TH S S. 3499 · 2020. 4. 4. · II 116TH CONGRESS 2D SESSION S. 3499 To amend coverage requirements...

II

116TH CONGRESS 2D SESSION S. 3499

To amend coverage requirements to ensure that no person incurs cost sharing

when receiving a test to confirm a COVID–19 infection.

IN THE SENATE OF THE UNITED STATES

MARCH 12, 2020

Ms. SMITH (for herself, Mr. PETERS, Mr. SCHUMER, Mrs. MURRAY, Mr.

WYDEN, Mr. CASEY, Mr. JONES, Mr. BROWN, Ms. DUCKWORTH, Mr.

TESTER, Mr. WHITEHOUSE, Mr. SANDERS, Ms. BALDWIN, Mr. REED,

Mr. MURPHY, Ms. KLOBUCHAR, Ms. HIRONO, Mr. SCHATZ, Mr. KING,

Mr. COONS, Ms. STABENOW, Mr. BOOKER, Mrs. FEINSTEIN, Ms. HAR-

RIS, Mr. UDALL, Ms. HASSAN, Mrs. GILLIBRAND, Mr. HEINRICH, Ms.

ROSEN, Mrs. SHAHEEN, Mr. KAINE, Ms. WARREN, Mr. CARPER, Mr.

WARNER, Mr. VAN HOLLEN, Mr. DURBIN, Mr. MARKEY, Mr.

BLUMENTHAL, Mr. BENNET, and Mr. MENENDEZ) introduced the fol-

lowing bill; which was read twice and referred to the Committee on

Health, Education, Labor, and Pensions

A BILL To amend coverage requirements to ensure that no person

incurs cost sharing when receiving a test to confirm

a COVID–19 infection.

Be it enacted by the Senate and House of Representa-1

tives of the United States of America in Congress assembled, 2

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3

(a) SHORT TITLE.—This Act may be cited as the 4

‘‘Free COVID–19 Testing Act’’. 5

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(b) TABLE OF CONTENTS.—The table of contents of 1

this Act is as follows: 2

Sec. 1. Short title; table of contents.

Sec. 2. Coverage of testing for COVID–19.

Sec. 3. Waiving cost sharing under the Medicare program for certain visits re-

lating to testing for COVID–19.

Sec. 4. Coverage of testing for COVID–19 at no cost sharing under the Medi-

care Advantage program.

Sec. 5. Coverage at no cost sharing of COVID–19 testing under Medicaid and

CHIP.

Sec. 6. Laboratory reimbursement for diagnostic testing for COVID–19 in un-

insured individuals.

Sec. 7. Application with respect to TRICARE, coverage for veterans, and cov-

erage for Federal civilians.

Sec. 8. Coverage of testing for COVID–19 at no cost sharing for Indians re-

ceiving contract health services.

SEC. 2. COVERAGE OF TESTING FOR COVID–19. 3

(a) IN GENERAL.—A group health plan and a health 4

insurance issuer offering group or individual health insur-5

ance coverage (including a grandfathered health plan (as 6

defined in section 1251(e) of the Patient Protection and 7

Affordable Care Act)) shall provide coverage, and shall not 8

impose any cost sharing (including deductibles, copay-9

ments, and coinsurance) requirements or prior authoriza-10

tion or other medical management requirements, for the 11

following items and services furnished during any portion 12

of the emergency period defined in paragraph (1)(B) of 13

section 1135(g) of the Social Security Act (42 U.S.C. 14

1320b–5(g)) beginning on or after the date of the enact-15

ment of this Act: 16

(1) In vitro diagnostic products (as defined in 17

section 809.3(a) of title 21, Code of Federal Regula-18

tions) for the detection of SARS–CoV–2 or the diag-19


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nosis of the virus that causes COVID–19 that are 1

