Equitable Community Access to Pharmacist Services Act
Bill: H.R.7213 | Sponsor: Rep. Kind, Ron (D-WI)
Policy area: Health

Summary:
Equitable Community Access to Pharmacist Services Act
This bill expands Medicare coverage to permanently include services provided by a pharmacist, including incidental services and supplies, related to testing, drug regimens, and vaccines for COVID-19, influenza, and certain other illnesses.
Specifically, the bill provides for continued coverage of pharmacist services relating to testing and vaccines for COVID-19 and influenza, as well as coverage of testing for respiratory syncytial virus and streptococcal pharyngitis (i.e., strep throat) and the initiation of drug regimens that are used to treat COVID-19, influenza, or strep throat. It also generally provides for coverage of pharmacist services during a public health emergency or to address health equity.
A pharmacist, or the facility with which the pharmacist is contracted or employed, may present a claim for reimbursement of 85% (or 100% during a declared emergency) of the applicable amount. A pharmacist may not bill an individual for such a service other than for the applicable deductible or coinsurance amounts.

To amend title XVIII of the Social Security Act to provide pharmacy 
   reimbursement for COVID-19-related and future emergency services.

    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 ``Equitable Community Access to 
Pharmacist Services Act''.

SEC. 2. COVERAGE OF PHARMACIST SERVICES UNDER MEDICARE PART B.

    (a) Coverage.--Section 1861(s)(2) of the Social Security 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 period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(II) pharmacist services and such services and supplies 
        furnished as an incident to the pharmacist's service as would 
        otherwise be covered under part B if furnished by a physician 
        or as an incident to a physician's service that--
                    ``(i) are furnished by a pharmacist, as licensed or 
                otherwise authorized--
                            ``(I) under State law; or
                            ``(II) under section 319F-3 or section 361 
                        of the Public Health Service Act, or other 
                        similar Federal law;
                    ``(ii) would otherwise be covered under part B if 
                furnished by a physician, or as incident to a 
                physician's service; and
                    ``(iii) are services--
                            ``(I) for testing and testing-related 
                        services for COVID-19, influenza, respiratory 
                        syncytial virus, or streptococcal pharyngitis;
                            ``(II) for the initiation of a drug regimen 
                        for COVID-19, influenza, or streptococcal 
                        pharyngitis;
                            ``(III) for the administration of a vaccine 
                        and related services for COVID-19 or influenza;
                            ``(IV) that address a public health need 
                        related to a public health emergency under 
                        section 319F-3 or section 361 of the Public 
                        Health Service Act, or other similar Federal 
                        law; or
                            ``(V) as determined by the Secretary by 
                        program instruction or otherwise, including the 
                        closing of gaps in health equity.''.
    (b) Payment.--Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and (DD)'' and inserting ``(DD)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``(EE) with respect to pharmacist services described 
        in section 1861(s)(2)(II) for which payment may be made under 
        section 1848, the amounts paid shall be equal to 85 percent (or 
        100 percent, in the case of such services furnished pursuant to 
        a Federal emergency authority described in clause (i)(II) of 
        such section) of an amount determined by the Secretary or the 
        lesser of the actual charge for the services or the physician 
        fee schedule amount provided under section 1848 if such 
        services had been furnished by a physician''.
    (c) Reassignment of Payment.--Section 1833 of the Social Security 
Act (42 U.S.C. 1395l) is amended by adding at the end the new 
subsection:
    ``(ee) With respect to pharmacist services described in section 
1861(s)(2)(II) payment may be made on the basis of a claim or request 
for payment presented by the pharmacist furnishing such services, or by 
a pharmacy, hospital, critical access hospital, skilled nursing 
facility or nursing facility (as defined in section 1919(a)), 
physician, group practice, or ambulatory surgical center with which the 
pharmacist has an employment or contractual relationship that provides 
for payment to be made under this part for such services to such 
pharmacy, hospital, critical access hospital, skilled nursing facility 
or nursing facility, physician, group practice, or ambulatory surgical 
center.''.
    (d) Prohibition on Balance Billing for Pharmacist Services.--
Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 
1395u(b)(18)(C)) is amended by adding at the end the following:
                            ``(vii) A pharmacist.''.
    (e) Rule of Construction.--Nothing in this section shall be 
construed--
            (1) to limit flexibilities provided under section 410.32 of 
        title 42, Code of Federal Regulations (or any successor 
        regulation) in response to COVID-19; or
            (2) to restrict the ability of pharmacies and pharmacists 
        to enroll and obtain reimbursement under existing pathways 
        under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.) as of the date of the enactment of this Act, including 
        reimbursement as mass immunizers.
    (f) Implementation Authority.--Notwithstanding any other provision 
of law, the Secretary of Health and Human Services shall implement the 
provisions of, and the amendments made by, this section by interim 
final rule, program instruction, or otherwise not later than the date 
that is 60 days after the date of the enactment of this Act.
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