Title: Health Care Emergency Guarantee Act
Policy area: Health

Summary:
Health Care Emergency Guarantee Act  This bill requires the Department of Health and Human Services (HHS) to pay the out-of-pocket expenses of individuals receiving medically-necessary care or services during the COVID-19 (i.e., coronavirus disease 2019) pandemic. Specifically, the bill covers the costs for services provided through public or private health insurance and to uninsured individuals, including prescription drugs and care related to COVID-19, beginning on the date of enactment of this bill until a COVID-19 vaccine is widely available to the public.  Health insurance plans are prohibited from increasing the cost-sharing requirements of plans while this program is in effect and HHS must report to Congress on the program on a weekly basis.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3790 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 3790

 To provide reimbursements for certain costs of health care items and 
  services, including prescription drugs, furnished during the public 
          health emergency declared with respect to COVID-19.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 20, 2020

  Mrs. Gillibrand (for Mr. Sanders (for himself, Mrs. Gillibrand, Mr. 
     Markey, Ms. Warren, Mr. Booker, Mr. Merkley, and Ms. Harris)) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To provide reimbursements for certain costs of health care items and 
  services, including prescription drugs, furnished during the public 
          health emergency declared with respect to COVID-19.

    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 ``Health Care Emergency Guarantee 
Act''.

SEC. 2. REIMBURSEMENTS FOR CERTAIN COSTS OF HEALTH CARE ITEMS AND 
              SERVICES INCLUDING PRESCRIPTION DRUGS FURNISHED DURING 
              PUBLIC HEALTH EMERGENCY.

