1069 
(1) STATE
REPORTING
REQUIREMENTS.—Not 
later than December 31, 2022, any State with re-
spect to which an application is approved by the Sec-
retary pursuant to subsection (c) shall submit a re-
port to the Secretary that contains the following in-
formation: 
(A) Activities and programs that were 
funded using Federal funds attributable to such 
increase. 
(B) The number of eligible individuals who 
were served by such activities and programs. 
(C) The number of eligible individuals who 
were able to resume home and community- 
based services as a result of such activities and 
programs. 
(2) HHS EVALUATION.— 
(A) IN
GENERAL.—The Secretary shall 
evaluate the implementation and outcomes of 
this section in the aggregate using an external 
evaluator with experience evaluating home and 
community-based services, disability programs, 
and older adult programs. 
(B) EVALUATION
CRITERIA.—For pur-
poses of subparagraph (A), the external eval-
uator shall— 
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(i) document and evaluate changes in 
access, availability, and quality of home 
and community-based services in each 
HCBS program State; 
(ii) document and evaluate aggregate 
changes in access, availability, and quality 
of home and community-based services 
across all such States; and 
(iii) evaluate the implementation and 
outcomes of this section based on— 
(I) the impact of this section on 
increasing funding for home and com-
munity-based services; 
(II) the impact of this section on 
achieving targeted access, availability, 
and quality of home and community- 
based services; and 
(III) promising practices identi-
fied by activities conducted pursuant 
to subsection (d) that increase access 
to, availability of, and quality of home 
and community-based services. 
(C) DISSEMINATION OF EVALUATION FIND-
INGS.—The Secretary shall— 
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(i) disseminate the findings from the 
evaluations conducted under this para-
graph to— 
(I) all State Medicaid directors; 
and 
(II) the Committee on Energy 
and Commerce of the House of Rep-
resentatives, the Committee on Fi-
nance of the Senate, and the Special 
Committee on Aging of the Senate; 
and 
(ii) make all evaluation findings pub-
licly available in an accessible electronic 
format and any other accessible format de-
termined appropriate by the Secretary. 
(D) OVERSIGHT.—Each State with respect 
to which an application is approved by the Sec-
retary pursuant to subsection (c) shall ensure 
adequate oversight of the expenditure of Fed-
eral funds pursuant to such increase in accord-
ance with the Medicaid regulations, including 
section 1115 and 1915 waiver regulations and 
special terms and conditions for any relevant 
waiver or grant program. 
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(3) NON-APPLICATION OF THE PAPERWORK RE-
DUCTION
ACT.—Chapter 35 of title 44, United 
States Code (commonly referred to as the ‘‘Paper-
work Reduction Act of 1995’’), shall not apply to the 
provisions of this subsection. 
(f) ADDITIONAL DEFINITIONS.—In this section: 
(1) COVID–19 PUBLIC
HEALTH
EMERGENCY 
PERIOD.—The term ‘‘COVID–19 public health emer-
gency period’’ means the portion of the emergency 
period described 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. 
(2) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 
individual’’ means an individual who is eligible for or 
enrolled for medical assistance under a State Med-
icaid program. 
(3) MEDICAID PROGRAM.—The term ‘‘Medicaid 
program’’ means, with respect to a State, the State 
program under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) (including any waiver or 
demonstration under such title or under section 
1115 of such Act (42 U.S.C. 1315) relating to such 
title). 
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(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
SEC. 103. COVERAGE AT NO COST SHARING OF COVID–19 
VACCINE AND TREATMENT. 
(a) MEDICAID.— 
(1) IN GENERAL.—Section 1905(a)(4) of the 
Social Security Act (42 U.S.C. 1396d(a)(4)) is 
amended— 
(A) by striking ‘‘and (D)’’ and inserting 
‘‘(D)’’; and 
(B) by striking the semicolon at the end 
and inserting ‘‘; (E) during the portion of the 
emergency period described in paragraph (1)(B) 
of section 1135(g) beginning on the date of the 
enactment of the Investing in America’s Health 
Care During the COVID–19 Pandemic Act, a 
COVID–19 vaccine licensed under section 351 
of the Public Health Service Act, or approved 
or authorized under sections 505 or 564 of the 
Federal Food, Drug, and Cosmetic Act, and ad-
ministration of the vaccine; (F) during such 
portion of the emergency period described in 
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paragraph (1)(B) of section 1135(g), items or 
services for the prevention or treatment of 
COVID–19, including drugs approved or au-
thorized under such section 505 or such section 
564 or, without regard to the requirements of 
section 
1902(a)(10)(B) 
(relating 
to 
com-
parability), in the case of an individual who is 
diagnosed with or presumed to have COVID– 
19, during such portion of such emergency pe-
riod during which such individual is infected (or 
presumed infected) with COVID–19, the treat-
ment of a condition that may complicate the 
treatment of COVID–19;’’. 
