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II
116TH CONGRESS
2D SESSION
S. 3536
To provide for special enrollment periods during public health emergencies,
coverage of services related to public health emergencies, and for other
purposes.
IN THE SENATE OF THE UNITED STATES
MARCH 19, 2020
Mr. CASEY (for himself, Mr. BOOKER, and Mr. REED) introduced the
following bill; which was read twice and referred to the Committee on Finance
A BILL
To provide for special enrollment periods during public health
emergencies, coverage of services related to public health
emergencies, and for other purposes.
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.
3
This Act may be cited as the ‘‘Ensuring Coverage in
4
Public Health Emergencies Act of 2020’’.
5
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•S 3536 IS
SEC. 2. SPECIAL ENROLLMENT PERIODS DURING PUBLIC
1
HEALTH EMERGENCIES.
2
(a) PUBLIC HEALTH SERVICE ACT.—Title XXVII of
3
the Public Health Service Act (42 U.S.C. 300gg et seq.)
4
is amended—
5
(1) in section 2702(b)(2) (42 U.S.C. 300gg–
6
1(b)(2)), by inserting ‘‘, which shall include a special
7
enrollment period of 30 days during a public health
8
emergency declared under section 319, which period
9
may be extended for such time as the Secretary may
10
require’’ before the period at the end; and
11
(2) in section 2704(f) (42 U.S.C. 300gg–3(f)),
12
by adding at the end the following:
13
‘‘(4) PUBLIC
HEALTH
EMERGENCIES.—If the
14
Secretary declares a public health emergency under
15
section 319, group health plan, and a group health
16
insurance issuer offering group health insurance cov-
17
erage in connection with a group health plan, shall
18
permit an employee who is eligible, but not enrolled,
19
for coverage under the terms of the plan or coverage
20
(or a dependent of such an employee if the depend-
21
ent is eligible, but not enrolled, for coverage under
22
such terms) to enroll for coverage under the terms
23
of the plan or coverage during the special enrollment
24
period required under section 2702(b)(2) of the Pub-
25
lic Health Service Act (42 U.S.C. 300gg–1(b)(2)).’’.
26
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•S 3536 IS
(b) ERISA.—Section 701(f) of the Employee Retire-
1
ment Income Security Act of 1974 (29 U.S.C. 1181(f))
2
is amended by adding at the end the following:
3
‘‘(4) PUBLIC
HEALTH
EMERGENCIES.—If the
4
Secretary of Health and Human Services declares a
5
public health emergency under section 319 of the
6
Public Health Service Act (42 U.S.C. 247d), a
7
group health plan, or a health insurance issuer offer-
8
ing group health insurance coverage in connection
9
with such a plan, shall permit an employee who is
10
eligible, but not enrolled, for coverage under the
11
terms of the plan or coverage (or a dependent of
12
such an employee if the dependent is eligible, but
13
not enrolled, for coverage under such terms) to en-
14
roll for coverage under the terms of the plan or cov-
15
erage during the special enrollment period required
16
under section 2702(b)(2) of the Public Health Serv-
17
ice Act (42 U.S.C. 300gg–1(b)(2)).’’.
18
(c) IRC.—Section 9801(f) of the Internal Revenue
19
Code of 1986 (26 U.S.C. 9801(f)) is amended by adding
20
at the end the following new paragraph:
21
‘‘(4) PUBLIC
HEALTH
EMERGENCIES.—If the
22
Secretary of Health and Human Services declares a
23
public health emergency under section 319 of the
24
Public Health Service Act (42 U.S.C. 247d), a
25
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•S 3536 IS
group health plan shall permit an employee who is
1
eligible, but not enrolled, for coverage under the
2
terms of the plan (or a dependent of such an em-
3
ployee if the dependent is eligible, but not enrolled,
4
for coverage under such terms) to enroll for coverage
5
under the terms of the plan during the special en-
6
rollment period required under section 2702(b)(2) of
7
the Public Health Service Act (42 U.S.C. 300gg–
8
1(b)(2)).’’.
9
(d) RULE
OF
CONSTRUCTION.—Nothing in the
10
amendments made by subsections (a) and (b) shall be con-
11
strued to prevent group health plan or health insurance
12
issuer from offering a special enrollment period in addition
13
to any such period required under Federal law.
14
SEC. 3. COVERAGE OF PREVENTION AND TREATMENT RE-
15
LATED TO PUBLIC HEALTH EMERGENCIES.