    (a) In General.--During the period beginning on the date of 
enactment of this Act and ending on the date the Secretary certifies to 
Congress that a vaccine approved by the Food and Drug Administration 
for COVID-19 is widely available to the public, the Secretary shall 
make payments to qualified providers with respect to applicable health 
care items and services as defined in subsection (b) that are furnished 
to an applicable individual an amount equal to--
            (1) in the case of any portion of such period in which an 
        applicable individual is enrolled in a public or private health 
        insurance plan, the amount of any cost-sharing, including any 
        deductibles, copayments, coinsurance or similar charges, that 
        would otherwise be applicable under such plan, including with 
        respect to prescription drug coverage under the plan;
            (2) in the case of any portion of such period in which an 
        applicable individual is uninsured, an amount equal to the 
        amount that would be paid to the qualified provider for the 
        same or equivalent items or services, including with respect to 
        any inpatient or physician-administered drugs (and excluding 
        outpatient prescription drugs or biologicals with respect to 
        which coverage is provided under subsection (e)), under the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.).
    (b) Applicable Health Care Items and Services; Applicable 
Individual Defined.--In this section:
            (1) Applicable health care items and services.--The term 
        ``applicable health care items and services'' means, with 
        respect to an applicable individual, any health care items and 
        services that are medically necessary or appropriate for the 
        maintenance of health or for the diagnosis, treatment, or 
        rehabilitation of a health condition of the applicable 
        individual, including--
                    (A) any testing services and treatments for COVID-
                19 or related complications, including vaccines, 
                diagnostic tests, drugs and biologicals, and therapies; 
                and
                    (B) in the case of an applicable individual who is 
                enrolled in a public or private health insurance plan, 
                any health care items and services covered by such plan 
                as of March 1, 2020, or in the case of an applicable 
                individual who enrolls in such plan after the date, any 
                health care items and services covered by such plan as 
                of the date of such enrollment.
            (2) Applicable individual.--The term ``applicable 
        individual'' means an individual who is a resident of the 
        United States.
    (c) Requirements.--
            (1) No effect on applicable cost-sharing requirements.--
        Nothing in this section shall affect the application of any 
        requirements applicable under Federal or State law with respect 
        to coverage of health care items and services without any cost-
        sharing.
            (2) Maintenance of effort.--
                    (A) In general.--During the period described in 
                subsection (a), a public or private health plan shall 
                not increase cost-sharing, decrease benefits, or 
                otherwise make coverage less generous than the benefits 
                offered on the date of enactment of this Act.
                    (B) New items and services.--During such period, a 
                public or private health plan shall provide coverage of 
                new items and services, including those related to 
                COVID-19, as appropriate, at a minimum, at a level 
                consistent with the prior coverage practices and 
                formularies of the plan.
            (3) Limitation on out-of-pocket expenses.--During such 
        period, in order to be eligible to receive payments under this 
        section, a qualified provider shall agree not to impose on an 
        applicable individual any charge for applicable health care 
        items and services furnished to the applicable individual.
            (4) Permissible billing of plans; limitation on balance 
        billing.--During such period, in order to be eligible to 
        receive payments under this section, a qualified provider shall 
        agree, with respect to applicable health care items and 
        services furnished to an applicable individual when such 
        individual is enrolled in a public or private health insurance 
        plan--
                    (A) not to impose any charge on the plan for such 
                items and services beyond the amount otherwise payable 
                by the plan; and
                    (B) not to bill the applicable individual for any 
                amounts in excess of the amount described in 
                subparagraph (A).
            (5) Medical debt collection.--A qualified provider shall 
        agree--
                    (A) to immediately halt all medical debt 
                collection, including collection activities carried out 
                by third parties, during such period and shall not 
                collect medical debt or have third parties collect 
                medical debt for applicable health care items and 
                services furnished during such period; and
                    (B) to refrain from pursuing medical debt 
                collection, including collection activities carried out 
                by third parties, after such period with respect to 
                items and services related to the diagnosis or 
                treatment of COVID-19 (regardless of whether such 
                services were furnished before, during, or after such 
                period) and shall not collect medical debt or have 
                third parties collect medical debt for such items or 
                services after such period.
            (6) Submission of bills and documentation.--A qualified 
        provider shall agree to submit bills and any required 
        supporting documentation relating to the provision of 
        applicable health care items and services within 30 days after 
        the date of providing such services, in such manner as the 
        Secretary determines appropriate.
    (d) Waiver of Late Enrollment Penalties Under Medicare.--During the 
period described in subsection (a), no increase in the monthly premium 
of an individual pursuant to section 1818(c), 1839(b), or 1860D-13 of 
the Social Security Act (42 U.S.C. 1395i-2(c), 1395r(b), 1395w-113) 
shall be effected in the case of any individual who enrolls for 
benefits under title XVIII of such Act with respect to any period prior 
to the date of such enrollment.
    (e) Coverage With Respect to Outpatient Prescription Drugs.--
            (1) In general.--During the period described in subsection 
        (a), with respect to outpatient prescription drugs or 
        biologicals described in subsection (b)(1)(A) that are 
        dispensed to uninsured individuals, the Secretary shall 
        establish procedures under which--
                    (A) such drugs or biologicals are dispensed at no 
                cost to such individuals;
                    (B) pharmacies that dispense such drugs or 
                biologicals--
                            (i) are reimbursed by the Secretary for 
                        such drugs or biologicals dispensed to such 
                        individuals at an amount equal to the price 
                        paid by the Secretary of Veterans Affairs to 
                        procure the drug or biological under the laws 
                        administered by the Secretary of Veterans 
                        Affairs; and
                            (ii) agree not to charge such individuals 
                        for any difference between the amount 
                        reimbursed under clause (i) and the cost to the 
                        pharmacy for the drug; and
