Title: Ensuring Coverage in Public Health Emergencies Act of 2020
Policy area: Health

Summary:
Ensuring Coverage in Public Health Emergencies Act of 2020
This bill requires private health insurance plans to provide a 30-day special enrollment period for eligible individuals after a public health emergency is declared. An employee who is eligible but not enrolled may enroll in an employer-provided group health plan during the special enrollment period.  The bill also requires such plans to cover services related to the disease or condition resulting in the public health emergency including, if applicable, vaccines, diagnostic testing, and treatment and care for the disease or condition. Such coverage does not require a positive diagnosis of the disease or condition and cost sharing must be comparable to similar services covered outside the circumstance of a public health emergency.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3536 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 3536

    To provide for special enrollment periods during public health 
emergencies, coverage of services related to public health emergencies, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 19, 2020

   Mr. Casey (for himself, Mr. Booker, and Mr. Reed) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
    To provide for special enrollment periods during public health 
emergencies, coverage of services related to public health emergencies, 
                        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 Coverage in Public Health 
Emergencies Act of 2020''.

SEC. 2. SPECIAL ENROLLMENT PERIODS DURING PUBLIC HEALTH EMERGENCIES.

    (a) Public Health Service Act.--Title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.) is amended--
            (1) in section 2702(b)(2) (42 U.S.C. 300gg-1(b)(2)), by 
        inserting ``, which shall include a special enrollment period 
        of 30 days during a public health emergency declared under 
        section 319, which period may be extended for such time as the 
        Secretary may require'' before the period at the end; and
            (2) in section 2704(f) (42 U.S.C. 300gg-3(f)), by adding at 
        the end the following:
            ``(4) Public health emergencies.--If the Secretary declares 
        a public health emergency under section 319, group health plan, 
        and a group health insurance issuer offering group health 
        insurance coverage in connection with a group health plan, 
        shall permit an employee who is eligible, but not enrolled, for 
        coverage under the terms of the plan or coverage (or a 
        dependent of such an employee if the dependent is eligible, but 
        not enrolled, for coverage under such terms) to enroll for 
        coverage under the terms of the plan or coverage during the 
        special enrollment period required under section 2702(b)(2) of 
        the Public Health Service Act (42 U.S.C. 300gg-1(b)(2)).''.
    (b) ERISA.--Section 701(f) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1181(f)) is amended by adding at the 
end the following:
            ``(4) Public health emergencies.--If the Secretary of 
        Health and Human Services declares a public health emergency 
        under section 319 of the Public Health Service Act (42 U.S.C. 
        247d), a group health plan, or a health insurance issuer 
        offering group health insurance coverage in connection with 
        such a plan, shall permit an employee who is eligible, but not 
        enrolled, for coverage under the terms of the plan or coverage 
        (or a dependent of such an employee if the dependent is 
        eligible, but not enrolled, for coverage under such terms) to 
        enroll for coverage under the terms of the plan or coverage 
        during the special enrollment period required under section 
        2702(b)(2) of the Public Health Service Act (42 U.S.C. 300gg-
        1(b)(2)).''.
    (c) IRC.--Section 9801(f) of the Internal Revenue Code of 1986 (26 
U.S.C. 9801(f)) is amended by adding at the end the following new 
paragraph:
            ``(4) Public health emergencies.--If the Secretary of 
        Health and Human Services declares a public health emergency 
        under section 319 of the Public Health Service Act (42 U.S.C. 
        247d), a group health plan shall permit an employee who is 
        eligible, but not enrolled, for coverage under the terms of the 
        plan (or a dependent of such an employee if the dependent is 
        eligible, but not enrolled, for coverage under such terms) to 
        enroll for coverage under the terms of the plan during the 
        special enrollment period required under section 2702(b)(2) of 
        the Public Health Service Act (42 U.S.C. 300gg-1(b)(2)).''.
    (d) Rule of Construction.--Nothing in the amendments made by 
subsections (a) and (b) shall be construed to prevent group health plan 
or health insurance issuer from offering a special enrollment period in 
addition to any such period required under Federal law.

SEC. 3. COVERAGE OF PREVENTION AND TREATMENT RELATED TO PUBLIC HEALTH 
              EMERGENCIES.

    (a) Required Coverage.--
            (1) In general.--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:

``SEC. 2729A. COVERAGE OF PREVENTION AND TREATMENT RELATED TO PUBLIC 
              HEALTH EMERGENCIES.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group or individual health insurance coverage shall provide 
coverage for such services related to a disease or condition relating 
to a public health emergency declared under section 319, which, as 
applicable, shall include any services for the prevention or treatment, 
of the disease or condition.
    ``(b) Scope of Benefits.--The prevention and treatment measures for 
which coverage is required under subsection (a) shall--
            ``(1) be at the same level as benefits for the prevention 
        or treatment of other similar or related diseases or 
        conditions, if applicable, under the plan or coverage; and
            ``(2) include, with respect to the disease or condition 
        reasonably related to the public health emergency, even if no 
        diagnosis has been made and even if the enrollee ultimately is 
        determined not to have the disease or condition, as 
        applicable--
                    ``(A) vaccines to prevent the disease or condition, 
                if applicable;
                    ``(B) testing for diagnosis of the disease or 
                condition, if applicable;
                    ``(C) care related to symptoms an enrollee may 
                experience; and
                    ``(D) treatments for the disease or condition.
    ``(c) Cost-Sharing.--Cost-sharing for services for which coverage 
is required under subsection (a) shall be comparable to similar such 
services that would be covered by the plan or coverage outside of a 
public health emergency.
    ``(d) Waiver of Restrictions.--
            ``(1) In general.--A group health plan or health insurance 
        issuer offering group or individual health insurance coverage 
        shall waive any restriction (including any prior authorization 
        requirement, limitation on filling or refilling prescription 
        drugs, or other restrictions) on access to covered benefits 
        required under this section, if the service is determined by a 
        qualified health professional to be medically necessary by the 
        provider and the Secretary determines such restriction to be 
        unduly burdensome in the context of the applicable public 
        health emergency.
            ``(2) Term of waiver.--Any waiver of restrictions pursuant 
        to paragraph (1) shall apply only for the duration of the 
        public health emergency, as declared under section 319.''.
            (2) ERISA.--
                    (A) In general.--Subpart B of part 7 of subtitle B 
                of title I of the Employee Retirement Income Security 
                Act of 1974 (29 U.S.C. 1181 et. seq.) is amended by 
                adding at the end the following:

``SEC. 716. COVERAGE OF PREVENTION AND TREATMENT RELATED TO PUBLIC 
              HEALTH EMERGENCIES.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group health insurance coverage, shall provide coverage for 
such services related to a disease or condition relating to a public 
health emergency declared under section 319 of the Public Health 
Service Act, which, as applicable, shall include any services for the 
prevention or treatment, of the disease or condition.
    ``(b) Scope of Benefits.--The prevention and treatment measures for 
which coverage is required under subsection (a) shall--
            ``(1) be at the same level as benefits for the prevention 
        or treatment of other similar or related diseases or 
        conditions, if applicable, under the plan or coverage; and
            ``(2) include, with respect to the disease or condition 
        reasonably related to the public health emergency, even if no 
        diagnosis has been made and even if the enrollee ultimately is 
        determined not to have the disease or condition, as 
        applicable--
                    ``(A) vaccines to prevent the disease or condition, 
                if applicable;
                    ``(B) testing for diagnosis of the disease or 
                condition, if applicable;
                    ``(C) care related to symptoms an enrollee may 
                experience; and
                    ``(D) treatments for the disease or condition.
    ``(c) Cost-Sharing.--Cost-sharing for services for which coverage 
is required under subsection (a) shall be comparable to similar such 
services that would be covered by the plan or coverage outside of a 
public health emergency.
    ``(d) Waiver of Restrictions.--
            ``(1) In general.--A group health plan or health insurance 
        issuer offering group health insurance coverage shall waive any 
        restriction (including any prior authorization requirement, 
        limitation on filling or refilling prescription drugs, or other 
        restrictions) on access to covered benefits required under this 
        section, if the service is determined by a qualified health 
        professional to be medically necessary by the provider and the 
        Secretary determines such restriction to be unduly burdensome 
        in the context of the applicable public health emergency.
            ``(2) Term of waiver.--Any waiver of restrictions pursuant 
        to paragraph (1) shall apply only for the duration of the 
        public health emergency, as declared under section 319 of the 
        Public Health Service Act.''.
                    (B) Clerical amendment.--The table of sections for 
                subpart B of part 7 of subtitle B of title I of the 
                Employee Retirement Income Security Act of 1974 is 
                amended by adding at the end the following:

``Sec. 715. Additional market reforms.
``Sec. 716. Coverage of prevention and treatment related to public 
                            health emergencies.''.
            (3) IRC.--
                    (A) In general.--Subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986 is amended by adding at 
                the end the following new section:

``SEC. 9816. COVERAGE OF PREVENTION AND TREATMENT RELATED TO PUBLIC 
              HEALTH EMERGENCIES.

    ``(a) In General.--A group health plan shall provide coverage for 
such services related to a disease or condition relating to a public 
health emergency declared under section 319 of the Public Health 
Service Act, which, as applicable, shall include any services for the 
prevention or treatment, of the disease or condition.
    ``(b) Scope of Benefits.--The prevention and treatment measures for 
which coverage is required under subsection (a) shall--
            ``(1) be at the same level as benefits for the prevention 
        or treatment of other similar or related diseases or 
        conditions, if applicable, under the plan; and
            ``(2) include, with respect to the disease or condition 
        reasonably related to the public health emergency, even if no 
        diagnosis has been made and even if the enrollee ultimately is 
        determined not to have the disease or condition, as 
        applicable--
                    ``(A) vaccines to prevent the disease or condition, 
                if applicable;
                    ``(B) testing for diagnosis of the disease or 
                condition, if applicable;
                    ``(C) care related to symptoms an enrollee may 
                experience; and
                    ``(D) treatments for the disease or condition.
    ``(c) Cost-Sharing.--Cost-sharing for services for which coverage 
is required under subsection (a) shall be comparable to similar such 
services that would be covered by the plan outside of a public health 
emergency.
    ``(d) Waiver of Restrictions.--
            ``(1) In general.--A group health plan shall waive any 
        restriction (including any prior authorization requirement, 
        limitation on filling or refilling prescription drugs, or other 
        restrictions) on access to covered benefits required under this 
        section, if the service is determined by a qualified health 
        professional to be medically necessary by the provider and the 
        Secretary determines such restriction to be unduly burdensome 
        in the context of the applicable public health emergency.
            ``(2) Term of waiver.--Any waiver of restrictions pursuant 
        to paragraph (1) shall apply only for the duration of the 
        public health emergency, as declared under section 319 of the 
        Public Health Service Act.''.
                    (B) Clerical amendment.--The table of sections for 
                subchapter B of chapter 100 of such Code is amended by 
                adding at the end the following new item:

``Sec. 9816. Coverage of prevention and treatment related to public 
                            health emergencies.''.

SEC. 4. EFFECTIVE DATE; APPLICATION.

    The amendments made by this Act shall take effect on the date of 
enactment of this Act and shall apply with respect to plans years in 
effect on the date of enactment of this Act, and plan years beginning 
on or after such date.
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