16
(a) REQUIRED COVERAGE.—
17
(1) IN GENERAL.—Subpart II of part A of title
18
XXVII of the Public Health Service Act (42 U.S.C.
19
300gg–11 et seq.) is amended by adding at the end
20
the following:
21
‘‘SEC. 2729A. COVERAGE OF PREVENTION AND TREATMENT
22
RELATED TO PUBLIC HEALTH EMERGENCIES.
23
‘‘(a) IN GENERAL.—A group health plan or a health
24
insurance issuer offering group or individual health insur-
25
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•S 3536 IS
ance coverage shall provide coverage for such services re-
1
lated to a disease or condition relating to a public health
2
emergency declared under section 319, which, as applica-
3
ble, shall include any services for the prevention or treat-
4
ment, of the disease or condition.
5
‘‘(b) SCOPE
OF BENEFITS.—The prevention and
6
treatment measures for which coverage is required under
7
subsection (a) shall—
8
‘‘(1) be at the same level as benefits for the
9
prevention or treatment of other similar or related
10
diseases or conditions, if applicable, under the plan
11
or coverage; and
12
‘‘(2) include, with respect to the disease or con-
13
dition reasonably related to the public health emer-
14
gency, even if no diagnosis has been made and even
15
if the enrollee ultimately is determined not to have
16
the disease or condition, as applicable—
17
‘‘(A) vaccines to prevent the disease or
18
condition, if applicable;
19
‘‘(B) testing for diagnosis of the disease or
20
condition, if applicable;
21
‘‘(C) care related to symptoms an enrollee
22
may experience; and
23
‘‘(D) treatments for the disease or condi-
24
tion.
25
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•S 3536 IS
‘‘(c) COST-SHARING.—Cost-sharing for services for
1
which coverage is required under subsection (a) shall be
2
comparable to similar such services that would be covered
3
by the plan or coverage outside of a public health emer-
4
gency.
5
‘‘(d) WAIVER OF RESTRICTIONS.—
6
‘‘(1) IN
GENERAL.—A group health plan or
7
health insurance issuer offering group or individual
8
health insurance coverage shall waive any restriction
9
(including any prior authorization requirement, limi-
10
tation on filling or refilling prescription drugs, or
11
other restrictions) on access to covered benefits re-
12
quired under this section, if the service is deter-
13
mined by a qualified health professional to be medi-
14
cally necessary by the provider and the Secretary de-
15
termines such restriction to be unduly burdensome
16
in the context of the applicable public health emer-
17
gency.
18
‘‘(2) TERM OF WAIVER.—Any waiver of restric-
19
tions pursuant to paragraph (1) shall apply only for
20
the duration of the public health emergency, as de-
21
clared under section 319.’’.
22
(2) ERISA.—
23
(A) IN GENERAL.—Subpart B of part 7 of
24
subtitle B of title I of the Employee Retirement
25
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•S 3536 IS
Income Security Act of 1974 (29 U.S.C. 1181
1
et. seq.) is amended by adding at the end the
2
following:
3
‘‘SEC. 716. COVERAGE OF PREVENTION AND TREATMENT
4
RELATED TO PUBLIC HEALTH EMERGENCIES.
5
‘‘(a) IN GENERAL.—A group health plan or a health
6
insurance issuer offering group health insurance coverage,
7
shall provide coverage for such services related to a disease
8
or condition relating to a public health emergency declared
9
under section 319 of the Public Health Service Act, which,
10
as applicable, shall include any services for the prevention
11
or treatment, of the disease or condition.
12
‘‘(b) SCOPE
OF BENEFITS.—The prevention and
13
treatment measures for which coverage is required under
14
subsection (a) shall—
15
‘‘(1) be at the same level as benefits for the
16
prevention or treatment of other similar or related
17
diseases or conditions, if applicable, under the plan
18
or coverage; and
19
‘‘(2) include, with respect to the disease or con-
20
dition reasonably related to the public health emer-
21
gency, even if no diagnosis has been made and even
22
if the enrollee ultimately is determined not to have
23
the disease or condition, as applicable—
24
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•S 3536 IS
‘‘(A) vaccines to prevent the disease or
1
condition, if applicable;
2
‘‘(B) testing for diagnosis of the disease or
3
condition, if applicable;
4
‘‘(C) care related to symptoms an enrollee
5
may experience; and
6
‘‘(D) treatments for the disease or condi-
7
tion.
