Stop COVID–19 Test Surprise Medical Bills Act of 2021

Bill: 117-s-2411
Sponsor: full_name: Sen. Smith, Tina [D-MN]
Introduced: 2021-07-21
Policy area: Health
Subjects: Cardiovascular and respiratory health

Emergency medical services and trauma care

Employee benefits and pensions

Government information and archives

Government studies and investigations

Health care costs and insurance

Health care coverage and access

Infectious and parasitic diseases

Medical tests and diagnostic methods

Medicare
Latest action: action_date: 2021-07-21
text: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Summaries:
action_date: 2021-07-21
action_desc: Introduced in Senate
text: <p><b>Stop COVID-19 Test Surprise Medical Bills Act of 2021</b></p> <p>This bill modifies provisions requiring health insurance plans to cover COVID-19 diagnostic testing services at no cost, without prior authorization, and without medical management requirements. This includes the rates at which insurance plans must reimburse providers of such tests.<br> <br> The bill also requires the Department of Health and Human Services (HHS) to survey and report on the cash prices of testing services and the compliance of providers with the requirement to publish the prices of tests.</p> <p>Additionally, HHS, jointly with the Department of the Treasury and the Department of Labor, must issue guidance clarifying the process for submitting claims for testing services.</p>

tv_txt: II 117th CONGRESS 1st Session S. 2411 IN THE SENATE OF THE UNITED STATES July 21, 2021 Ms. Smith (for herself and Ms. Klobuchar ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To prevent surprise medical bills with respect to COVID–19 testing.

1. Short title This Act may be cited as the Stop COVID–19 Test Surprise Medical Bills Act of 2021 . 2. Medical management Section 6001 of the Families First Coronavirus Response Act ( Public Law 116–127 ) is amended by adding at the end the following: (e) Medical management For purposes of this section, the term medical management includes determinations about why an individual sought testing, the nature of the clinical assessment that was associated with the testing, whether the individual was showing symptoms, what provider ordered the testing, the frequency of testing obtained by the individual, and other reviews of the encounters or events that proceeded or followed a service described in subsection (a). Such term does not include reasonable efforts by a group health plan or health insurance issuer to encourage individuals to obtain tests from lower priced providers (provided that such reasonable efforts do not delay or otherwise impede access to testing). . 3. Pricing of diagnostic testing Section 3202 of the CARES Act ( Public Law 116–136 ) is amended— (1) in subsection (a)— (A) by amending paragraph (1) to read as follows: (1) With respect to such items and services provided by a participating provider, such plan or issuer shall reimburse such provider the rate that the health plan or issuer has negotiated with such provider before the public health emergency declared under section 319 of the Public Health Service Act ( 42 U.S.C. 247d ) with respect to COVID–19. ; and (B) by amending paragraph (2) to read as follows: (2) With respect to such items and services provided by a nonparticipating provider or facility, such plan or issuer shall reimburse such provider in an amount equal to the lesser of— (A) the cash price for a diagnostic test for COVID–19; or (B) 2 times the reimbursement rate for the applicable items and services under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). ; (2) in subsection (b)(2), by striking $300 and inserting $10,000 ; and (3) by adding at the end the following: (c) No charges for COVID–19 testing A provider shall not bill, and shall not hold liable, any individual receiving items and services described in section 6001(a) of division F of the Families First Coronavirus Response Act ( Public Law 116–127 ) for a payment amount for such an item or service furnished by such provider. . 4. Improvements to transparency policy (a) In general Section 3202 of the CARES Act ( Public Law 116–136 ), as amended by section 3, is further amended by adding at the end the following: (d) Improvements to transparency policy Not later than 30 days after the date of enactment of this subsection, the Secretary of Health and Human Services shall survey a sample of providers of the items and services described in section 6001(a) of division F of the Families First Coronavirus Response Act ( Public Law 116–127 ) regarding the cash prices for such items and services as listed by the providers on a public internet website. The Secretary shall survey no fewer than 200 providers representing a diversity of sizes, geographic locations, test types, and care settings (such as hospitals, laboratories, and free-standing emergency rooms). (e) Public report Not later than 45 days after the date of enactment of this subsection, the Secretary of Health and Human Services shall publish a report on cash prices for items and services published under subsection (b)(1), which shall include— (1) the compliance rate of providers with the cash price publication requirement under subsection (b)(1); (2) the average cash price for each item and service described in section 6001(a) of division F of the Families First Coronavirus Response Act ( Public Law 116–127 ) and published under subsection (b)(1); (3) with respect to each such item and service, a comparison of such average cash price to the reimbursement rate under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ); and (4) any outlier cash prices published under subsection (b)(1) (including the names of the providers charging such prices) that substantially exceed the average cash price. . 5. Guidance on billing for provider visits associated with COVID–19 testing The Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury, shall jointly issue guidance, not later than 30 days after the date of enactment of this Act, for purposes of clarifying— (1) the process for submitting claims for items and services described in section 6001(a) of the Families First Coronavirus Response Act ( Public Law 116–127 ) to ensure that individuals enrolled in individual or group health insurance coverage or group health plans to whom such items and services are furnished are not subject to cost-sharing or prior authorization or other medical management requirements; and (2) that providers should not collect cost-sharing amounts from individuals seeking items and services described in section 6001(a) of such Act.