Title: To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program.
Policy area: Health

Summary:
This bill requires the Centers for Medicare & Medicaid Services (CMS) to pay any required cost-sharing amounts for specified COVID-19 (i.e., coronavirus disease 2019) treatment services for Medicare beneficiaries.
Providers are prohibited from holding beneficiaries liable for such amounts. Additionally, the CMS may recoup amounts that would have been paid through a beneficiary's supplemental insurance from the applicable insurer, in accordance with specified procedures.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6727 Introduced in House (IH)]

<DOC>






116th CONGRESS
  2d Session
                                H. R. 6727

    To hold Medicare beneficiaries harmless for specified COVID-19 
  treatment services furnished under part A or part B of the Medicare 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 5, 2020

  Ms. Schrier (for herself and Mr. McEachin) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
addition to the Committees on Energy and Commerce, and Armed Services, 
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 hold Medicare beneficiaries harmless for specified COVID-19 
  treatment services furnished under part A or part B of the Medicare 
                                program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. HOLDING MEDICARE BENEFICIARIES HARMLESS FOR SPECIFIED COVID-
              19 TREATMENT SERVICES FURNISHED UNDER PART A OR PART B OF 
              THE MEDICARE PROGRAM.

    (a) In General.--Notwithstanding any other provision of law, in the 
case of a specified COVID-19 treatment service (as defined in 
subsection (b)) furnished to an individual entitled to benefits under 
part A or enrolled under part B of title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) for which payment is made under such part 
A or such part B, the Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall provide that--
            (1) any cost-sharing required (including any deductible, 
        copayment, or coinsurance) applicable to such individual under 
        such part A or such part B with respect to such item or service 
        is paid by the Secretary; and
            (2) the provider of services or supplier (as defined in 
        section 1861 of the Social Security Act (42 U.S.C. 1395x)) does 
        not hold such individual liable for such requirement.
    (b) Definition of Specified COVID-19 Treatment Services.--For 
purposes of this section, 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 (42 U.S.C. 1395 et seq.) 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).
    (c) Recovery of Cost-Sharing Amounts Paid by the Secretary in the 
Case of Supplemental Insurance Coverage.--
            (1) In general.--In the case of any amount paid by the 
        Secretary pursuant to subsection (a)(1) that the Secretary 
        determines would otherwise have been paid by a group health 
        plan or health insurance issuer (as such terms are defined in 
        section 2791 of the Public Health Service Act (42 U.S.C. 300gg-
        91)), a private entity offering a medicare supplemental policy 
        under section 1882 of the Social Security Act (42 U.S.C. 
        1395ss), any other health plan offering supplemental coverage, 
        a State plan under title XIX of the Social Security Act, or the 
        Secretary of Defense under the TRICARE program, such plan, 
        issuer, private entity, other health plan, State plan, or 
        Secretary of Defense, as applicable, shall pay to the 
        Secretary, not later than 1 year after such plan, issuer, 
        private entity, other health plan, State plan, or Secretary of 
        Defense receives a notice under paragraph (3), such amount in 
        accordance with this subsection.
            (2) Required information.--Not later than 9 months after 
        the date of the enactment of this Act, each group health plan, 
        health insurance issuer, private entity, other health plan, 
        State plan, and Secretary of Defense described in paragraph (1) 
        shall submit to the Secretary such information as the Secretary 
        determines necessary for purposes of carrying out this 
        subsection. Such information so submitted shall be updated by 
        such plan, issuer, private entity, other health plan, State 
        plan, or Secretary of Defense, as applicable, at such time and 
        in such manner as specified by the Secretary.
            (3) Review of claims and notification.--The Secretary shall 
        establish a process under which claims for items and services 
        for which the Secretary has paid an amount pursuant to 
        subsection (a)(1) are reviewed for purposes of identifying if 
        such amount would otherwise have been paid by a plan, issuer, 
        private entity, other health plan, State plan, or Secretary of 
        Defense described in paragraph (1). In the case such a claim is 
        so identified, the Secretary shall determine the amount that 
        would have been otherwise payable by such plan, issuer, private 
        entity, other health plan, State plan, or Secretary of Defense 
        and notify such plan, issuer, private entity, other health 
        plan, State plan, or Secretary of Defense of such amount.
            (4) Enforcement.--The Secretary may impose a civil monetary 
        penalty in an amount determined appropriate by the Secretary in 
        the case of a plan, issuer, private entity, other health plan, 
        or State plan that fails to comply with a provision of this 
        section. The provisions of section 1128A of the Social Security 
        Act shall apply to a civil monetary penalty imposed under the 
        previous sentence in the same manner as such provisions apply 
        to a penalty or proceeding under subsection (a) or (b) of such 
        section.
    (d) Funding.--The Secretary shall provide for the transfer to the 
Centers for Medicare & Medicaid Program Management Account from the 
Federal Hospital Insurance Trust Fund and the Federal Supplementary 
Medical Trust Fund (in such portions as the Secretary determines 
appropriate) $100,000,000 for purposes of carrying out this section.
    (e) Report.--Not later than 3 years after the date of the enactment 
of this Act, the Inspector General of the Department of Health and 
Human Services shall submit to Congress a report containing an analysis 
of amounts paid pursuant to subsection (a)(1) compared to amounts paid 
to the Secretary pursuant to subsection (c).
    (f) Implementation.--Notwithstanding any other provision of law, 
the Secretary may implement the provisions of this section by program 
instruction or otherwise.
                                 <all>