Stop COVID–19 Test Surprise Medical Bills Act of 2021
Bill: S.2411 | Sponsor: Sen. Smith, Tina (D-MN)
Policy area: Health

Summary:
Stop COVID-19 Test Surprise Medical Bills Act of 2021
This bill modifies provisions requiring health insurance plans to cover COVID-19 diagnostic testing services at no cost, without prior authorization, and without medical management requirements. This includes the rates at which insurance plans must reimburse providers of such tests.  The bill also requires the Department of Health and Human Services (HHS) to survey and report on the cash prices of testing services and the compliance of providers with the requirement to publish the prices of tests.
Additionally, HHS, jointly with the Department of the Treasury and the Department of Labor, must issue guidance clarifying the process for submitting claims for testing services.

To prevent surprise medical bills with respect to COVID-19 testing.

    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 ``Stop COVID-19 Test Surprise Medical 
Bills Act of 2021''.

SEC. 2. MEDICAL MANAGEMENT.

    Section 6001 of the Families First Coronavirus Response Act (Public 
Law 116-127) is amended by adding at the end the following:
    ``(e) Medical Management.--For purposes of this section, the term 
`medical management' includes determinations about why an individual 
sought testing, the nature of the clinical assessment that was 
associated with the testing, whether the individual was showing 
symptoms, what provider ordered the testing, the frequency of testing 
obtained by the individual, and other reviews of the encounters or 
events that proceeded or followed a service described in subsection 
(a). Such term does not include reasonable efforts by a group health 
plan or health insurance issuer to encourage individuals to obtain 
tests from lower priced providers (provided that such reasonable 
efforts do not delay or otherwise impede access to testing).''.

SEC. 3. PRICING OF DIAGNOSTIC TESTING.

    Section 3202 of the CARES Act (Public Law 116-136) is amended--
            (1) in subsection (a)--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) With respect to such items and services provided by a 
        participating provider, such plan or issuer shall reimburse 
        such provider the rate that the health plan or issuer has 
        negotiated with such provider before the public health 
        emergency declared under section 319 of the Public Health 
        Service Act (42 U.S.C. 247d) with respect to COVID-19.''; and
                    (B) by amending paragraph (2) to read as follows:
            ``(2) With respect to such items and services provided by a 
        nonparticipating provider or facility, such plan or issuer 
        shall reimburse such provider in an amount equal to the lesser 
        of--
                    ``(A) the cash price for a diagnostic test for 
                COVID-19; or
                    ``(B) 2 times the reimbursement rate for the 
                applicable items and services under the Medicare 
                program under title XVIII of the Social Security Act 
                (42 U.S.C. 1395 et seq.).'';
            (2) in subsection (b)(2), by striking ``$300'' and 
        inserting ``$10,000''; and
            (3) by adding at the end the following:
    ``(c) No Charges for COVID-19 Testing.--A provider shall not bill, 
and shall not hold liable, any individual receiving items and services 
described in section 6001(a) of division F of the Families First 
Coronavirus Response Act (Public Law 116-127) for a payment amount for 
such an item or service furnished by such provider.''.

SEC. 4. IMPROVEMENTS TO TRANSPARENCY POLICY.

    (a) In General.--Section 3202 of the CARES Act (Public Law 116-
136), as amended by section 3, is further amended by adding at the end 
the following:
    ``(d) Improvements to Transparency Policy.--Not later than 30 days 
after the date of enactment of this subsection, the Secretary of Health 
and Human Services shall survey a sample of providers of the items and 
services described in section 6001(a) of division F of the Families 
First Coronavirus Response Act (Public Law 116-127) regarding the cash 
prices for such items and services as listed by the providers on a 
public internet website. The Secretary shall survey no fewer than 200 
providers representing a diversity of sizes, geographic locations, test 
types, and care settings (such as hospitals, laboratories, and free-
standing emergency rooms).
    ``(e) Public Report.--Not later than 45 days after the date of 
enactment of this subsection, the Secretary of Health and Human 
Services shall publish a report on cash prices for items and services 
published under subsection (b)(1), which shall include--
            ``(1) the compliance rate of providers with the cash price 
        publication requirement under subsection (b)(1);
            ``(2) the average cash price for each item and service 
        described in section 6001(a) of division F of the Families 
        First Coronavirus Response Act (Public Law 116-127) and 
        published under subsection (b)(1);
            ``(3) with respect to each such item and service, a 
        comparison of such average cash price to the reimbursement rate 
        under the Medicare program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.); and
            ``(4) any outlier cash prices published under subsection 
        (b)(1) (including the names of the providers charging such 
        prices) that substantially exceed the average cash price.''.

SEC. 5. GUIDANCE ON BILLING FOR PROVIDER VISITS ASSOCIATED WITH COVID-
              19 TESTING.

    The Secretary of Health and Human Services, the Secretary of Labor, 
and the Secretary of the Treasury, shall jointly issue guidance, not 
later than 30 days after the date of enactment of this Act, for 
purposes of clarifying--
            (1) the process for submitting claims for items and 
        services described in section 6001(a) of the Families First 
        Coronavirus Response Act (Public Law 116-127) to ensure that 
        individuals enrolled in individual or group health insurance 
        coverage or group health plans to whom such items and services 
        are furnished are not subject to cost-sharing or prior 
        authorization or other medical management requirements; and
            (2) that providers should not collect cost-sharing amounts 
        from individuals seeking items and services described in 
        section 6001(a) of such Act.
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