Committee 
on Ways and Means, and the Committee on En-
ergy and Commerce of the House of Represent-
atives and the Committee on Health, Edu-
cation, Labor, and Pensions and the Committee 
on Finance of the Senate regarding the pre-
mium assistance provided under this subsection 
that includes— 
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(i) the number of individuals provided 
such assistance as of the date of the re-
port; and 
(ii) the total amount of expenditures 
incurred (with administrative expenditures 
noted separately) in connection with such 
assistance as of the date of the report. 
(B) FINAL
REPORT.—As soon as prac-
ticable after the last period of COBRA continu-
ation coverage for which premium assistance is 
provided under this section, the Secretary of the 
Treasury and the Secretary of Labor shall 
jointly submit a final report to each Committee 
referred to in subparagraph (A) that includes— 
(i) the number of individuals provided 
premium assistance under this section; 
(ii) 
the 
average 
dollar 
amount 
(monthly and annually) of premium assist-
ance provided to such individuals; and 
(iii) the total amount of expenditures 
incurred (with administrative expenditures 
noted separately) in connection with pre-
mium assistance under this section. 
(14) COBRA PREMIUM ASSISTANCE.— 
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(A) IN GENERAL.—Subchapter B of chap-
ter 65 of the Internal Revenue Code of 1986 is 
amended by adding at the end the following 
new section: 
‘‘SEC. 6432. CONTINUATION COVERAGE PREMIUM ASSIST-
ANCE. 
‘‘(a) IN GENERAL.—The person to whom premiums 
are payable for continuation coverage under section 
30312(a)(1) of the Worker Health Coverage Protection 
Act shall be allowed as a credit against the tax imposed 
by section 3111(a), or so much of the taxes imposed under 
section 3221(a) as are attributable to the rate in effect 
under section 3111(a), for each calendar quarter an 
amount equal to the premiums not paid by assistance eligi-
ble individuals for such coverage by reason of such section 
30312(a)(1) with respect to such calendar quarter. 
‘‘(b) PERSON TO WHOM PREMIUMS ARE PAYABLE.— 
For purposes of subsection (a), except as otherwise pro-
vided by the Secretary, the person to whom premiums are 
payable under such continuation coverage shall be treated 
as being— 
‘‘(1) in the case of any group health plan which 
is a multiemployer plan (as defined in section 3(37) 
of the Employee Retirement Income Security Act of 
1974), the plan, 
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‘‘(2) in the case of any group health plan not 
described in paragraph (1)— 
‘‘(A) which provides furlough continuation 
coverage described in section 30312(a)(1)(A)(ii) 
of the Worker Health Coverage Protection Act 
or subject to the COBRA continuation provi-
sions contained in— 
‘‘(i) this title, 
‘‘(ii) the Employee Retirement Income 
Security Act of 1974, 
‘‘(iii) the Public Health Service Act, 
or 
‘‘(iv) title 5, United States Code, or 
‘‘(B) under which some or all of the cov-
erage is not provided by insurance, 
the employer maintaining the plan, and 
‘‘(3) in the case of any group health plan not 
described in paragraph (1) or (2), the insurer pro-
viding the coverage under the group health plan. 
‘‘(c) LIMITATIONS AND REFUNDABILITY.— 
‘‘(1) CREDIT
LIMITED
TO
CERTAIN
EMPLOY-
MENT TAXES.—The credit allowed by subsection (a) 
with respect to any calendar quarter shall not exceed 
the tax imposed by section 3111(a), or so much of 
the taxes imposed under section 3221(a) as are at-
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tributable to the rate in effect under section 
3111(a), for such calendar quarter (reduced by any 
credits allowed under subsections (e) and (f) of sec-
tion 3111, sections 7001 and 7003 of the Families 
First Coronavirus Response Act, section 2301 of the 
CARES Act, and sections 20204 and 20212 of the 
COVID–19 Tax Relief Act of 2020 for such quarter) 
on the wages paid with respect to the employment 
of all employees of the employer. 
