Telehealth Coverage and Payment Parity Act
Bill: H.R.4480 | Sponsor: Rep. Phillips, Dean (D-MN)
Policy area: Health

Summary:
Telehealth Coverage and Payment Parity Act  This bill requires private health insurance plans to cover certain services provided via telecommunications systems (i.e., telehealth). Specifically, the telehealth services must be deemed medically necessary by a health care provider and covered under the plan if provided in person. Plans must apply the same cost-sharing and reimbursement amounts that would otherwise apply to such services and may waive cost-sharing requirements for any services to diagnose or treat COVID-19, including via telehealth.

To amend the Public Health Service Act to require group health plans 
   and health insurance issuers offering group or individual health 
   insurance coverage to provide coverage for services furnished via 
 telehealth if such services would be covered if furnished in-person, 
                        and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Telehealth Coverage and Payment 
Parity Act''.

SEC. 2. REQUIRING GROUP HEALTH PLANS AND HEALTH INSURANCE ISSUERS 
              OFFERING GROUP OR INDIVIDUAL HEALTH INSURANCE COVERAGE TO 
              PROVIDE COVERAGE FOR SERVICES FURNISHED VIA TELEHEALTH IF 
              SUCH SERVICES WOULD BE COVERED IF FURNISHED IN-PERSON.

    (a) Public Health Service Act.--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. REQUIRED COVERAGE OF TELEHEALTH SERVICES.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage, 
including a grandfathered health plan (as defined in section 1251(e) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 18011(e)))--
            ``(1) shall--
                    ``(A) provide benefits under such plan or such 
                coverage for any eligible service (as defined in 
                subsection (b)), including a mental health and 
                substance use disorder service, furnished via a 
                qualifying telecommunications system (as defined in 
                subsection (b)) by a health care provider to an 
                individual who is a participant, beneficiary, or 
                enrollee under such plan or such coverage, 
                notwithstanding that such provider furnishing such 
                service is not at the same location as the individual;
                    ``(B) so provide such benefits for such service 
                under the same terms and with application of the same 
                cost-sharing requirements (including a deductible, 
                copayment, or coinsurance) as would apply if such 
                service were furnished by such provider to such 
                individual in-person;
                    ``(C) reimburse such provider for such service in 
                an amount equal to the amount of reimbursement for such 
                service had such service been furnished by such 
                provider to such individual in-person;
                    ``(D) not impose any requirement under such plan or 
                coverage that such provider have a prior relationship 
                with such individual; and
                    ``(E) not restrict the ability of any health care 
                provider with a contractual relationship for furnishing 
                an eligible service under such plan or coverage from 
                furnishing such service via a qualifying 
                telecommunications system, and shall not establish 
                incentives or penalties under such plan or coverage for 
                receiving such an eligible service from such a provider 
                via such a system; and
            ``(2) may waive any cost-sharing requirement (including 
        application of a deductible, copayment, or coinsurance) for an 
        item or service furnished for purposes of diagnosing or 
        treating COVID-19, including any such service that is an 
        eligible service furnished via a qualifying telecommunications 
        system.
    ``(b) Definitions.--In this section:
            ``(1) Eligible service.--The term `eligible service' means, 
        with respect to a group health plan and a health insurance 
        issuer offering group or individual health insurance coverage, 
        a service--
                    ``(A) for which benefits are provided under such 
                plan or such coverage when such service is furnished 
                in-person;
                    ``(B) that is medically necessary (as determined by 
                the health care provider furnishing such service); and
                    ``(C) that is able to be safely and effectively 
                furnished via a telecommunications system.
            ``(2) Qualifying telecommunications system.--The term 
        `qualifying telecommunications system' means a 
        telecommunications system that includes, at a minimum, audio 
        capabilities permitting two-way, real-time interactive 
        communication between the individual receiving an eligible 
        service via such system and the health care provider furnishing 
        such system, including a telephone, videoconferencing system, 
        internet communications system, streaming media communications 
        system, and such other system as specified by the Secretary of 
        Health and Human Services.''.
    (b) Application.--The amendment made by subsection (a) shall apply 
with respect to plan years beginning on or after January 1, 2022.
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