No Cost for Monkeypox Testing Act of 2022
Bill: H.R.8693 | Sponsor: Rep. Maloney, Sean Patrick (D-NY)
Policy area: Health

Summary:
No Cost for Monkeypox Testing Act of 2022  This bill requires specified public health care programs and private health insurance to cover, through December 31, 2023, testing for monkeypox without imposing cost-sharing, including deductibles, coinsurance, and copayments. (Monkeypox is a viral disease that is endemic to parts of Africa and causes symptoms similar to, but less severe than, smallpox.)
The bill also establishes procedures for uninsured individuals to access such testing at no cost.

To ensure access to cost-free monkeypox testing 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 ``No Cost for Monkeypox Testing Act of 
2022''.

SEC. 2. ENSURING ACCESS TO COST-FREE MONKEYPOX TESTING SERVICES.

    (a) Group Health Plans and Group and Individual Health Insurance 
Coverage.--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. COVERAGE OF MONKEYPOX TESTING WITH NO COST SHARING.

    ``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 or prior authorization or other medical management 
requirements, for the following items and services furnished during the 
period beginning on the date of the enactment of this section and 
ending on December 31, 2023:
            ``(1) Tests for the detection of the monkeypox virus or the 
        diagnosis of monkeypox (including the administration of such 
        testing).
            ``(2) Items and services furnished to an individual during 
        health care provider office visits (which term in this 
        paragraph includes in-person visits and telehealth visits), 
        urgent care center visits, and emergency room visits that 
        result in an order for or administration of a test described in 
        paragraph (1), but only to the extent such items and services 
        relate to the furnishing or administration of such test or to 
        the evaluation of such individual for purposes of determining 
        the need of such individual for such test.''.
    (b) Medicare.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended--
            (1) in subsection (a)(1)--
                    (A) by striking ``and'' before ``(DD)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``and (EE) with respect to a specified 
                monkeypox testing-related service described in 
                paragraph (1) of subsection (ee) for which payment may 
                be made under a specified outpatient payment provision 
                described in paragraph (2) of such subsection, the 
                amounts paid shall be 100 percent of the payment amount 
                otherwise recognized under such respective specified 
                outpatient payment provision for such service,'';
            (2) in subsection (b), in the first sentence--
                    (A) by striking ``and'' before ``(12)''; and
                    (B) by inserting before the period at the end the 
                following: ``, and (13) such deductible shall not apply 
                with respect to any specified monkeypox testing-related 
                service described in paragraph (1) of subsection (ee) 
                for which payment may be made under a specified 
                outpatient payment provision described in paragraph (2) 
                of such subsection''; and
            (3) by adding at the end the following new subsection:
    ``(ee) Specified Monkeypox Testing-Related Services.--For purposes 
of subsection (a)(1)(EE):
            ``(1) Description.--
                    ``(A) In general.--A specified monkeypox testing-
                related service described in this paragraph is a 
                medical visit that--
                            ``(i) is in any of the categories of HCPCS 
                        evaluation and management service codes 
                        described in subparagraph (B);
                            ``(ii) is furnished during any portion of 
                        the period that begins on the date of the 
                        enactment of this subsection and ends on 
                        December 31, 2023;
                            ``(iii) results in an order for or 
                        administration of a clinical diagnostic 
                        laboratory test described in section 
                        1852(a)(1)(B)(iv)(IV); and
                            ``(iv) relates to the furnishing or 
                        administration of such test or to the 
                        evaluation of such individual for purposes of 
                        determining the need of such individual for 
                        such test.
                    ``(B) Categories of hcpcs codes.--For purposes of 
                subparagraph (A), the categories of HCPCS evaluation 
                and management services codes are the categories 
                described in subsection (cc)(1)(B).
            ``(2) Specified outpatient payment provision.--A specified 
        outpatient payment provision described in this paragraph is any 
        such provision described in subsection (cc)(2).''.
    (c) Medicare Advantage.--Section 1852(a)(1)(B) of the Social 
Security Act (42 U.S.C. 1395w-22(a)(1)(B)) is amended--
            (1) in clause (iv)--
                    (A) by redesignating subclause (VII) as subclause 
                (IX); and
                    (B) by inserting after subclause (VI) the following 
                new subclauses:
                                    ``(VII) Clinical diagnostic 
                                laboratory tests administered during 
                                the period beginning on the date of the 
                                enactment of this subclause and ending 
                                on December 31, 2023, for the detection 
                                of the monkeypox virus or the diagnosis 
                                of monkeypox and the administration of 
                                such test.
                                    ``(VIII) Specified monkeypox 
                                testing-related services (as described 
                                in section 1833(ee)(1)) for which 
                                payment would be payable under a 
                                specified outpatient payment provision 
                                described in section 1833(ee)(2).'';
            (2) in clause (v), by striking ``subclauses (IV), (V), and 
        (VI)'' and inserting ``subclauses (IV) through (VIII)''; and
