Plain English summary not yet available
The full original text is available below. Check back soon as we process this bill.
I
116TH CONGRESS
2D SESSION
H. R. 6486
To amend the Patient Protection and Affordable Care Act to require the
Secretary of Health and Human Services to establish a special enrollment
period during the COVID-19 emergency period, to require the Secretary
to carry out outreach and educational activities for such special enroll-
ment period, to require group health plans and health insurance issuers
offering group or individual health insurance coverage to provide coverage
without any cost sharing for certain items and services furnished during
any portion of such emergency period, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
APRIL 10, 2020
Mr. RUIZ (for himself and Ms. UNDERWOOD) 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 jurisdic-
tion of the committee concerned
A BILL
To amend the Patient Protection and Affordable Care Act
to require the Secretary of Health and Human Services
to establish a special enrollment period during the
COVID-19 emergency period, to require the Secretary
to carry out outreach and educational activities for such
special enrollment period, to require group health plans
and health insurance issuers offering group or individual
health insurance coverage to provide coverage without
any cost sharing for certain items and services furnished
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
2
•HR 6486 IH
during any portion of such emergency period, 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 ‘‘Care for COVID-19
4
Act 2.0’’.
5
SEC. 2. SPECIAL ENROLLMENT PERIOD THROUGH EX-
6
CHANGES; FEDERAL EXCHANGE OUTREACH
7
AND EDUCATIONAL ACTIVITIES.
8
(a) SPECIAL ENROLLMENT PERIOD THROUGH EX-
9
CHANGES.—Section 1311(c) of the Patient Protection and
10
Affordable Care Act (42 U.S.C. 18031(c)) is amended—
11
(1) in paragraph (6)—
12
(A) in subparagraph (C), by striking at the
13
end ‘‘and’’;
14
(B) in subparagraph (D), by striking at
15
the end the period and inserting ‘‘; and’’; and
16
(C) by adding at the end the following new
17
subparagraph:
18
‘‘(E) subject to subparagraph (B) of para-
19
graph (8), the special enrollment period de-
20
scribed in subparagraph (A) of such para-
21
graph.’’; and
22
(2) by adding at the end the following new
23
paragraph:
24
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
3
•HR 6486 IH
‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER-
1
TAIN PUBLIC HEALTH EMERGENCY.—
2
‘‘(A) IN GENERAL.—The Secretary shall,
3
subject to subparagraph (B), require an Ex-
4
change to provide—
5
‘‘(i) for a special enrollment period
6
during the emergency period described in
7
section 1135(g)(1)(B) of the Social Secu-
8
rity Act—
9
‘‘(I) which shall begin on the
10
date that is one week after the date of
11
the enactment of this paragraph and
12
which, in the case of an Exchange es-
13
tablished or operated by the Secretary
14
within a State pursuant to section
15
1321(c), shall be an 8-week period;
16
and
17
‘‘(II) during which any individual
18
who is otherwise eligible to enroll in a
19
qualified health plan through the Ex-
20
change may enroll in such a qualified
21
health plan; and
22
‘‘(ii) that, in the case of an individual
23
who enrolls in a qualified health plan
24
through the Exchange during such enroll-
25
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
4
•HR 6486 IH
ment period, the coverage period under
1
such plan shall begin, at the option of the
2
individual, on April 1, 2020, or on the first
3
day of the month following the day the in-
4
dividual selects a plan through such special
5
enrollment period.
6
‘‘(B) EXCEPTION.—The requirement of
7
subparagraph (A) shall not apply to a State-op-
8
erated or State-established Exchange if such
9
Exchange, prior to the date of the enactment of
10
this paragraph, established or otherwise pro-
11
vided for a special enrollment period to address
12
access to coverage under qualified health plans
13
offered through such Exchange during the
14
emergency
period
described
in
section
15
1135(g)(1)(B) of the Social Security Act.’’.
