Ensuring Parity in MA for Audio-Only Telehealth Act of 2020

Bill: 116-s-4840
Sponsor: full_name: Sen. Roberts, Pat [R-KS]
Introduced: 2020-10-21
Policy area: Health
Subjects: Cardiovascular and respiratory health

Emergency medical services and trauma care

Health care costs and insurance

Health care coverage and access

Health technology, devices, supplies

Infectious and parasitic diseases

Internet and video services

Internet, web applications, social media

Medical tests and diagnostic methods

Medicare

Telephone and wireless communication
Latest action: action_date: 2020-10-21
text: Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2020-10-21
action_desc: Introduced in Senate
text: <p><b>Ensuring Parity in MA for Audio-Only Telehealth Act of 2020</b></p> <p>This bill allows audio-only diagnoses that are made via telehealth to be used for purposes of determining risk adjustments to payments under Medicare Advantage. Additionally, the bill requires payments for Medicare telehealth services that are furnished during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019) to be made in the same amounts as those for in-person services.</p>

tv_txt: II 116th CONGRESS 2d Session S. 4840 IN THE SENATE OF THE UNITED STATES October 21 (legislative day, October 19), 2020 Mr. Roberts (for himself, Ms. Cortez Masto , Mr. Scott of South Carolina , and Mr. Casey ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans, and for other purposes.

1. Short title This Act may be cited as the Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 . 2. Requiring the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans Section 1853(a)(1) of the Social Security Act ( 42 U.S.C. 1395w–23(a)(1) ) is amended by adding at the end the following new subparagraph: (J) Inclusion of certain audio-only diagnoses for purposes of risk adjustment (i) In general For purposes of determining the appropriate adjustment for health status under subparagraph (C)(i) for plan years 2020 and 2021 (and for such other plan years determined appropriate by the Secretary), the Secretary, in determining the diseases or conditions of an individual, shall take into account a qualified diagnosis (as defined in clause (ii)) made with respect to such individual by a qualified provider (as so defined) via telehealth regardless of whether such diagnosis so made included the use of video communications. (ii) Definitions For purposes of this subparagraph: (I) Qualified diagnosis The term qualified diagnosis means a diagnosis made with respect to a chronic disease or condition of an individual during a plan year if such diagnosis was also made with respect to such individual in one of the last of the 3 plan years preceding such plan year. (II) Qualified provider The term qualified provider means, with respect to a qualified diagnosis made with respect to an individual during a plan year, a provider of services, clinician or supplier that— (aa) furnished an item or service to such individual during the 3-year period ending on the date such diagnosis was so made; or (bb) is in the same practice (as determined by tax identification number) of a provider of services or supplier who furnished such an item or service to such individual during such period. . 3. Requiring parity in telehealth payments during the COVID–19 emergency Section 1834(m) of the Social Security Act ( 42 U.S.C. 1395m(m) ) is amended by adding at the end the following new paragraph: (9) Special rule for telehealth payment parity during the COVID–19 emergency In the case of a telehealth service furnished during the emergency period described in section 1135(g)(1)(B) for which payment may be made under this subsection (including any service for which payment may be so made due to application of a waiver made under section 1135(b)), the amount of such payment shall be equal to the amount that would have been paid for such service had such service been furnished in-person. .