            (3) by adding at the end the following new clause:
                            ``(vii) Prohibition of application of 
                        certain requirements for monkeypox testing.--In 
                        the case of a test or service described in 
                        subclause (VII) or (VIII) of clause (iv) that 
                        is administered or furnished during the period 
                        described in such subclause (VII), an MA plan 
                        may not impose any prior authorization or other 
                        utilization management requirements with 
                        respect to the coverage of such a test or 
                        service under such plan.''.
    (d) Medicaid and CHIP.--
            (1) Medicaid.--
                    (A) In general.--Section 1905(a)(3) of the Social 
                Security Act (42 U.S.C. 1396d(a)(3)) is amended--
                            (i) in subparagraph (A), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (B), by striking the 
                        semicolon and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(C) tests administered during the period beginning on the 
        date of the enactment of this subparagraph and ending on 
        December 31, 2023, for the detection of the monkeypox virus or 
        the diagnosis of monkeypox and the administration of such 
        tests;''.
                    (B) No cost sharing.--
                            (i) In general.--Subsections (a)(2) and 
                        (b)(2) of section 1916 of the Social Security 
                        Act (42 U.S.C. 1396o) are each amended--
                                    (I) in subparagraph (H), by 
                                striking ``or'' at the end;
                                    (II) in subparagraph (I), by 
                                striking ``; and'' and inserting a 
                                comma; and
                                    (III) by adding at the end the 
                                following new subparagraphs:
                    ``(J) any test described in section 1905(a)(3)(C) 
                that is administered during the period described in 
                such section (and the administration of such test), or
                    ``(K) monkeypox testing-related services for which 
                payment may be made under the State plan; and''.
                            (ii) Application to alternative cost 
                        sharing.--Section 1916A(b)(3)(B) of the Social 
                        Security Act (42 U.S.C. 1396o-1(b)(3)(B)) is 
                        amended by adding at the end the following new 
                        clause:
                            ``(xiv) Any test described in section 
                        1905(a)(3)(C) that is administered during the 
                        period described in such section (and the 
                        administration of such test) and any service 
                        described in section 1916(a)(2)(K) that is 
                        furnished during any such period.''.
                            (iii) Clarification.--The amendments made 
                        this paragraph shall apply with respect to a 
                        State plan of a territory in the same manner as 
                        a State plan of one of the 50 States.
                    (C) Expansion of state option to provide coverage 
                of uninsured individuals to include monkeypox 
                testing.--Section 1902(a)(10) of the Social Security 
                Act (42 U.S.C. 1396a(a)(10)) is amended--
                            (i) in subparagraph (A)(ii)(XXIII), by 
                        striking ``any portion of the emergency period 
                        defined in paragraph (1)(B) of section 1135(g) 
                        beginning on or after the date of the enactment 
                        of this subclause'' and inserting ``the period 
                        beginning on the date of the enactment of this 
                        subclause and ending on December 31, 2022 (or, 
                        if latter, on the last day of the emergency 
                        period described in section 1135(g)(1)(B)),''; 
                        and
                            (ii) in the matter following subparagraph 
                        (G) designated as subclause (XVIII)--
                                    (I) by striking ``the period at the 
                                end of the emergency sentence described 
                                in such section'' and inserting ``the 
                                emergency period described in such 
                                section'';
                                    (II) by striking ``and testing and 
                                treatments'' and inserting ``testing 
                                and treatments''; and
                                    (III) by inserting ``any test 
                                described in section 1905(a)(3)(C) (and 
                                the administration of such test) that 
                                is administered during the period 
                                beginning on the date of the enactment 
                                of the No Cost for Monkeypox Testing 
                                Act of 2022 and ending on January 1, 
                                2023, and any service described in 
                                section 1916(a)(2)(K) that is furnished 
                                during such period'' after ``(or waiver 
                                of such plan)''.
            (2) CHIP.--
                    (A) In general.--Section 2103(c) of the Social 
                Security Act (42 U.S.C. 1397cc(c)) is amended by adding 
                at the end the following paragraph:
            ``(12) Certain monkeypox testing.--The child health 
        assistance provided to a targeted low-income child shall 
        include coverage of any test described in section 1905(a)(3)(C) 
        that is administered during the period beginning on the date of 
        the enactment of this paragraph and ending on December 31, 2023 
        (and the administration of such test).''.
                    (B) Prohibition of cost sharing.--Section 
                2103(e)(2) of the Social Security Act (42 U.S.C. 
                1397cc(e)(2)) is amended--
                            (i) in the header, by inserting ``monkeypox 
