Title: Care for COVID-19 Act 2.0
Policy area: Health

Summary:
Care for COVID-19 Act 2.0
This bill establishes a special health plan enrollment period and requires health plans to cover certain services during the COVID-19 (i.e., coronavirus disease 2019) public health emergency. The special enrollment period applies to plans offered through health insurance exchanges and is available to eligible individuals for eight weeks beginning one week after this bill is enacted. The bill also funds outreach activities for the Department of Health and Human Services (HHS) to notify individuals about the special enrollment period.  Additionally, the 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. HHS, the Department of Labor, and the Department of the Treasury must jointly issue guidance that specifies applicable medically necessary services not later than one week after this bill is enacted. Further, HHS must reimburse health plans for the amount of such cost-sharing requirements that are not imposed.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6486 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 6486

To amend the Patient Protection and Affordable Care Act to require the 
     Secretary of Health and Human Services to establish a special 
enrollment period during the COVID-19 emergency period, to require the 
  Secretary to carry out outreach and educational activities for such 
  special enrollment period, to require group health plans and health 
    insurance issuers offering group or individual health insurance 
coverage to provide coverage without any cost sharing for certain items 
and services furnished during any portion of such emergency period, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 10, 2020

Mr. Ruiz (for himself and Ms. Underwood) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Ways and Means, and Education and Labor, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of 
                        the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend the Patient Protection and Affordable Care Act to require the 
     Secretary of Health and Human Services to establish a special 
enrollment period during the COVID-19 emergency period, to require the 
  Secretary to carry out outreach and educational activities for such 
  special enrollment period, to require group health plans and health 
    insurance issuers offering group or individual health insurance 
coverage to provide coverage without any cost sharing for certain items 
and services furnished during any portion of such 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 ``Care for COVID-19 Act 2.0''.

SEC. 2. SPECIAL ENROLLMENT PERIOD THROUGH EXCHANGES; FEDERAL EXCHANGE 
              OUTREACH AND EDUCATIONAL ACTIVITIES.

    (a) Special Enrollment Period Through Exchanges.--Section 1311(c) 
of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)) 
is amended--
            (1) in paragraph (6)--
                    (A) in subparagraph (C), by striking at the end 
                ``and'';
                    (B) in subparagraph (D), by striking at the end the 
                period and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(E) subject to subparagraph (B) of paragraph (8), 
                the special enrollment period described in subparagraph 
                (A) of such paragraph.''; and
            (2) by adding at the end the following new paragraph:
            ``(8) Special enrollment period for certain public health 
        emergency.--
                    ``(A) In general.--The Secretary shall, subject to 
                subparagraph (B), require an Exchange to provide--
                            ``(i) for a special enrollment period 
                        during the emergency period described in 
                        section 1135(g)(1)(B) of the Social Security 
                        Act--
                                    ``(I) which shall begin on the date 
                                that is one week after the date of the 
                                enactment of this paragraph and which, 
                                in the case of an Exchange established 
                                or operated by the Secretary within a 
                                State pursuant to section 1321(c), 
                                shall be an 8-week period; and
                                    ``(II) during which any individual 
                                who is otherwise eligible to enroll in 
                                a qualified health plan through the 
                                Exchange may enroll in such a qualified 
                                health plan; and
                            ``(ii) that, in the case of an individual 
                        who enrolls in a qualified health plan through 
                        the Exchange during such enrollment period, the 
                        coverage period under such plan shall begin, at 
                        the option of the individual, on April 1, 2020, 
                        or on the first day of the month following the 
                        day the individual selects a plan through such 
                        special enrollment period.
                    ``(B) Exception.--The requirement of subparagraph 
                (A) shall not apply to a State-operated or State-
                established Exchange if such Exchange, prior to the 
                date of the enactment of this paragraph, established or 
                otherwise provided for a special enrollment period to 
                address access to coverage under qualified health plans 
                offered through such Exchange during the emergency 
                period described in section 1135(g)(1)(B) of the Social 
                Security Act.''.
    (b) Federal Exchange Outreach and Educational Activities.--Section 
1321(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 
18041(c)) is amended by adding at the end the following new paragraph:
            ``(3) Outreach and educational activities.--
                    ``(A) In general.--In the case of an Exchange 
                established or operated by the Secretary within a State 
                pursuant to this subsection, the Secretary shall carry 
                out outreach and educational activities for purposes of 
                informing potential enrollees in qualified health plans 
                offered through the Exchange of the availability of 
                coverage under such plans and financial assistance for 
                coverage under such plans. Such outreach and 
                educational activities shall be provided in a manner 
                that is culturally and linguistically appropriate to 
                the needs of the populations being served by the 
                Exchange (including hard-to-reach populations, such as 
                racial and sexual minorities, limited English 
                proficient populations, and young adults).
                    ``(B) Limitation on use of funds.--No funds 
                appropriated under this paragraph shall be used for 
                expenditures for promoting non-ACA compliant health 
                insurance coverage.
                    ``(C) Non-ACA compliant health insurance 
                coverage.--For purposes of subparagraph (B):
                            ``(i) The term `non-ACA compliant health 
                        insurance coverage' means health insurance 
                        coverage, or a group health plan, that is not a 
                        qualified health plan.
                            ``(ii) Such term includes the following:
                                    ``(I) An association health plan.
                                    ``(II) Short-term limited duration 
                                insurance.
                    ``(D) Funding.--Out of any funds in the Treasury 
                not otherwise appropriated, there are hereby 
                appropriated $25,000,000 to carry out this paragraph. 
                Funds appropriated under this subparagraph shall remain 
                available until expended.''.
    (c) Implementation.--The Secretary of Health and Human Services may 
implement the provisions of (including amendments made by) this section 
through subregulatory guidance, program instruction, or otherwise.

SEC. 3. 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 Services, 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, 2021, 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.
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