approved, cleared, or authorized under section 2

510(k), 513, 515, or 564 of the Federal Food, 3

Drug, and Cosmetic Act, and the administration of 4

such in vitro diagnostic products. 5

(2) Health care provider office visits, urgent 6

care center visits, and emergency room visits that 7

result in an order for or administration of an in 8

vitro diagnostic product described in paragraph (1). 9

(b) ENFORCEMENT.—The provisions of subsection 10

(a) shall be applied by the Secretary of Health and Human 11

Services, Secretary of Labor, and Secretary of the Treas-12

ury to group health plans and health insurance issuers of-13

fering group or individual health insurance coverage as if 14

included in the provisions of part A of title XXVII of the 15

Public Health Service Act, part 7 of the Employee Retire-16

ment Income Security Act of 1974, and subchapter B of 17

chapter 100 of the Internal Revenue Code of 1986, as ap-18

plicable. 19

(c) IMPLEMENTATION.—The Secretary of Health and 20

Human Services, Secretary of Labor, and Secretary of the 21

Treasury may implement the provisions of this section 22

through sub-regulatory guidance, program instruction, or 23

otherwise. 24


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(d) TERMS.—The terms ‘‘group health plan’’, ‘‘health 1

insurance issuer’’, ‘‘group health insurance coverage’’, and 2

‘‘individual health insurance coverage’’ have the meanings 3

given such terms in section 2791 of the Public Health 4

Service Act (42 U.S.C. 300gg–91), section 733 of the Em-5

ployee Retirement Income Security Act of 1974 (29 6

U.S.C. 1191b), and section 9832 of the Internal Revenue 7

Code of 1986, as applicable. 8

SEC. 3. WAIVING COST SHARING UNDER THE MEDICARE 9

PROGRAM FOR CERTAIN VISITS RELATING 10

TO TESTING FOR COVID–19. 11

(a) IN GENERAL.—Section 1833 of the Social Secu-12

rity Act (42 U.S.C. 1395l) is amended— 13

(1) in subsection (a)(1)— 14

(A) by striking ‘‘and’’ before ‘‘(CC)’’; and 15

(B) by inserting before the period at the 16

end the following: ‘‘, and (DD) with respect to 17

a specified COVID–19 testing-related service 18

described in paragraph (1) of subsection (cc) 19

for which payment may be made under a speci-20

fied outpatient payment provision described in 21

paragraph (2) of such subsection, the amounts 22

paid shall be 100 percent of the payment 23

amount otherwise recognized under such respec-24


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tive specified outpatient payment provision for 1

such service,’’; 2

(2) in subsection (b), in the first sentence— 3

(A) by striking ‘‘and’’ before ‘‘(10)’’; and 4

(B) by inserting before the period at the 5

end the following: ‘‘, and (11) such deductible 6

shall not apply with respect to any specified 7

COVID–19 testing-related service described in 8

paragraph (1) of subsection (cc) for which pay-9

ment may be made under a specified outpatient 10

payment provision described in paragraph (2) 11

of such subsection’’; and 12

(3) by adding at the end the following new sub-13

section: 14

‘‘(cc) SPECIFIED COVID–19 TESTING-RELATED 15

SERVICES.—For purposes of subsection (a)(1)(DD): 16

‘‘(1) DESCRIPTION.— 17

‘‘(A) IN GENERAL.—A specified COVID– 18

19 testing-related service described in this para-19

graph is a medical visit that— 20

‘‘(i) is in any of the categories of 21

HCPCS evaluation and management serv-22

ice codes described in subparagraph (B); 23

‘‘(ii) is furnished during any portion 24

of the emergency period (as defined in sec-25


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tion 1135(g)(1)(B)) beginning on or after 1

the date of the enactment of this sub-2

section; and 3

‘‘(iii) results in an order for or admin-4

istration of a diagnostic test described in 5

section 1852(a)(1)(B)(iv)(IV). 6

‘‘(B) CATEGORIES OF HCPCS CODES.—For 7

purposes of subparagraph (A), the categories of 8

HCPCS evaluation and management services 9

codes are the following: 10

‘‘(i) Office and other outpatient serv-11

ices. 12

‘‘(ii) Hospital observation services. 13

‘‘(iii) Emergency department services. 14

‘‘(iv) Nursing facility services. 15

‘‘(v) Domiciliary, rest home, or custo-16

dial care services. 17

‘‘(vi) Home services. 18

‘‘(2) SPECIFIED OUTPATIENT PAYMENT PROVI-19

SION.—A specified outpatient payment provision de-20

scribed in this paragraph is any of the following: 21

‘‘(A) The hospital outpatient prospective 22

payment system under subsection (t). 23

‘‘(B) The physician fee schedule under sec-24

tion 1848. 25


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‘‘(C) The prospective payment system de-1