(2) PROHIBITION OF COST SHARING.— 
(A) IN GENERAL.—Subsections (a)(2) and 
(b)(2) of section 1916 of the Social Security 
Act (42 U.S.C. 1396o) are each amended— 
(i) in subparagraph (F), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (G), by striking 
‘‘; and’’ and inserting ‘‘, or’’; and 
(iii) by adding at the end the fol-
lowing subparagraphs: 
‘‘(H) during the portion of the emergency 
period described in paragraph (1)(B) of section 
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1135(g) beginning on the date of the enactment 
of this subparagraph, a COVID–19 vaccine li-
censed under section 351 of the Public Health 
Service Act, or approved or authorized under 
section 505 or 564 of the Federal Food, Drug, 
and Cosmetic Act, and the administration of 
such vaccine, or 
‘‘(I) during such portion of the emergency 
period described in paragraph (1)(B) of section 
1135(g), any item or service furnished for the 
treatment of COVID–19, including drugs ap-
proved or authorized under such section 505 or 
such section 564 or, in the case of an individual 
who is diagnosed with or presumed to have 
COVID–19, during the portion of such emer-
gency period during which such individual is in-
fected (or presumed infected) with COVID–19, 
the treatment of a condition that may com-
plicate the treatment of COVID–19; and’’. 
(B) APPLICATION TO ALTERNATIVE COST 
SHARING.—Section 1916A(b)(3)(B) of the So-
cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 
is amended— 
(i) in clause (xi), by striking ‘‘any 
visit’’ and inserting ‘‘any service’’; and 
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(ii) by adding at the end the following 
clauses: 
‘‘(xii) During the portion of the emer-
gency period described in paragraph (1)(B) 
of section 1135(g) beginning on the date of 
the enactment of this clause, a COVID–19 
vaccine licensed under section 351 of the 
Public Health Service Act, or approved or 
authorized under section 505 or 564 of the 
Federal Food, Drug, and Cosmetic Act, 
and the administration of such vaccine. 
‘‘(xiii) During such portion of the 
emergency period described in paragraph 
(1)(B) of section 1135(g), an item or serv-
ice furnished for the treatment of COVID– 
19, including drugs approved or authorized 
under such section 505 or such section 564 
or, in the case of an individual who is diag-
nosed with or presumed to have COVID– 
19, during such portion of such emergency 
period during which such individual is in-
fected 
(or 
presumed 
infected) 
with 
COVID–19, the treatment of a condition 
that may complicate the treatment of 
COVID–19.’’. 
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(C) 
CLARIFICATION.—The 
amendments 
made by this subsection shall apply with respect 
to a State plan of a territory in the same man-
ner as a State plan of one of the 50 States. 