                    (C) manufacturers of such drugs or biologicals 
                reimburse pharmacies for any difference described in 
                subparagraph (B)(ii) with respect to drugs or 
                biologicals of the manufacturer that are dispensed to 
                such individuals.
            (2) Condition of coverage under medicare.--During the 
        period described in subsection (a), no coverage may be provided 
        under part B or D of title XVIII of the Social Security Act (42 
        U.S.C. 1395j et seq., 1395w-101 et seq.) with respect to a drug 
        or biological of a manufacturer if the manufacturer does not 
        enter into an agreement with the Secretary to carry out the 
        requirements applicable with respect to such manufacturers 
        under this subsection.
            (3) Requirement for participating pharmacies.--During the 
        period described in subsection (a), a prescription drug plan 
        under part D of title XVIII of the Social Security Act (42 
        U.S.C. 1395w-101 et seq.) may not contract with a pharmacy if 
        the pharmacy does not enter into an agreement with the 
        Secretary to carry out the requirements applicable with respect 
        to pharmacies under this subsection.
    (f) Other Definitions.--
            (1) Public or private health insurance plan.--
                    (A) In general.--The term ``public or private 
                health insurance plan'' means any of the following:
                            (i) A group health plan, or group health 
                        insurance coverage, as such terms are defined 
                        in section 2791 of the Public Health Service 
                        Act (42 U.S.C. 300gg-91).
                            (ii) A qualified health plan, as defined in 
                        section 1301 of the Patient Protection and 
                        Affordable Care Act (42 U.S.C. 18021).
                            (iii) Subject to subparagraph (B), any 
                        health insurance coverage (other than a plan 
                        described in clause (ii)) offered in the 
                        individual market, as such terms are defined in 
                        section 2791 of the Public Health Service Act, 
                        including any short-term limited duration 
                        insurance.
                            (iv) A health plan offered under chapter 89 
                        of title 5, United States Code.
                            (v) A Federal health care program (as 
                        defined under section 1128B(f) of the Social 
                        Security Act (42 U.S.C. 1320a-7b(f)), 
                        including--
                                    (I) health benefits furnished under 
                                the TRICARE program (as defined in 
                                section 1072 of title 10, United States 
                                Code);
                                    (II) health benefits furnished to 
                                veterans under the laws administered by 
                                the Secretary of Veterans Affairs; and
                                    (III) health benefits furnished 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 benefits are for items or services 
                                that have been authorized under the 
                                purchased/referred care system funded 
                                by the Indian Health Service or are 
                                covered as a health service of the 
                                Indian Health Service.
                    (B) Limitation on individual health insurance 
                coverage.--The term ``public or private health 
                insurance coverage'' includes the health insurance 
                coverage described in clause (iii) of subparagraph (A) 
                only with respect to an individual who is enrolled in 
                such coverage on March 1, 2020.
            (2) Qualified provider.--The term ``qualified provider'' 
        means a health care provider who is a participating provider 
        under the Medicare program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.). Such term includes a 
        health care provider who is not a participating provider under 
        such program if the health care provider would meet the 
        criteria for such participation and, if the State requires the 
        health care provider to be licensed by the State, is licensed 
        by the State in which the items or services are furnished.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (g) Implementation.--
            (1) In general.--The Secretary, in coordination with the 
        Secretary of the Treasury, the Commissioner of Social Security, 
        and the Secretary of Labor, shall implement the provisions of 
        this section not later than the date that is 7 days after the 
        date of the enactment of this Act.
            (2) Ensuring timely payment.--The Secretary shall establish 
        a process and issue such guidance as is necessary to ensure a 
        qualified provider receives payments under this section in a 
        timely manner.
            (3) Ensuring collection of data on disparities.--The 
        Secretary shall implement this section in a manner and issue 
        such guidance as is necessary to allow for the ongoing, 
        accurate, and timely collection and analysis of data on 
        disparities in accordance with subsection (h).
    (h) Collection of Data on Disparities.--
            (1) In general.--During the period described in subsection 
        (a), the Secretary shall collect data on disparities across 
        race, ethnicity, primary language, gender, sexual orientation, 
        disability status, age, geographic area, insurance status, and 
        socioeconomic status--
                    (A) in health outcomes and access to health care 
                related to the COVID-19 outbreak, including data on 
                COVID-19 cases, treatment, and deaths; and
                    (B) in patient access to applicable health care 
                items and services under this section.
            (2) Public availability.--The Secretary shall--
                    (A) make data collected under this subsection 
                publicly available on the internet website of the 
                Department of Health and Human Services as soon as is 
                practicable, but not later than 30 days after the date 
                of enactment of this Act, in a manner that allows 
                researchers, scholars, health care providers, and 
                others to access and analyze such data, without 
                compromising patient privacy; and
                    (B) update such data on a weekly basis thereafter 
                for the duration of the period described in subsection 
                (a).
    (i) Weekly Reports to Congress.--
            (1) In general.--On a weekly basis during the period 
        described in subsection (a), the Secretary shall report to 
        Congress on--
                    (A) the implementation of this section, including 
                information on the amount, type, and geographic 
                distribution of payments to qualified providers under 
                this section; and
                    (B) any disparities in health and access to health 
                care related to the COVID-19 outbreak or patient access 
                to applicable health care items and services under this 
                section, as identified through the collection and 
                analysis of data collected under subsection (h).
            (2) Public availability.--The Secretary shall make each 
        report submitted under paragraph (1) publicly available on the 
        internet website of the Department of Health and Human 
        Services.
    (j) Funding.--There are authorized to be appropriated such sums as 
are necessary to carry out this section.
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