veloped under section 1834(o). 2

‘‘(D) Section 1834(g), with respect to an 3

outpatient critical access hospital service. 4

‘‘(E) The payment basis determined in 5

regulations pursuant to section 1833(a)(3) for 6

rural health clinic services.’’. 7

(b) CLAIMS MODIFIER.—The Secretary of Health 8

and Human Services shall provide for an appropriate 9

modifier (or other identifier) to include on claims to iden-10

tify, for purposes of subparagraph (DD) of section 11

1833(a)(1), as added by subsection (a), specified COVID– 12

19 testing-related services described in paragraph (1) of 13

section 1833(cc) of the Social Security Act, as added by 14

subsection (a), for which payment may be made under a 15

specified outpatient payment provision described in para-16

graph (2) of such subsection. 17

(c) IMPLEMENTATION.—Notwithstanding any other 18

provision of law, the Secretary of Health and Human 19

Services may implement the provisions of, including 20

amendments made by, this section through program in-21

struction or otherwise. 22


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SEC. 4. COVERAGE OF TESTING FOR COVID–19 AT NO COST 1

SHARING UNDER THE MEDICARE ADVAN-2

TAGE PROGRAM. 3

(a) IN GENERAL.—Section 1852(a)(1)(B) of the So-4

cial Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is 5

amended— 6

(1) in clause (iv)— 7

(A) by redesignating subclause (IV) as 8

subclause (VI); and 9

(B) by inserting after subclause (III) the 10

following new subclauses: 11

‘‘(IV) Clinical diagnostic labora-12

tory test administered during any por-13

tion of the emergency period defined 14

in paragraph (1)(B) of section 15

1135(g) beginning on or after the 16

date of the enactment of the Free 17

COVID–19 Testing Act for the detec-18

tion of SARS–CoV–2 or the diagnosis 19

of the virus that causes COVID–19 20

and the administration of such test. 21

‘‘(V) Specified COVID–19 test-22

ing-related services (as described in 23

section 1833(cc)(1)) for which pay-24

ment would be payable under a speci-25


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fied outpatient payment provision de-1

scribed in section 1833(cc)(2).’’; 2

(2) in clause (v), by inserting ‘‘, other than sub-3

clauses (IV) and (V) of such clause,’’ after ‘‘clause 4

(iv)’’; and 5

(3) by adding at the end the following new 6

clause: 7

‘‘(vi) PROHIBITION OF APPLICATION 8

OF CERTAIN REQUIREMENTS FOR COVID–19 9

TESTING.—In the case of a product or 10

service described in subclause (IV) or (V), 11

respectively, of clause (iv) that is adminis-12

tered or furnished during any portion of 13

the emergency period described in such 14

subclause beginning on or after the date of 15

the enactment of this clause, an MA plan 16

may not impose any prior authorization or 17

other utilization management requirements 18

with respect to the coverage of such a 19

product or service under such plan.’’. 20

(b) IMPLEMENTATION.—Notwithstanding any other 21

provision of law, the Secretary of Health and Human 22

Services may implement the amendments made by this 23

section by program instruction or otherwise. 24


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SEC. 5. COVERAGE AT NO COST SHARING OF COVID–19 1

TESTING UNDER MEDICAID AND CHIP. 2

(a) MEDICAID.— 3

(1) IN GENERAL.—Section 1905(a)(3) of the 4

Social Security Act (42 U.S.C. 1396d(a)(3)) is 5

amended— 6

(A) by striking ‘‘other laboratory’’ and in-7

serting ‘‘(A) other laboratory’’; 8

(B) by inserting ‘‘and’’ after the semicolon; 9

and 10

(C) by adding at the end the following new 11

subparagraph: 12

‘‘(B) in vitro diagnostic products (as defined in 13

section 809.3(a) of title 21, Code of Federal Regula-14

tions) administered during any portion of the emer-15

gency period defined in paragraph (1)(B) of section 16

1135(g) beginning on or after the date of the enact-17

ment of this subparagraph for the detection of 18

SARS–CoV–2 or the diagnosis of the virus that 19

causes COVID–19 that are approved, cleared, or au-20

thorized under section 510(k), 513, 515, or 564 of 21

the Federal Food, Drug, and Cosmetic Act, and the 22

administration of such in vitro diagnostic products;’’. 23

(2) NO COST SHARING.— 24


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(A) IN GENERAL.—Subsections (a)(2) and 1