                        testing,'' after ``covid-19 treatment''; and
                            (ii) by inserting ``tests described in 
                        subsection (c)(12) (and administration of such 
                        tests) furnished during the period described in 
                        such section, services described in section 
                        1916(a)(2)(K) furnished during such period'' 
                        before ``, or for pregnancy-related 
                        assistance''.
    (e) Application With Respect to Tricare, Coverage for Veterans, and 
Coverage for Federal Civilians.--
            (1) Tricare.--The Secretary of Defense may not require any 
        copayment or other cost sharing under chapter 55 of title 10, 
        United States Code, for tests described in paragraph (1) of 
        section 2730 of the Public Health Service Act (or the 
        administration of such tests) or item and services described in 
        paragraph (2) of such section furnished during the period 
        beginning on the date of the enactment of this Act and ending 
        on December 31, 2023.
            (2) Veterans.--The Secretary of Veterans Affairs may not 
        require any copayment or other cost sharing under chapter 17 of 
        title 38, United States Code, for tests described in paragraph 
        (1) of section 2730 of the Public Health Service Act (or the 
        administration of such tests) or items and services described 
        in paragraph (2) of such section furnished during the period 
        described in paragraph (1).
            (3) Federal civilians.--No copayment or other cost sharing 
        may be required for any individual occupying a position in the 
        civil service (as that term is defined in section 2101(1) of 
        title 5, United States Code) enrolled in a health benefits 
        plan, including any plan under chapter 89 of title 5, United 
        States Code, or for any other individual currently enrolled in 
        any plan under chapter 89 of title 5 for tests described in 
        paragraph (1) of section 2730 of the Public Health Service Act 
        (or the administration of such tests) or items and services 
        described in paragraph (2) of such section furnished during the 
        period described in paragraph (1).
    (f) Coverage of Testing for Monkeypox at No Cost Sharing for 
Indians Receiving Purchased/Referred Care.--The Secretary of Health and 
Human Services shall cover, without the imposition of any cost sharing 
requirements, the cost of providing any test described in paragraph (1) 
of section 2730 of the Public Health Service Act (or the administration 
of such tests) or items and services described in paragraph (2) of such 
section furnished during the period described in subsection (e)(1) to 
Indians (as defined in section 4 of the Indian Health Care Improvement 
Act (25 U.S.C. 1603)) receiving health services through the Indian 
Health Service, including through an Urban Indian Organization, 
regardless of whether such items or services have been authorized under 
the purchased/referred care system funded by the Indian Health Service 
or is covered as a health service of the Indian Health Service.
    (g) Access for Certain Uninsured Individuals.--
            (1) In general.--The Secretary of Health and Human Services 
        shall establish a program under which--
                    (A) program-registered providers submit claims to 
                the Secretary with respect to the furnishing, during 
                the period described in subsection (e)(1), of tests 
                described in paragraph (1) of section 2730 of the 
                Public Health Service Act (or the administration of 
                such tests) or items and services described in 
                paragraph (2) of such section furnished to uninsured 
                individuals; and
                    (B) the Secretary, subject to the availability of 
                appropriations, pays each such provider for such tests, 
                items, and services in an amount determined appropriate 
                by the Secretary.
            (2) Definitions.--In this section:
                    (A) Program-registered provider.--The term 
                ``program-registered provider'' means a health care 
                provider that--
                            (i) enters into an agreement with the 
                        Secretary under which the provider agrees not 
                        to hold an uninsured individual liable for the 
                        cost of tests, items, and services described in 
                        paragraph (1) with respect to which a payment 
                        is made under subparagraph (B) of such 
                        paragraph; and
                            (ii) meets such other requirements as the 
                        Secretary may specify.
                    (B) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
                    (C) Uninsured individual.--The term ``uninsured 
                individual'' means, with respect to an individual and a 
                test, item, or service described in paragraph (1), an 
                individual who--
                            (i) is not enrolled in--
                                    (I) a Federal health care program 
                                (as defined in section 1128B(f) of the 
                                Social Security Act (42 U.S.C. 1320a-
                                7b(f)));
                                    (II) a group health plan or health 
                                insurance coverage offered by a health 
                                insurance issuer in the group or 
                                individual market (as such terms are 
                                defined in section 2791 of the Public 
                                Health Service Act (42 U.S.C. 300gg-
                                91)); or
                                    (III) a health plan offered under 
                                chapter 89 of title 5, United States 
                                Code; or
                            (ii) is enrolled in a program, plan, or 
                        coverage described in subparagraph (A) that 
                        does not provide any benefits for such test, 
                        item, or service under such program, plan, or 
                        coverage (as applicable).
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