(b) STATE PEDIATRIC VACCINE DISTRIBUTION PRO-
GRAM.—Section 1928 of the Social Security Act (42 
U.S.C. 1396s) is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (A), by striking ‘‘; 
and’’ and inserting a semicolon; 
(B) in subparagraph (B), by striking the 
period and inserting ‘‘; and’’; and 
(C) by adding at the end the following sub-
paragraph: 
‘‘(C) during the portion of the emergency 
period described in paragraph (1)(B) of section 
1135(g) beginning on the date of the enactment 
of this subparagraph, each vaccine-eligible child 
(as defined in subsection (b)) is entitled to re-
ceive a COVID–19 vaccine from a program-reg-
istered provider (as defined in subsection 
(h)(7)) without charge for— 
‘‘(i) the cost of such vaccine; or 
‘‘(ii) the administration of such vac-
cine.’’; 
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(2) in subsection (c)(2)— 
(A) in subparagraph (C)(ii), by inserting ‘‘, 
but, during the portion of the emergency period 
described in paragraph (1)(B) of section 
1135(g) beginning on the date of the enactment 
of the Investing in America’s Health Care Dur-
ing the COVID–19 Pandemic Act, may not im-
pose a fee for the administration of a COVID– 
19 vaccine’’ before the period; and 
(B) by adding at the end the following sub-
paragraph: 
‘‘(D) The provider will provide and admin-
ister an approved COVID–19 vaccine to a vac-
cine-eligible child in accordance with the same 
requirements as apply under the preceding sub-
paragraphs to the provision and administration 
of a qualified pediatric vaccine to such a 
child.’’; and 
(3) in subsection (d)(1), in the first sentence, 
by inserting ‘‘, including, during the portion of the 
emergency period described in paragraph (1)(B) of 
section 1135(g) beginning on the date of the enact-
ment of the Investing in America’s Health Care 
During the COVID–19 Pandemic Act, with respect 
to a COVID–19 vaccine licensed under section 351 
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of the Public Health Service Act, or approved or au-
thorized under section 505 or 564 of the Federal 
Food, Drug, and Cosmetic Act’’ before the period. 
(c) CHIP.— 
(1) IN GENERAL.—Section 2103(c) of the So-
cial Security Act (42 U.S.C. 1397cc(c)) is amended 
by adding at the end the following paragraph: 
‘‘(11) COVERAGE OF COVID–19 VACCINES AND 
TREATMENT.—Regardless of the type of coverage 
elected by a State under subsection (a), child health 
assistance provided under such coverage for targeted 
low-income children and, in the case that the State 
elects to provide pregnancy-related assistance under 
such coverage pursuant to section 2112, such preg-
nancy-related assistance for targeted low-income 
pregnant women (as defined in section 2112(d)) 
shall include coverage, during the portion of the 
emergency period described in paragraph (1)(B) of 
section 1135(g) beginning on the date of the enact-
ment of this paragraph, of— 
‘‘(A) a COVID–19 vaccine licensed under 
section 351 of the Public Health Service Act, or 
approved or authorized under section 505 or 
564 of the Federal Food, Drug, and Cosmetic 
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Act, and the administration of such vaccine; 
and 
‘‘(B) any item or service furnished for the 
treatment of COVID–19, including drugs ap-
proved or authorized under such section 505 or 
such section 564, or, in the case of an indi-
vidual who is diagnosed with or presumed to 
have COVID–19, during the portion of such 
emergency period during which such individual 
is infected (or presumed infected) with COVID– 
19, the treatment of a condition that may com-
plicate the treatment of COVID–19.’’. 
(2) PROHIBITION OF COST SHARING.—Section 
2103(e)(2) of the Social Security Act (42 U.S.C. 
1397cc(e)(2)), as amended by section 6004(b)(3) of 
the Families First Coronavirus Response Act, is 
amended— 
(A) in the paragraph header, by inserting 
‘‘A COVID–19 VACCINE, COVID–19 TREATMENT,’’ 
before ‘‘OR PREGNANCY-RELATED ASSISTANCE’’; 
and 
(B) by striking ‘‘visits described in section 
1916(a)(2)(G), or’’ and inserting ‘‘services de-
scribed in section 1916(a)(2)(G), vaccines de-
scribed in section 1916(a)(2)(H) administered 
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during the portion of the emergency period de-
scribed in paragraph (1)(B) of section 1135(g) 
beginning on the date of the enactment of the 
Investing in America’s Health Care During the 
COVID–19 Pandemic Act, items or services de-
scribed in section 1916(a)(2)(I) furnished dur-
ing such emergency period, or’’. 