(b)(2) of section 1916 of the Social Security 2

Act (42 U.S.C. 1396o) are each amended— 3

(i) in subparagraph (D), by striking 4

‘‘or’’ at the end; 5

(ii) in subparagraph (E), by striking 6

‘‘; and’’ and inserting a comma; and 7

(iii) by adding at the end the fol-8

lowing new subparagraphs: 9

‘‘(F) any in vitro diagnostic product de-10

scribed in section 1905(a)(3)(B) that is admin-11

istered during any portion of the emergency pe-12

riod described in such section beginning on or 13

after the date of the enactment of this subpara-14

graph (and the administration of such product), 15

or 16

‘‘(G) any medical visit for which payment 17

may be made under the State plan, that is fur-18

nished during any such portion of such emer-19

gency period, and that relates to testing for 20

COVID–19; and’’. 21

(B) APPLICATION TO ALTERNATIVE COST 22

SHARING.—Section 1916A(b)(3)(B) of the So-23

cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 24


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is amended by adding at the end the following 1

new clause: 2

‘‘(xi) Any in vitro diagnostic product 3

described in section 1905(a)(3)(B) that is 4

administered during any portion of the 5

emergency period described in such section 6

beginning on or after the date of the enact-7

ment of this clause (and the administration 8

of such product) and any visit described in 9

section 1916(a)(2)(G) that is furnished 10

during any such portion.’’. 11

(C) CLARIFICATION.—The amendments 12

made this paragraph shall apply with respect to 13

a State plan of a territory in the same manner 14

as a State plan of one of the 50 States. 15

(3) STATE OPTION TO PROVIDE COVERAGE FOR 16

UNINSURED INDIVIDUALS.— 17

(A) IN GENERAL.—Section 1902(a)(10) of 18

the Social Security Act (42 U.S.C. 19

1396a(a)(10)) is amended— 20

(i) in subparagraph (A)(ii)— 21

(I) in subclause (XXI), by strik-22

ing ‘‘or’’ at the end; 23

(II) in subclause (XXII), by add-24

ing ‘‘or’’ at the end; and 25


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(III) by adding at the end the 1

following new subclause: 2

‘‘(XXIII) during any portion of 3

the emergency period defined in para-4

graph (1)(B) of section 1135(g) be-5

ginning on or after the date of the en-6

actment of this subclause, who are un-7

insured individuals (as defined in sub-8

section (ss));’’; and 9

(ii) in the matter following subpara-10

graph (G)— 11

(I) by striking ‘‘and (XVII)’’ and 12

inserting ‘‘, (XVII)’’; and 13

(II) by inserting after ‘‘instead of 14

through subclause (VIII)’’ the fol-15

lowing: ‘‘, and (XVIII) the medical as-16

sistance made available to an unin-17

sured individual (as defined in sub-18

section (ss)) who is eligible for med-19

ical assistance only because of sub-20

paragraph (A)(ii)(XXIII) shall be lim-21

ited to medical assistance for any in 22

vitro diagnostic product described in 23

section 1905(a)(3)(B) that is adminis-24

tered during any portion of the emer-25


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gency period described in such section 1

beginning on or after the date of the 2

enactment of this subclause (and the 3

administration of such product) and 4

any visit described in section 5

1916(a)(2)(G) that is furnished dur-6

ing any such portion’’. 7

(B) RECEIPT AND INITIAL PROCESSING OF 8

APPLICATIONS AT CERTAIN LOCATIONS.—Sec-9

tion 1902(a)(55) of the Social Security Act (42 10

U.S.C. 1396a(a)(55)) is amended, in the matter 11

preceding subparagraph (A), by striking ‘‘or 12

(a)(10)(A)(ii)(IX)’’ and inserting 13

‘‘(a)(10)(A)(ii)(IX), or (a)(10)(A)(ii)(XXIII)’’. 14

(C) UNINSURED INDIVIDUAL DEFINED.— 15

Section 1902 of the Social Security Act (42 16

U.S.C. 1396a) is amended by adding at the end 17

the following new subsection: 18

‘‘(ss) UNINSURED INDIVIDUAL DEFINED.—For pur-19

poses of this section, the term ‘uninsured individual’ 20

means, notwithstanding any other provision of this title, 21

any individual who is— 22

‘‘(1) not described in subsection (a)(10)(A)(i); 23

and 24


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‘‘(2) not enrolled in a Federal health care pro-1

