Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021
Bill: H.R.2166 | Sponsor: Rep. Sewell, Terri A. (D-AL)
Policy area: Health

Summary:
Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021
This bill allows audio-only diagnoses that are made via telehealth to be used for purposes of determining risk adjustments to payments under Medicare Advantage. Additionally, the bill requires payments for Medicare telehealth services that are furnished during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019) to be made in the same amounts as those for in-person services.

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 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 ``Ensuring Parity in MA and PACE for 
Audio-Only Telehealth Act of 2021''.

SEC. 2. REQUIRING THE INCLUSION OF CERTAIN AUDIO-ONLY DIAGNOSES IN THE 
              DETERMINATION OF RISK ADJUSTMENT FOR MEDICARE ADVANTAGE 
              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 adjustment.--
                            ``(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 appropriate by the 
                        Secretary), the Secretary, in determining the 
                        diseases or conditions of an individual, shall 
                        take into account diagnoses obtained through a 
                        telehealth encounter, and in the case of a 
                        qualified diagnosis (as defined in clause (ii)) 
                        made with respect to such individual by a 
                        qualified provider (as so defined), shall not 
                        require the use of video communications with 
                        respect to such telehealth encounter.
                            ``(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 
                                individual during a plan year if such 
                                diagnosis 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 services, 
                                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 
                                        identification number) of a 
                                        provider of services or 
                                        supplier who furnished such an 
                                        item or service to such 
                                        individual during such 
                                        period.''.
    (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 following new sentence: ``For purposes of applying the 
adjustment 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 payment parity during the 
        covid-19 emergency.--In the case of a telehealth service 
        furnished during the emergency period described in section 
        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 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.''.
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