(d) CONFORMING AMENDMENTS.—Section 1937 of 
the Social Security Act (42 U.S.C. 1396u–7) is amend-
ed— 
(1) in subsection (a)(1)(B), by inserting ‘‘, 
under 
subclause 
(XXIII) 
of 
section 
1902(a)(10)(A)(ii),’’ 
after 
‘‘section 
1902(a)(10)(A)(i)’’; and 
(2) in subsection (b)(5), by adding before the 
period the following: ‘‘, and, effective on the date of 
the enactment of the Investing in America’s Health 
Care During the COVID–19 Pandemic Act, must 
comply with subparagraphs (F) through (I) of sub-
sections (a)(2) and (b)(2) of section 1916 and sub-
section (b)(3)(B) of section 1916A’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act and shall apply with respect to a COVID–19 vac-
cine beginning on the date that such vaccine is licensed 
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under section 351 of the Public Health Service Act (42 
U.S.C. 262), or approved or authorized under section 505 
or 564 of the Federal Food, Drug, and Cosmetic Act. 
SEC. 104. OPTIONAL COVERAGE AT NO COST SHARING OF 
COVID–19 TREATMENT AND VACCINES UNDER 
MEDICAID FOR UNINSURED INDIVIDUALS. 
(a) IN GENERAL.—Section 1902(a)(10) of the Social 
Security Act (42 U.S.C. 1396a(a)(10) is amended, in the 
matter following subparagraph (G), by striking ‘‘and any 
visit described in section 1916(a)(2)(G)’’ and inserting the 
following: ‘‘, any COVID–19 vaccine that is administered 
during any such portion (and the administration of such 
vaccine), any item or service that is furnished during any 
such portion for the treatment of COVID–19, including 
drugs approved or authorized under section 505 or 564 
of the Federal Food, Drug, and Cosmetic Act, or, in the 
case of an individual who is diagnosed with or presumed 
to have COVID–19, during the period such individual is 
infected (or presumed infected) with COVID–19, the 
treatment of a condition that may complicate the treat-
ment of COVID–19, and any services described in section 
1916(a)(2)(G)’’. 
(b) DEFINITION OF UNINSURED INDIVIDUAL.— 
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(1) IN
GENERAL.—Subsection (ss) of section 
1902 of the Social Security Act (42 U.S.C. 1396a) 
is amended to read as follows: 
‘‘(ss) UNINSURED INDIVIDUAL DEFINED.—For pur-
poses of this section, the term ‘uninsured individual’ 
means, notwithstanding any other provision of this title, 
any individual who is not covered by minimum essential 
coverage (as defined in section 5000A(f)(1) of the Internal 
Revenue Code of 1986).’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect and apply as if in-
cluded in the enactment of the Families First 
Coronavirus Response Act (Public Law 116–127). 
(c) CLARIFICATION REGARDING EMERGENCY SERV-
ICES FOR CERTAIN INDIVIDUALS.—Section 1903(v)(2) of 
the Social Security Act (42 U.S.C. 1396b(v)(2)) is amend-
ed by adding at the end the following flush sentence: 
‘‘For purposes of subparagraph (A), care and serv-
ices described in such subparagraph include any in 
vitro 
diagnostic 
product 
described 
in 
section 
1905(a)(3)(B) (and the administration of such prod-
uct), any COVID–19 vaccine (and the administra-
tion of such vaccine), any item or service that is fur-
nished for the treatment of COVID–19, including 
drugs approved or authorized under section 505 or 
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564 of the Federal Food, Drug, and Cosmetic Act, 
or a condition that may complicate the treatment of 
COVID–19, and any services described in section 
1916(a)(2)(G).’’. 
(d) INCLUSION
OF COVID–19 CONCERN
AS
AN 
EMERGENCY CONDITION.—Section 1903(v)(3) of the So-
cial Security Act (42 U.S.C. 1396b(v)(3)) is amended by 
adding at the end the following flush sentence: 
‘‘Such term includes any indication that an alien de-
scribed in paragraph (1) may have contracted 
COVID–19.’’. 
SEC. 105. MEDICAID COVERAGE FOR CITIZENS OF FREELY 
ASSOCIATED STATES. 
(a) IN GENERAL.—Section 402(b)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 
the end the following new subparagraph: 
‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 
OF FREELY ASSOCIATED STATES.—With respect 
to eligibility for benefits for the designated Fed-
eral program defined in paragraph (3)(C) (re-
lating to the Medicaid program), section 401(a) 
and paragraph (1) shall not apply to any indi-
vidual who lawfully resides in 1 of the 50 States 
or the District of Columbia in accordance with 
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the Compacts of Free Association between the 
Government of the United States and the Gov-
ernments of the Federated States of Micro-
nesia, the Republic of the Marshall Islands, and 
the Republic of Palau and shall not apply, at 
the option of the Governor of Puerto Rico, the 
Virgin Islands, Guam, the Northern Mariana 
Islands, or American Samoa as communicated 
to the Secretary of Health and Human Services 
in writing, to any individual who lawfully re-
sides in the respective territory in accordance 
with such Compacts.’’. 