8
‘‘(c) COST-SHARING.—Cost-sharing for services for
9
which coverage is required under subsection (a) shall be
10
comparable to similar such services that would be covered
11
by the plan or coverage outside of a public health emer-
12
gency.
13
‘‘(d) WAIVER OF RESTRICTIONS.—
14
‘‘(1) IN
GENERAL.—A group health plan or
15
health insurance issuer offering group health insur-
16
ance coverage shall waive any restriction (including
17
any prior authorization requirement, limitation on
18
filling or refilling prescription drugs, or other re-
19
strictions) on access to covered benefits required
20
under this section, if the service is determined by a
21
qualified health professional to be medically nec-
22
essary by the provider and the Secretary determines
23
such restriction to be unduly burdensome in the con-
24
text of the applicable public health emergency.
25
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‘‘(2) TERM OF WAIVER.—Any waiver of restric-
1
tions pursuant to paragraph (1) shall apply only for
2
the duration of the public health emergency, as de-
3
clared under section 319 of the Public Health Serv-
4
ice Act.’’.
5
(B) CLERICAL AMENDMENT.—The table of
6
sections for subpart B of part 7 of subtitle B
7
of title I of the Employee Retirement Income
8
Security Act of 1974 is amended by adding at
9
the end the following:
10
‘‘Sec. 715. Additional market reforms.
‘‘Sec. 716. Coverage of prevention and treatment related to public health emer-
gencies.’’.
(3) IRC.—
11
(A) IN GENERAL.—Subchapter B of chap-
12
ter 100 of the Internal Revenue Code of 1986
13
is amended by adding at the end the following
14
new section:
15
‘‘SEC. 9816. COVERAGE OF PREVENTION AND TREATMENT
16
RELATED TO PUBLIC HEALTH EMERGENCIES.
17
‘‘(a) IN GENERAL.—A group health plan shall pro-
18
vide coverage for such services related to a disease or con-
19
dition relating to a public health emergency declared
20
under section 319 of the Public Health Service Act, which,
21
as applicable, shall include any services for the prevention
22
or treatment, of the disease or condition.
23
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•S 3536 IS
‘‘(b) SCOPE
OF BENEFITS.—The prevention and
1
treatment measures for which coverage is required under
2
subsection (a) shall—
3
‘‘(1) be at the same level as benefits for the
4
prevention or treatment of other similar or related
5
diseases or conditions, if applicable, under the plan;
6
and
7
‘‘(2) include, with respect to the disease or con-
8
dition reasonably related to the public health emer-
9
gency, even if no diagnosis has been made and even
10
if the enrollee ultimately is determined not to have
11
the disease or condition, as applicable—
12
‘‘(A) vaccines to prevent the disease or
13
condition, if applicable;
14
‘‘(B) testing for diagnosis of the disease or
15
condition, if applicable;
16
‘‘(C) care related to symptoms an enrollee
17
may experience; and
18
‘‘(D) treatments for the disease or condi-
19
tion.
20
‘‘(c) COST-SHARING.—Cost-sharing for services for
21
which coverage is required under subsection (a) shall be
22
comparable to similar such services that would be covered
23
by the plan outside of a public health emergency.
24
‘‘(d) WAIVER OF RESTRICTIONS.—
25
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•S 3536 IS
‘‘(1) IN GENERAL.—A group health plan shall
1
waive any restriction (including any prior authoriza-
2
tion requirement, limitation on filling or refilling
3
prescription drugs, or other restrictions) on access to
4
covered benefits required under this section, if the
5
service is determined by a qualified health profes-
6
sional to be medically necessary by the provider and
7
the Secretary determines such restriction to be un-
8
duly burdensome in the context of the applicable
9
public health emergency.
10
‘‘(2) TERM OF WAIVER.—Any waiver of restric-
11
tions pursuant to paragraph (1) shall apply only for
12
the duration of the public health emergency, as de-
13
clared under section 319 of the Public Health Serv-
14
ice Act.’’.
15
(B) CLERICAL AMENDMENT.—The table of
16
sections for subchapter B of chapter 100 of
17
such Code is amended by adding at the end the
18
following new item:
19
‘‘Sec. 9816. Coverage of prevention and treatment related to public health
emergencies.’’.
SEC. 4. EFFECTIVE DATE; APPLICATION.
20
The amendments made by this Act shall take effect
21
on the date of enactment of this Act and shall apply with
22
respect to plans years in effect on the date of enactment
23
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•S 3536 IS
of this Act, and plan years beginning on or after such
1
date.
2
Æ
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