gram (as defined in section 1128B(f)), a group 2

health plan, group or individual health insurance 3

coverage offered by a health insurance issuer (as 4

such terms are defined in section 2791 of the Public 5

Health Service Act), or a health plan offered under 6

chapter 89 of title 5, United States Code.’’. 7

(D) FEDERAL MEDICAL ASSISTANCE PER-8

CENTAGE.—Section 1905(b) of the Social Secu-9

rity Act (42 U.S.C. 1396d(b)) is amended by 10

adding at the end the following new sentence: 11

‘‘Notwithstanding the first sentence of this sub-12

section, the Federal medical assistance percent-13

age shall be 100 per centum with respect to 14

(and, notwithstanding any other provision of 15

this title, available for) medical assistance pro-16

vided to uninsured individuals (as defined in 17

section 1902(ss)) who are eligible for such as-18

sistance only on the basis of section 19

1902(a)(10)(A)(ii)(XXIII) and with respect to 20

expenditures described in section 1903(a)(7) 21

that a State demonstrates to the satisfaction of 22

the Secretary are attributable to administrative 23

costs related to providing for such medical as-24


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sistance to such individuals under the State 1

plan.’’. 2

(b) CHIP.— 3

(1) IN GENERAL.—Section 2103(c) of the So-4

cial Security Act (42 U.S.C. 1397cc(c)) is amended 5

by adding at the end the following paragraph: 6

‘‘(9) CERTAIN IN VITRO DIAGNOSTIC PRODUCTS 7

FOR COVID–19 TESTING.—The child health assist-8

ance provided to a targeted low-income child shall 9

include coverage of any in vitro diagnostic product 10

described in section 1905(a)(3)(B) that is adminis-11

tered during any portion of the emergency period de-12

scribed in such section beginning on or after the 13

date of the enactment of this subparagraph (and the 14

administration of such product).’’. 15

(2) COVERAGE FOR TARGETED LOW-INCOME 16

PREGNANT WOMEN.—Section 2112(b)(4) of the So-17

cial Security Act (42 U.S.C. 1397ll(b)(4)) is amend-18

ed by inserting ‘‘under section 2103(c)’’ after ‘‘same 19

requirements’’. 20

(3) PROHIBITION OF COST SHARING.—Section 21

2103(e)(2) of the Social Security Act (42 U.S.C. 22

1397cc(e)(2)) is amended— 23


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(A) in the paragraph header, by inserting 1

‘‘, COVID–19 TESTING,’’ before ‘‘OR PREGNANCY- 2

RELATED ASSISTANCE’’; and 3

(B) by striking ‘‘category of services de-4

scribed in subsection (c)(1)(D) or’’ and insert-5

ing ‘‘categories of services described in sub-6

section (c)(1)(D), in vitro diagnostic products 7

described in subsection (c)(9) (and administra-8

tion of such products), visits described in sec-9

tion 1916(a)(2)(G), or’’. 10

SEC. 6. LABORATORY REIMBURSEMENT FOR DIAGNOSTIC 11

TESTING FOR COVID–19 IN UNINSURED INDI-12

VIDUALS. 13

(a) REIMBURSEMENT.—Through the National Dis-14

aster Medical System under section 2812 of the Public 15

Health Service Act (42 U.S.C. 300hh–11), and in coordi-16

nation with the Administrator of the Centers for Medicare 17

& Medicaid Services, the Secretary of Health and Human 18

Services shall, subject to the availability of appropriations 19

under subsection (c), pay the claims of laboratories for 20

reimbursement, as described in subsection (a)(3)(D) of 21

such section 2812, for health services consisting of diag-22

nostic testing to detect or diagnose COVID–19 in unin-23

sured individuals. The amount that will be paid shall be 24

equal to the amount that would have been paid to a physi-25


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cian or laboratory under Clinical Laboratory Fee Schedule 1