(b) EXCEPTION TO 5–YEAR LIMITED ELIGIBILITY.— 
Section 403(d) of such Act (8 U.S.C. 1613(d)) is amend-
ed— 
(1) in paragraph (1), by striking ‘‘or’’ at the 
end; 
(2) in paragraph (2), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(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).’’. 
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(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-
onciliation Act of 1996 and eligible 
for benefits under this title by reason 
of application of such section;’’. 
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(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. 
SEC. 106. TEMPORARY INCREASE IN MEDICAID DSH ALLOT-
MENTS. 
(a) IN GENERAL.—Section 1923(f)(3) of the Social 
Security Act (42 U.S.C. 1396r–4(f)(3)) is amended— 
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(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.’’. 
(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— 
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(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. 
SEC. 107. 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 
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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 
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. 
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(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. 
SEC. 108. 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’’. 
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(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— 
(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.—Not-
withstanding the preceding provisions of this 
paragraph, a State may not provide medical as-
sistance through the enrollment of an individual 
with benchmark coverage or benchmark equiva-
lent coverage described in subparagraph (A)(i) 
unless, subject to section 1903(i)(9) and in ac-
cordance with section 1902(a)(4), the bench-
mark benefit package or benchmark equivalent 
coverage (or the State)— 
‘‘(i) ensures necessary transportation 
for individuals enrolled under such package 
or coverage to and from providers; and 
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‘‘(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 authorized under sec-
tion 1902(a)(4), unless the State plan provides 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 
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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-
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 
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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 for Medicare & Medicaid 
Services, shall convene a series of meetings to 
obtain input from appropriate stakeholders to 
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-
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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 
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-
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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— 
(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— 
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‘‘(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 
‘‘(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. 
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1099 
(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 
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 
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1100 
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. 
TITLE II—MEDICARE 
PROVISIONS 
SEC. 201. HOLDING MEDICARE BENEFICIARIES HARMLESS 
FOR SPECIFIED COVID–19 TREATMENT SERV-
ICES 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 
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1101 
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 
(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). 
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1102 
(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– 
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, 
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1103 
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. 
(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. 
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1104 
(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 
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). 
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1105 
(f) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement the provi-
sions of this section by program instruction or otherwise. 
SEC. 202. 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— 
(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.’’. 
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1106 
(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 
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)). 
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1107 
SEC. 203. 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’’; 
(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’; 
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1108 
‘‘(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-
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. 
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1109 
SEC. 204. COVERAGE OF TREATMENTS FOR COVID–19 AT NO 
COST SHARING UNDER THE MEDICARE AD-
VANTAGE 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 201(b) of the 
Investing in America’s Health Care During 
the COVID–19 Pandemic Act) that is fur-
nished during a plan year occurring during 
any portion of the emergency period de-
fined in section 1135(g)(1)(B) beginning 
on or after the date of the enactment of 
this clause, a Medicare Advantage plan 
may not, with respect to such service, im-
pose— 
‘‘(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-
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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. 
SEC. 205. REQUIRING COVERAGE UNDER MEDICARE PDPS 
AND MA–PD PLANS, WITHOUT THE IMPOSI-
TION OF COST SHARING OR UTILIZATION 
MANAGEMENT REQUIREMENTS, OF DRUGS 
INTENDED TO TREAT COVID–19 DURING CER-
TAIN 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.— 
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‘‘(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 
‘‘(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). 
