Title: To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person during the COVID-19 emergency.
Policy area: Health

Summary:
This bill requires private health insurance plans to cover certain services provided via telecommunications systems (i.e., telehealth) during the COVID-19 (i.e., coronavirus disease 2019) public health emergency. Specifically, the telehealth services must be deemed medically necessary by a health care provider and covered under the plan if provided in person. Plans must apply the same cost-sharing and reimbursement amounts that would otherwise apply to such services and may waive cost-sharing requirements for any services to diagnose or treat COVID-19, including via telehealth.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6644 Introduced in House (IH)]

<DOC>






116th CONGRESS
  2d Session
                                H. R. 6644

  To require group health plans and health insurance issuers offering 
 group or individual health insurance coverage to provide coverage for 
services furnished via telehealth if such services would be covered if 
           furnished in-person during the COVID-19 emergency.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 28, 2020

 Ms. Schrier (for herself, Mr. David P. Roe of Tennessee, Mr. Morelle, 
and Mr. Van Drew) 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 require group health plans and health insurance issuers offering 
 group or individual health insurance coverage to provide coverage for 
services furnished via telehealth if such services would be covered if 
           furnished in-person during the COVID-19 emergency.

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

SECTION 1. REQUIRING GROUP HEALTH PLANS AND HEALTH INSURANCE ISSUERS 
              OFFERING GROUP OR INDIVIDUAL HEALTH INSURANCE COVERAGE TO 
              PROVIDE COVERAGE FOR SERVICES FURNISHED VIA TELEHEALTH IF 
              SUCH SERVICES WOULD BE COVERED IF FURNISHED IN-PERSON 
              DURING THE COVID-19 EMERGENCY.

    (a) In General.--During any portion of the emergency period 
described in section 1135(g)(1)(B) of the Social Security Act (42 
U.S.C. 1320b-5(g)(1)(B)), notwithstanding sections 2703 and 2715(d)(4) 
of the Public Health Service Act (42 U.S.C. 300gg-2, 300gg-15(d)(4)), a 
group health plan and a health insurance issuer offering group health 
insurance coverage, including a grandfathered health plan (as defined 
in section 1251(e) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18011(e)))--
            (1) shall--
                    (A) provide benefits under such plan or such 
                coverage for any eligible service (as defined in 
                subsection (c)), including a mental health and 
                substance use disorder service, furnished via a 
                qualifying telecommunications system (as defined in 
                subsection (c)) by a health care provider to an 
                individual who is a participant, beneficiary, or 
                enrollee under such plan or such coverage, 
                notwithstanding that such provider furnishing such 
                service is not at the same location as the individual;
                    (B) so provide such benefits for such service under 
                the same terms and with application of the same cost-
                sharing requirements (including a deductible, 
                copayment, or coinsurance) as would apply if such 
                service were furnished by such provider to such 
                individual in-person;
                    (C) reimburse such provider for such service in an 
                amount equal to the amount of reimbursement for such 
                service had such service been furnished by such 
                provider to such individual in-person;
                    (D) not impose any requirement under such plan or 
                coverage that such provider have a prior relationship 
                with such individual; and
                    (E) not restrict the ability of any health care 
                provider with a contractual relationship for furnishing 
                an eligible service under such plan or coverage from 
                furnishing such service via a qualifying 
                telecommunications system, and shall not establish 
                incentives or penalties under such plan or coverage for 
                receiving such an eligible service from such a provider 
                via such a system; and
            (2) may waive any cost-sharing requirement (including 
        application of a deductible, copayment, or coinsurance) for an 
        item or service furnished for purposes of diagnosing or 
        treating COVID-19, including any such service that is an 
        eligible service furnished via a qualifying telecommunications 
        system.
    (b) Application.--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.
    (c) Definitions.--In this section:
            (1) Eligible service.--The term ``eligible service'' means, 
        with respect to a group health plan and a health insurance 
        issuer offering group or individual health insurance coverage, 
        a service--
                    (A) for which benefits are provided under such plan 
                or such coverage when such service is furnished in-
                person;
                    (B) that is medically necessary (as determined by 
                the health care provider furnishing such service); and
                    (C) that is able to be safely and effectively 
                furnished via a telecommunications system.
            (2) Health insurance 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.
            (3) Qualifying telecommunications system.--The term 
        ``qualifying telecommunications system'' means a 
        telecommunications system that includes, at a minimum, audio 
        capabilities permitting two-way, real-time interactive 
        communication between the individual receiving an eligible 
        service via such system and the health care provider furnishing 
        such system, including a telephone, videoconferencing system, 
        internet communications system, streaming media communications 
        system, and such other systems as specified by the Secretary of 
        Health and Human Services.
    (d) Effective Date.--This section shall apply with respect to items 
and services furnished on or after the first day of the emergency 
period described in subsection (a).
                                 <all>