‘‘(2) REFUNDABILITY OF EXCESS CREDIT.— 
‘‘(A) CREDIT
IS
REFUNDABLE.—If the 
amount of the credit under subsection (a) ex-
ceeds the limitation of paragraph (1) for any 
calendar quarter, such excess shall be treated 
as an overpayment that shall be refunded under 
sections 6402(a) and 6413(b). 
‘‘(B) CREDIT MAY BE ADVANCED.—In an-
ticipation of the credit, including the refundable 
portion under subparagraph (A), the credit may 
be advanced, according to forms and instruc-
tions provided by the Secretary, up to an 
amount calculated under subsection (a) through 
the end of the most recent payroll period in the 
quarter. 
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‘‘(C) TREATMENT
OF
DEPOSITS.—The 
Secretary shall waive any penalty under section 
6656 for any failure to make a deposit of the 
tax imposed by section 3111(a), or so much of 
the taxes imposed under section 3221(a) as are 
attributable to the rate in effect under section 
3111(a), if the Secretary determines that such 
failure was due to the anticipation of the credit 
allowed under this section. 
‘‘(D) TREATMENT
OF
PAYMENTS.—For 
purposes of section 1324 of title 31, United 
States Code, any amounts due to an employer 
under this paragraph shall be treated in the 
same manner as a refund due from a credit 
provision referred to in subsection (b)(2) of 
such section. 
‘‘(3) LIMITATION
ON
REIMBURSEMENT
FOR 
FURLOUGHED EMPLOYEES.—In the case of an indi-
vidual who for any month is an assistance eligible 
individual described in section 30312(a)(3)(B) of the 
Worker Health Coverage Protection Act with respect 
to any coverage, the credit determined with respect 
to such individual under subsection (a) for any such 
month ending during a calendar quarter shall not 
exceed the amount of premium the individual would 
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have paid for a full month of such coverage for the 
month preceding the first month for which an indi-
vidual is such an assistance eligible individual. 
‘‘(d) GOVERNMENTAL ENTITIES.—For purposes of 
this section, the term ‘person’ includes any governmental 
entity or Indian tribal government (as defined in section 
139E(c)(1)). 
‘‘(e) DENIAL OF DOUBLE BENEFIT.—For purposes 
of chapter 1, the gross income of any person allowed a 
credit under this section shall be increased for the taxable 
year which includes the last day of any calendar quarter 
with respect to which such credit is allowed by the amount 
of such credit. No amount for which a credit is allowed 
under this section shall be taken into account as qualified 
wages under section 2301 of the CARES Act or as quali-
fied health plan expenses under section 7001(d) or 
7003(d) of the Families First Coronavirus Response Act. 
‘‘(f) REPORTING.—Each person entitled to reim-
bursement under subsection (a) for any period shall sub-
mit such reports (at such time and in such manner) as 
the Secretary may require, including— 
‘‘(1) an attestation of involuntary termination 
of employment, reduction of hours, or furloughing, 
for each assistance eligible individual on the basis of 
whose termination, reduction of hours, or fur-
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loughing entitlement to reimbursement is claimed 
under subsection (a), 
‘‘(2) a report of the amount of payroll taxes off-
set under subsection (a) for the reporting period, 
and 
‘‘(3) a report containing the TINs of all covered 
employees, the amount of subsidy reimbursed with 
respect to each employee, and a designation with re-
spect to each employee as to whether the subsidy re-
imbursement is for coverage of 1 individual or 2 or 
more individuals. 
‘‘(g) REGULATIONS.—The Secretary shall issue such 
regulations or other guidance as may be necessary or ap-
propriate to carry out this section, including— 
‘‘(1) the requirement to report information or 
the establishment of other methods for verifying the 
correct amounts of reimbursements under this sec-
tion, 
‘‘(2) the application of this section to group 
health plans that are multiemployer plans (as de-
fined in section 3(37) of the Employee Retirement 
Income Security Act of 1974), 
‘‘(3) to allow the advance payment of the credit 
determined under subsection (a), subject to the limi-
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tations provided in this section, based on such infor-
mation as the Secretary shall require, 
‘‘(4) to provide for the reconciliation of such 
advance payment with the amount of the credit at 
the time of filing the return of tax for the applicable 
quarter or taxable year, and 
‘‘(5) with respect to the application of the cred-
it to third party payors (including professional em-
ployer organizations, certified professional employer 
organizations, or agents under section 3504).’’. 