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‘‘(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.— 
(1) 
ELIMINATION
OF
COST-SHARING
FOR 
DRUGS
INTENDED
TO
TREAT
COVID–19
UNDER 
STANDARD AND ALTERNATIVE PRESCRIPTION DRUG 
COVERAGE.—Section 1860D–2 of the Social Security 
Act (42 U.S.C. 1395w–102) is amended— 
(A) in subsection (b)— 
(i) in paragraph (1)(A), by striking 
‘‘The coverage’’ and inserting ‘‘Subject to 
paragraph (8), the coverage’’; 
(ii) in paragraph (2)— 
(I) in subparagraph (A), by in-
serting after ‘‘Subject to subpara-
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1113 
graphs (C) and (D)’’ the following: 
‘‘and paragraph (8)’’; 
(II) in subparagraph (C)(i), by 
striking ‘‘paragraph (4)’’ and insert-
ing ‘‘paragraphs (4) and (8)’’; and 
(III) in subparagraph (D)(i), by 
striking ‘‘paragraph (4)’’ and insert-
ing ‘‘paragraphs (4) and (8)’’; 
(iii) in paragraph (4)(A)(i), by strik-
ing ‘‘The coverage’’ and inserting ‘‘Subject 
to paragraph (8), the coverage’’; and 
(iv) by adding at the end the following 
new paragraph: 
‘‘(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-
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1114 
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)— 
(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: 
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1115 
‘‘(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 
(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. 
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1116 
SEC. 206. 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, 
‘‘(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 December 1, 2020, and 
ends on the last day of the month in which the 
emergency period (as described in section 
1135(g)(1)(B)) ends.’’. 
(b) 
COVERAGE
PERIOD
FOR
INDIVIDUALS 
TRANSITIONING
FROM
OTHER
COVERAGE.—Section 
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1117 
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-
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 
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1118 
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. 
SEC. 207. COVID–19 SKILLED NURSING FACILITY PAYMENT 
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.— 
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1119 
‘‘(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 
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 
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1120 
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). 
‘‘(iv) The facility provides care at 
such facility (or, in the case of an election 
made with respect to a portion of such fa-
cility, to provide care in such portion of 
such facility) only to eligible individuals. 
‘‘(v) The facility arranges for and 
transfers all residents of such facility (or 
such portion of such facility, as applicable) 
who are not eligible individuals to other 
skilled nursing facilities (or other portions 
of such facility, as applicable). 
‘‘(vi) The facility complies with the 
notice requirement described in paragraph 
(4). 
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1121 
‘‘(vii) The facility meets the reporting 
requirement described in paragraph (5). 
‘‘(viii) Any other requirement deter-
mined appropriate by the Secretary. 
‘‘(3) DURATION OF DESIGNATION.— 
‘‘(A) IN
GENERAL.—A designation of a 
skilled nursing facility (or portion of such facil-
ity) as a COVID–19 treatment center shall 
begin on a date specified by the Secretary and 
end upon the earliest of the following: 
‘‘(i) The revocation of such designa-
tion under subparagraph (B). 
‘‘(ii) The submission of a notification 
by such facility to the Secretary that such 
facility elects to terminate such designa-
tion. 
‘‘(iii) The termination of the program 
(as specified in paragraph (6)). 
‘‘(B) REVOCATION.—The Secretary may 
revoke the designation of a skilled nursing facil-
ity (or portion of such facility) as a COVID–19 
treatment center if the Secretary determines 
that the facility is no longer in compliance with 
a requirement described in paragraph (2)(B). 
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1122 
‘‘(4) RESIDENT
NOTICE
REQUIREMENT.—For 
purposes of paragraph (2)(B)(vi), the notice require-
ment described in this paragraph is that, not later 
than 72 hours before the date specified by the Sec-
retary under paragraph (3)(A) with respect to the 
designation of a skilled nursing facility (or portion 
of such facility) as a COVID–19 treatment center, 
the facility provides a notification to each resident of 
such facility (and to appropriate representatives or 
family members of each such resident, as specified 
by the Secretary) that contains the following: 
‘‘(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 
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1123 
‘‘(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-
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. 
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‘‘(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, 
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-
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1125 
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— 
(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 
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1126 
be increased by 20 percent to reflect increased costs 
associated with such residents.’’. 
SEC. 208. 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-
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. 
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1132 
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.— 
(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 211 of the Investing in Amer-
ica’s Health Care During the COVID–19 Pan-
demic Act’’ after ‘‘Care Act’’. 
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1133 
SEC. 212. RELIEF FOR SMALL RURAL HOSPITALS FROM IN-
ACCURATE 
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 
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 
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1141 
(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 
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-
VerDate Sep 11 2014 
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