I 
117TH CONGRESS 
1ST SESSION H. R. 2166 
To amend title XVIII of the Social Security Act to require the inclusion 
of certain audio-only diagnoses in the determination of risk adjustment 
for Medicare Advantage plans and PACE programs, and for other pur-
poses. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 23, 2021 
Ms. SEWELL (for herself, Mr. BILIRAKIS, Mr. CA´RDENAS, Mrs. WALORSKI, 
Mr. KIND, Mr. SMITH
of Missouri, Ms. HOULAHAN, and Mr. 
FITZPATRICK) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on En-
ergy and Commerce, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to require 
the inclusion of certain audio-only diagnoses in the deter-
mination of risk adjustment for Medicare Advantage 
plans and PACE programs, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ensuring Parity in 
MA and PACE for Audio-Only Telehealth Act of 2021’’. 
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SEC. 2. REQUIRING THE INCLUSION OF CERTAIN AUDIO- 
ONLY DIAGNOSES IN THE DETERMINATION 
OF RISK ADJUSTMENT FOR MEDICARE AD-
VANTAGE PLANS AND PACE PROGRAMS. 
(a) IN GENERAL.—Section 1853(a)(1) of the Social 
Security Act (42 U.S.C. 1395w–23(a)(1)) is amended by 
adding at the end the following new subparagraph: 
‘‘(J) INCLUSION OF CERTAIN AUDIO-ONLY 
DIAGNOSES FOR PURPOSES OF RISK ADJUST-
MENT.— 
‘‘(i) IN
GENERAL.—For purposes of 
determining the appropriate adjustment 
for health status under subparagraph 
(C)(i) for plan years 2020 and 2021 (and 
for such other plan years determined ap-
propriate by the Secretary), the Secretary, 
in determining the diseases or conditions 
of an individual, shall take into account di-
agnoses obtained through a telehealth en-
counter, and in the case of a qualified di-
agnosis (as defined in clause (ii)) made 
with respect to such individual by a quali-
fied provider (as so defined), shall not re-
quire the use of video communications with 
respect to such telehealth encounter. 
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‘‘(ii) DEFINITIONS.—For purposes of 
this subparagraph: 
‘‘(I) QUALIFIED
DIAGNOSIS.— 
The term ‘qualified diagnosis’ means 
a diagnosis made with respect to a 
chronic disease or condition of an in-
dividual during a plan year if such di-
agnosis was also made with respect to 
such individual in one of the last of 
the 3 plan years preceding such plan 
year. 
‘‘(II) QUALIFIED
PROVIDER.— 
The term ‘qualified provider’ means, 
with respect to a qualified diagnosis 
made with respect to an individual 
during a plan year, a provider of serv-
ices, clinician or supplier that— 
‘‘(aa) furnished an item or 
service to such individual during 
the 3-year period ending on the 
date such diagnosis was so made; 
or 
‘‘(bb) is in the same practice 
(as determined by tax identifica-
tion number) of a provider of 
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services or supplier who fur-
nished such an item or service to 
such individual during such pe-
riod.’’. 
(b) PACE PROGRAM CONFORMING AMENDMENT.— 
Section 1894(d)(2) of the Social Security Act (42 U.S.C. 
1395eee(d)(2)) is amended by adding at the end the fol-
lowing new sentence: ‘‘For purposes of applying the ad-
justment under subparagraph (C)(i) of section 1853(a)(1) 
to such amounts, subparagraph (J) of such section shall 
be applied as if each reference to ‘plan year’ and ‘plan 
years 2020 and 2021’ were instead a reference to ‘year’ 
and ‘2020 and 2021’, respectively.’’. 
SEC. 3. REQUIRING PARITY IN TELEHEALTH PAYMENTS 
DURING THE COVID–19 EMERGENCY. 
Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended by adding at the end the 
following new paragraph: 
‘‘(9) SPECIAL
RULE
FOR
TELEHEALTH
PAY-
MENT
PARITY
DURING
THE
COVID–19
EMER-
GENCY.—In the case of a telehealth service fur-
nished during the emergency period described in sec-
tion 1135(g)(1)(B) for which payment may be made 
under this subsection (including any service for 
which payment may be so made due to application 
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of a waiver made under section 1135(b)), the 
amount of such payment shall be equal to the 
amount that would have been paid for such service 
had such service been furnished in-person.’’. 
Æ 
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