(B) in subparagraph (E), by striking ‘‘; 
and’’ at the end and inserting ‘‘, or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(F) items and services described in sec-
tion 1905(a)(30); and’’; and 
(2) in section 1916A(b)(3)(B), by adding at the 
end the following new clause: 
‘‘(xi) Items and services described in 
section 1905(a)(30).’’. 
(e) CONTINUOUS COVERAGE FOR INDIVIDUALS WHO 
LOSE MEDICAID ELIGIBILITY BASED ON INCOME.—Sec-
tion 1902(e) of the Social Security Act (42 U.S.C. 
1396a(e)) is amended by adding at the end the following 
new paragraph: 
‘‘(16) CONTINUOUS COVERAGE FOR ITEMS AND 
SERVICES FURNISHED IN CONNECTION WITH QUALI-
FYING
VALLEY
FEVER
CLINICAL
TRIALS.—In the 
case of an individual who is eligible for medical as-
sistance under the State plan (or a waiver of such 
plan) based on the application of modified adjusted 
gross income under paragraph (14)(A), who while so 
eligible is furnished items and services described in 
section 1905(a)(30) in connection with participation 
in a qualifying Valley fever clinical trial (as defined 
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in section 2709A(b)(4) of the Public Health Service 
Act), and who while so furnished such items and 
services loses eligibility for such medical assistance 
due to a change in income of the family of which 
such individual is a member, such individual shall be 
deemed to continue to be an individual eligible for 
such medical assistance, without regard to such 
change in income, only with respect to such items 
and services through the end of the month in which 
such qualifying Valley fever clinical trial ends.’’. 
(f) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall apply with respect to items and 
services furnished, and eligibility determinations 
made, on or after January 1, 2021. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.) that the 
Secretary of Health and Human Services determines 
requires State legislation in order for the respective 
plan to meet any requirement imposed by amend-
ments made by this section, the respective plan shall 
not be regarded as failing to comply with the re-
quirements of such title solely on the basis of its 
failure to meet such an additional requirement be-
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fore the first day of the first calendar quarter begin-
ning after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment 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 the session shall be 
considered to be a separate regular session of the 
State legislature. 
SEC. 5. REQUIREMENT FOR GROUP HEALTH PLANS AND 
HEALTH INSURANCE ISSUERS TO PROVIDE 
COVERAGE FOR ITEMS AND SERVICES FUR-
NISHED IN CONNECTION WITH QUALIFYING 
VALLEY FEVER CLINICAL TRIALS. 
(a) IN GENERAL.—Subpart I of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg 
et seq.) is amended— 
(1) by redesignating the second section 2709 as 
section 2710; and 
(2) by inserting after the first section 2709 the 
following new section: 
‘‘SEC. 2709A. COVERAGE FOR INDIVIDUALS PARTICIPATING 
IN QUALIFYING VALLEY FEVER CLINICAL 
TRIALS. 
‘‘(a) IN GENERAL.—Notwithstanding section 2709, a 
group health plan or health insurance issuer offering 
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group or individual health insurance coverage shall, with 
respect to an enrollee of such plan or coverage, respec-
tively, provide coverage for any item or service furnished 
to such enrollee in connection with such enrollee’s partici-
pation in a qualifying Valley fever clinical trial, including 
travel and incidental expenses— 
‘‘(1) without regard to whether such item or 
service is furnished by a participating provider or 
participating facility with respect to such item or 
service; and 
‘‘(2) in a manner so that, if such item or serv-
ice is furnished to such enrollee by a nonpartici-
pating provider or nonparticipating facility, the cost- 
sharing requirement (expressed as a copayment 
amount or coinsurance rate) is not greater than the 
requirement that would apply if such item or service 
were furnished by a participating provider or partici-
pating facility. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) NONPARTICIPATING
FACILITY; PARTICI-
PATING FACILITY.— 
‘‘(A) NONPARTICIPATING
FACILITY.—The 
term ‘nonparticipating facility’ means, with re-
spect to an item or service and a group health 
plan or group or individual health insurance 
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coverage, a health care facility that does not 
have a contractual relationship with the sponsor 
of such plan or issuer of such coverage for fur-
nishing such item or service under the plan or 
coverage. 
‘‘(B) PARTICIPATING FACILITY.—The term 
‘participating facility’ means, with respect to an 
item or service and a group health plan or 
group or individual health insurance coverage, a 
health care facility that has a contractual rela-
tionship with the sponsor of such plan or issuer 
of such coverage for furnishing such item or 
service under the plan or coverage. 
‘‘(2) NONPARTICIPATING
PROVIDER; PARTICI-
PATING PROVIDER.— 
‘‘(A) NONPARTICIPATING PROVIDER.—The 
term ‘nonparticipating provider’ means, with re-
spect to an item or service and a group health 
plan or group or individual health insurance 
coverage, a physician or other health care pro-
vider who is acting within the scope of practice 
of that provider’s license or certification under 
applicable State law and who does not have a 
contractual relationship with the sponsor of 
such plan or issuer of such coverage for fur-
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nishing such item or service under the plan or 
coverage. 
‘‘(B) 
PARTICIPATING
PROVIDER.—The 
term ‘participating provider’ means, with re-
spect to an item or service and a group health 
plan or group or individual health insurance 
coverage, a physician or other health care pro-
vider who is acting within the scope of practice 
of that provider’s license or certification under 
applicable State law and who has a contractual 
relationship with the sponsor of such plan or 
issuer of such coverage for furnishing such item 
or service under the plan or coverage. 
‘‘(3) QUALIFYING
VALLEY
FEVER
CLINICAL 
TRIAL.— 
‘‘(A) IN GENERAL.—The term ‘qualifying 
Valley fever clinical trial’ means a phase I, 
phase II, phase III, or phase IV clinical trial 
that is conducted in relation to the prevention, 
detection, or treatment of Valley fever (as de-
fined in section 399V–7) and is described in 
any of the following clauses: 
‘‘(i) The study or investigation is ap-
proved or funded (which may include fund-
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dividuals with no interest in the outcome 
of the review.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2021. 
SEC. 6. MEDICARE COVERAGE OF ITEMS AND SERVICES 
FURNISHED IN CONNECTION WITH QUALI-
FYING VALLEY FEVER CLINICAL TRIALS. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended— 
(1) in subparagraph (GG), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (HH), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(II) items and services furnished in connection 
with participation in a qualifying Valley fever clinical 
trial (as defined in section 2709A(b)(4) of the Public 
Health Service Act), including travel and incidental 
expenses;’’. 
(b) PAYMENT.—Section 1833(a)(1) of the Social Se-
curity Act (42 U.S.C. 1395l(a)(1)) is amended— 
(1) by striking ‘‘and (CC)’’ and inserting 
‘‘(CC)’’; and 
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(2) by inserting before the semicolon at the end 
the following: ‘‘, and (DD) with respect to items and 
services described in section 1861(s)(2)(II), the 
amount paid shall be 100 percent of the lesser of the 
actual charge for the services or the amount deter-
mined under the payment basis determined under 
section 1848’’. 
Æ 
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