Coverage for COVID–19 Treatment Act of 2021
Bill: H.R.796 | Sponsor: Rep. Blunt Rochester, Lisa (D-DE)
Policy area: Health

Summary:
Coverage for COVID-19 Treatment Act of 2021
This bill requires private health insurance plans to cover, without any cost-sharing requirement, medically necessary services for individuals who have been diagnosed with, or are presumed to have, COVID-19 (i.e., coronavirus disease 2019).
The Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury must, not later than one week after this bill is enacted, jointly issue guidance specifying the applicable services. Further, HHS must reimburse insurance plans for the cost-sharing amount for such services that would otherwise have been required. The bill provides funding for this reimbursement.

To require group health plans and health insurance issuers offering 
   group or individual health insurance coverage to provide coverage 
 without imposing any cost sharing requirements for certain items and 
services furnished during any portion of the COVID-19 emergency period, 
                        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 ``Coverage for COVID-19 Treatment Act 
of 2021''.

SEC. 2. COVERAGE OF COVID-19 RELATED TREATMENT AT NO COST SHARING.

    (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)) shall provide coverage, and shall 
not impose any cost sharing (including deductibles, copayments, and 
coinsurance) requirements, for the following items and services 
furnished during any portion of the emergency period defined 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:
            (1) Medically necessary items and services (including in-
        person or telehealth visits in which such items and services 
        are furnished) that are furnished to an individual who has been 
        diagnosed with (or after provision of the items and services is 
        diagnosed with) COVID-19 to treat or mitigate the effects of 
        COVID-19.
            (2) Medically necessary items and services (including in-
        person or telehealth visits in which such items and services 
        are furnished) that are furnished to an individual who is 
        presumed to have COVID-19 but is never diagnosed as such, if 
        the following conditions are met:
                    (A) Such items and services are furnished to the 
                individual to treat or mitigate the effects of COVID-19 
                or to mitigate the impact of COVID-19 on society.
                    (B) Health care providers have taken appropriate 
                steps under the circumstances to make a diagnosis, or 
                confirm whether a diagnosis was made, with respect to 
                such individual, for COVID-19, if possible.
    (b) Items and Services Related to Covid-19.--For purposes of this 
section--
            (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 medically 
        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 individual health insurance coverage offered by a 
        health insurance issuer.
    (c) Reimbursement to Plans and Coverage for Waiving Cost-Sharing.--
            (1) In general.--A group health plan or 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)) 
        that does not impose cost sharing requirements as described in 
        subsection (a) shall notify the Secretary of Health and Human 
        Services, Secretary of Labor, and Secretary of the Treasury 
        (through a joint process established jointly by the 
        Secretaries) of the total dollar amount of cost-sharing that, 
        but for the application of subsection (a), would have been 
        required under such plans and coverage for items and services 
        related to COVID-19 furnished during the period to which 
        subsection (a) applies to enrollees, participants, and 
        beneficiaries in the plan or coverage to whom such subsection 
        applies, but which was not imposed for such items and services 
        so furnished pursuant to such subsection and the Secretary of 
        Health and Human Services, in coordination with the Secretary 
        of Labor and the Secretary of the Treasury, shall make payments 
        in accordance with this subsection to the plan or issuer equal 
        to such total dollar amount.
            (2) Methodology for payments.--The Secretary of Health and 
        Human Service, in coordination with the Secretary of Labor and 
        the Secretary of the Treasury shall establish a payment system 
        for making payments under this subsection. Any such system 
        shall make payment for the value of cost sharing not imposed by 
        the plan or issuer involved.
            (3) Timing of payments.--Payments made under paragraph (1) 
        shall be made no later than May 1, 2022, for amounts of cost 
        sharing waivers with respect to 2020. Payments under this 
        subsection with respect to such waivers with respect to a year 
        subsequent to 2020 that begins during the period to which 
        subsection (a) applies shall be made no later than May of the 
        year following such subsequent year.
            (4) Appropriations.--There is authorized to be 
        appropriated, and there is appropriated, out of any monies in 
        the Treasury not otherwise appropriated, such funds as are 
        necessary to carry out this subsection.
    (d) 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 insurance 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 Security Act of 1974, and subchapter B of chapter 100 of 
        the Internal Revenue Code of 1986, as applicable.
            (2) Private right of action.--An individual with respect to 
        whom an action is taken by a group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage in violation of subsection (a) may commence a civil 
        action against the plan or issuer for appropriate relief. The 
        previous sentence shall not be construed as limiting any 
        enforcement mechanism otherwise applicable pursuant to 
        paragraph (1).
    (e) Implementation.--The Secretary of Health and Human Services, 
Secretary of Labor, and Secretary of the Treasury may implement the 
provisions of this section through sub-regulatory guidance, program 
instruction or otherwise.
    (f) Terms.--The terms ``group health plan''; ``health insurance 
issuer''; ``group health insurance coverage'', and ``individual health 
insurance coverage'' have the meanings given such terms in section 2791 
of the Public Health Service Act (42 U.S.C. 300gg-91), section 733 of 
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b), 
and section 9832 of the Internal Revenue Code of 1986, as applicable.
                                 <all>