under section 1833(h)(8) of the Social Security Act. 2

(b) DEFINITION.—In this section, the term ‘‘unin-3

sured individual’’ means an individual who is not enrolled 4

in— 5

(1) a Federal health care program (as defined 6

under section 1128B(f) of the Social Security Act 7

(42 U.S.C. 1320a–7b(f))); or 8

(2) a group health plan or health insurance cov-9

erage offered by a health insurance issuer in the 10

group or individual market (as such terms are de-11

fined in section 2791 of the Public Health Service 12

Act (42 U.S.C. 300gg–91)) or a health plan offered 13

under chapter 89 of title 5, United States Code. 14

(c) FUNDING.—To carry out this section, there is au-15

thorized to be appropriated, and there is hereby appro-16

priated, out of amounts in the Treasury not otherwise obli-17

gated, $1,000,000,000, to remain available until ex-18

pended. 19

SEC. 7. APPLICATION WITH RESPECT TO TRICARE, COV-20

ERAGE FOR VETERANS, AND COVERAGE FOR 21

FEDERAL CIVILIANS. 22

(a) TRICARE.—The Secretary of Defense may not 23

require any copayment or other cost sharing under chap-24

ter 55 of title 10, United States Code, for in vitro diag-25


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nostic products described in paragraph (1) of section 2(a) 1

(or the administration of such products) or visits described 2

in paragraph (2) of such section furnished during any por-3

tion of the emergency period defined in paragraph (1)(B) 4

of section 1135(g) of the Social Security Act (42 U.S.C. 5


ment of this Act. 7

(b) VETERANS.—The Secretary of Veterans Affairs 8

may not require any copayment or other cost sharing 9

under chapter 17 of title 38, United States Code, for in 10

vitro diagnostic products described in paragraph (1) of 11

section 2(a) (or the adminsitration of such products) or 12

visits described in paragraph (2) of such section furnished 13

during any portion of the emergency period defined in 14

paragraph (1)(B) of section 1135(g) of the Social Security 15

Act (42 U.S.C. 1320b–5(g)) beginning on or after the date 16

of the enactment of this Act. 17

(c) FEDERAL CIVILIANS.—No copayment or other 18

cost sharing may be required for any individual occupying 19

a position in the civil service (as that term is defined in 20

section 2101(1) of title 5, United States Code) enrolled 21

in a health benefits plan, including any plan under chapter 22

89 of title 5, United States Code, or for any other indi-23

vidual currently enrolled in any plan under chapter 89 of 24

title 5 for diagnostic tests’’ after ‘‘including any plan 25


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under chapter 89 of title 5, United States Code), for in 1

vitro diagnostic products described in paragraph (1) of 2

section 2(a) (or the administration of such products) or 3

visits described in paragraph (2) of such section furnished 4

during any portion of the emergency period defined in 5

paragraph (1)(B) of section 1135(g) of the Social Security 6

Act (42 U.S.C. 1320b–5(g)) beginning on or after the date 7

of the enactment of this Act. 8

SEC. 8. COVERAGE OF TESTING FOR COVID–19 AT NO COST 9

SHARING FOR INDIANS RECEIVING CON-10

TRACT HEALTH SERVICES. 11

The Secretary of Health and Human Services shall 12

cover, without the imposition of any cost sharing require-13

ments, the cost of providing any COVID–19 related items 14

and services as described in paragraph (1) of section 2(a) 15

(or the administration of such products) or visits described 16

in paragraph (2) of such section furnished during any por-17

tion of the emergency period defined in paragraph (1)(B) 18

of section 1135(g) of the Social Security Act (42 U.S.C. 19


ment of this Act to Indians (as defined in section 4 of 21

the Indian Health Care Improvement Act (25 U.S.C. 22

1603)) receiving health services through the Indian Health 23

Service, regardless of whether such items or services have 24

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TH S S. 3499 · 2020. 4. 4. · II 116TH CONGRESS 2D SESSION S. 3499 To amend coverage requirements...

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Transcript of TH S S. 3499 · 2020. 4. 4. · II 116TH CONGRESS 2D SESSION S. 3499 To amend coverage requirements...