Title: Medicare Advantage COVID Treatment Act
Policy area: Health

Summary:
Medicare Advantage COVID Treatment Act
This bill requires Medicare Advantage (MA) plans to cover specified treatment services relating to COVID-19 (i.e., coronavirus disease 2019) without cost-sharing during the public health emergency declared on January 31, 2020. The CMS must reimburse MA plans for cost-sharing amounts that would otherwise have been received, in accordance with a specified timeline.
MA plans are also prohibited from instituting prior authorization or other utilization management requirements with respect to coverage of specified critical treatment services (e.g., ventilator services and intensive care unit services).

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6640 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 6640

To amend title XVIII of the Social Security Act to provide coverage for 
 COVID-19 at no cost sharing under the medicare advantage program, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 28, 2020

Ms. Mucarsel-Powell (for herself and Mr. Kind) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
 addition to the Committee on Energy and Commerce, 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 title XVIII of the Social Security Act to provide coverage for 
 COVID-19 at no cost sharing under the medicare advantage program, 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 ``Medicare Advantage COVID Treatment 
Act''.

SEC. 2. COVERAGE OF TREATMENTS FOR COVID-19 AT NO COST SHARING UNDER 
              THE MEDICARE ADVANTAGE PROGRAM.

    (a) In General.--Section 1852(a)(1)(B) of the Social Security Act 
(42 U.S.C. 1395w-22(a)(1)(B)) is amended by adding at the end the 
following new clause:
                            ``(vii) Special coverage rules for 
                        specified covid-19 treatment services.--
                                    ``(I) In general.--Notwithstanding 
                                clause (i), in the case of a specified 
                                COVID-19 treatment service that is 
                                furnished during a plan year occurring 
                                during any portion of the emergency 
                                period defined in section 1135(g)(1)(B) 
                                beginning on or after the date of the 
                                enactment of this clause, a Medicare 
                                Advantage plan may not, with respect to 
                                such service, impose--
                                            ``(aa) any cost-sharing 
                                        requirement (including a 
                                        deductible, copayment, or 
                                        coinsurance requirement); and
                                            ``(bb) in the case such 
                                        service is a critical specified 
                                        COVID-19 treatment service 
                                        (including ventilator services 
                                        and intensive care unit 
                                        services), any prior 
                                        authorization or other 
                                        utilization management 
                                        requirement.
                                A Medicare Advantage plan may not take 
                                the application of this clause into 
                                account for purposes of a bid amount 
                                submitted by such plan under section 
                                1854(a)(6).
                                    ``(II) Specified covid-19 treatment 
                                service defined.--For purposes of this 
                                clause, the term `specified COVID-19 
                                treatment service' means any item or 
                                service furnished to an individual for 
                                which payment may be made under part A 
                                or part B of title XVIII of the Social 
                                Security Act if such item or service is 
                                included in a claim with an ICD-10-CM 
                                code relating to COVID-19 (as described 
                                in the document entitled `ICD-10-CM 
                                Official Coding Guidelines--Supplement 
                                Coding encounters related to COVID-19 
                                Coronavirus Outbreak' published on 
                                February 20, 2020, or as otherwise 
                                specified by the Secretary).''.
    (b) Reimbursement of Medicare Advantage Plans for Elimination of 
Cost Sharing.--Section 1853 of the Social Security Act (42 U.S.C. 
1395w-23) is amended by adding at the end the following new subsection:
    ``(p) Additional Payment to Account for Cost Sharing Elimination 
for COVID-19 Treatment Services.--
            ``(1) In general.--A Medicare Advantage plan shall notify 
        the Secretary of the total dollar amount of cost sharing that, 
        but for the application of section 1852(a)(1)(B)(vii), would 
        have been required under such plan for specified COVID-19 
        treatment services (as defined in subclause (II) of such 
        section) furnished during a plan year described in such section 
        to individuals enrolled in the plan. The Secretary shall make 
        periodic and timely payments in accordance with this subsection 
        to such plan that, in the aggregate, equal such total dollar 
        amount.
            ``(2) Timing of payment.--Payments by the Secretary under 
        this subsection shall be made beginning March 1, 2021, for 
        amounts described in such paragraph that would have been 
        required under such plan for specified COVID-19 treatment 
        services furnished during plan year 2020. Payments by the 
        Secretary under this subsection for such amounts that would 
        have been so required under such plan for such services 
        furnished during a plan year subsequent to plan year 2020 shall 
        be made beginning March 1 of the plan year following such 
        subsequent plan year.
            ``(3) Non-application.--Section 1853(c)(7) shall not apply 
        with respect to the application of this subsection.
            ``(4) Appropriation.--There are transferred to the Centers 
        for Medicare & Medicaid Program Management Fund, out of any 
        monies in the Treasury not otherwise obligated, such sums as 
        may be necessary to the Secretary for purposes of making 
        payments under this subsection.''.
    (c) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services may implement the amendments 
made by this section by program instruction or otherwise.
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