(B) SOCIAL SECURITY TRUST FUNDS HELD 
HARMLESS.—There are hereby appropriated to 
the Federal Old-Age and Survivors Insurance 
Trust Fund and the Federal Disability Insur-
ance Trust Fund established under section 201 
of the Social Security Act (42 U.S.C. 401) and 
the Social Security Equivalent Benefit Account 
established under section 15A(a) of the Rail-
road Retirement Act of 1974 (45 U.S.C. 231n– 
1(a)) amounts equal to the reduction in reve-
nues to the Treasury by reason of this section 
(without 
regard 
to 
this 
subparagraph). 
Amounts appropriated by the preceding sen-
tence shall be transferred from the general fund 
at such times and in such manner as to rep-
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licate to the extent possible the transfers which 
would have occurred to such Trust Fund or Ac-
count had this section not been enacted. 
(C) CLERICAL AMENDMENT.—The table of 
sections for subchapter B of chapter 65 of the 
Internal Revenue Code of 1986 is amended by 
adding at the end the following new item: 
‘‘Sec. 6432. Continuation coverage premium assistance.’’. 
(D) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to pre-
miums to which subsection (a)(1)(A) applies. 
(E) SPECIAL RULE IN CASE OF EMPLOYEE 
PAYMENT THAT IS NOT REQUIRED UNDER THIS 
SECTION.— 
(i) IN GENERAL.—In the case of an 
assistance eligible individual who pays, 
with respect any period of coverage to 
which subsection (a)(1)(A) applies, the 
amount of the premium for such coverage 
that the individual would have (but for this 
Act) been required to pay, the person to 
whom such payment is payable shall reim-
burse such individual for the amount of 
such premium paid. 
(ii) CREDIT OF REIMBURSEMENT.—A 
person to which clause (i) applies shall be 
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allowed a credit in the manner provided 
under section 6432 of the Internal Rev-
enue Code of 1986 for any payment made 
to the employee under such clause. 
(iii) PAYMENT
OF
CREDITS.—Any 
person to which clause (i) applies shall 
make the payment required under such 
clause to the individual not later than 60 
days after the date on which such indi-
vidual elects continuation coverage under 
section 30312(a)(1) of the Worker Health 
Coverage Protection Act. 
(15) PENALTY
FOR
FAILURE
TO
NOTIFY 
HEALTH PLAN OF CESSATION OF ELIGIBILITY FOR 
PREMIUM ASSISTANCE.— 
(A) IN GENERAL.—Part I of subchapter B 
of chapter 68 of the Internal Revenue Code of 
1986 is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 6720C. PENALTY FOR FAILURE TO NOTIFY HEALTH 
PLAN OF CESSATION OF ELIGIBILITY FOR 
CONTINUATION COVERAGE PREMIUM ASSIST-
ANCE. 
‘‘(a) IN GENERAL.—Except in the case of failure de-
scribed in subsection (b) or (c), any person required to 
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(A) ELIGIBLE INSTITUTIONS WITH A LI-
QUIDITY LEVEL OF LESS THAN OR EQUAL TO 90 
DAYS.—In the case of an eligible institution de-
scribed in paragraph (2)(A), the Secretary shall 
require such eligible institution to report to the 
Secretary the liquidity level and total student 
enrollment of such eligible institution not less 
than once every 15 days, until such eligible in-
stitution closes or no longer participates in a 
COVID–19 provisional program participation 
agreement under this subsection. 
(B) ELIGIBLE INSTITUTIONS WITH A LI-
QUIDITY LEVEL OF GREATER THAN 90 DAYS.— 
In the case of an eligible institution that enters 
into a COVID–19 provisional program partici-
pation agreement under this subsection and has 
a liquidity level of greater than 90 days on the 
date of the application of such eligible institu-
tion under subsection (c)(1), the Secretary shall 
require such eligible institution to report to the 
Secretary the liquidity level and total student 
enrollment of such eligible institution not less 
than once every 30 days, until such eligible in-
stitution closes or no longer participates in a 
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