16
(b) FEDERAL EXCHANGE OUTREACH
AND EDU-
17
CATIONAL ACTIVITIES.—Section 1321(c) of the Patient
18
Protection and Affordable Care Act (42 U.S.C. 18041(c))
19
is amended by adding at the end the following new para-
20
graph:
21
‘‘(3) OUTREACH
AND
EDUCATIONAL
ACTIVI-
22
TIES.—
23
‘‘(A) IN GENERAL.—In the case of an Ex-
24
change established or operated by the Secretary
25
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
5
•HR 6486 IH
within a State pursuant to this subsection, the
1
Secretary shall carry out outreach and edu-
2
cational activities for purposes of informing po-
3
tential enrollees in qualified health plans offered
4
through the Exchange of the availability of cov-
5
erage under such plans and financial assistance
6
for coverage under such plans. Such outreach
7
and educational activities shall be provided in a
8
manner that is culturally and linguistically ap-
9
propriate to the needs of the populations being
10
served by the Exchange (including hard-to-
11
reach populations, such as racial and sexual mi-
12
norities, limited English proficient populations,
13
and young adults).
14
‘‘(B) LIMITATION ON USE OF FUNDS.—No
15
funds appropriated under this paragraph shall
16
be used for expenditures for promoting non-
17
ACA compliant health insurance coverage.
18
‘‘(C) NON-ACA COMPLIANT
HEALTH
IN-
19
SURANCE
COVERAGE.—For purposes of sub-
20
paragraph (B):
21
‘‘(i) The term ‘non-ACA compliant
22
health insurance coverage’ means health
23
insurance coverage, or a group health plan,
24
that is not a qualified health plan.
25
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
6
•HR 6486 IH
‘‘(ii) Such term includes the following:
1
‘‘(I) An association health plan.
2
‘‘(II) Short-term limited duration
3
insurance.
4
‘‘(D) FUNDING.—Out of any funds in the
5
Treasury not otherwise appropriated, there are
6
hereby appropriated $25,000,000 to carry out
7
this paragraph. Funds appropriated under this
8
subparagraph shall remain available until ex-
9
pended.’’.
10
(c) IMPLEMENTATION.—The Secretary of Health and
11
Human Services may implement the provisions of (includ-
12
ing amendments made by) this section through subregu-
13
latory guidance, program instruction, or otherwise.
14
SEC. 3. COVERAGE OF COVID-19 RELATED TREATMENT AT
15
NO COST SHARING.
16
(a) IN GENERAL.—A group health plan and a health
17
insurance issuer offering group or individual health insur-
18
ance coverage (including a grandfathered health plan (as
19
defined in section 1251(e) of the Patient Protection and
20
Affordable Care Act)) shall provide coverage, and shall not
21
impose any cost sharing (including deductibles, copay-
22
ments, and coinsurance) requirements, for the following
23
items and services furnished during any portion of the
24
emergency period defined in paragraph (1)(B) of section
25
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
7
•HR 6486 IH
1135(g) of the Social Security Act (42 U.S.C. 1320b–
1
5(g)) beginning on or after the date of the enactment of
2
this Act:
3
(1) Medically necessary items and services (in-
4
cluding in-person or telehealth visits in which such
5
items and services are furnished) that are furnished
6
to an individual who has been diagnosed with (or
7
after provision of the items and services is diagnosed
8
with) COVID-19 to treat or mitigate the effects of
9
COVID-19.
10
(2) Medically necessary items and services (in-
11
cluding in-person or telehealth visits in which such
12
items and services are furnished) that are furnished
13
to an individual who is presumed to have COVID-
14
19 but is never diagnosed as such, if the following
15
conditions are met:
16
(A) Such items and services are furnished
17
to the individual to treat or mitigate the effects
18
of COVID-19 or to mitigate the impact of
19
COVID-19 on society.
20
(B) Health care providers have taken ap-
21
propriate steps under the circumstances to
22
make a diagnosis, or confirm whether a diag-
23
nosis was made, with respect to such individual,
24
for COVID-19, if possible.
25
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
8
•HR 6486 IH
(b) ITEMS
AND SERVICES RELATED
TO COVID-
1
19.—For purposes of this section—
2
(1) not later than one week after the date of
3
the enactment of this section, the Secretary of
4
Health and Human Services, Secretary of Labor,
5
and Secretary of the Treasury shall jointly issue
6
guidance specifying applicable diagnoses and medi-
7
cally necessary items and services related to COVID-
8
19; and
9
(2) such items and services shall include all
10
items or services that are relevant to the treatment
11
or mitigation of COVID-19, regardless of whether
12
such items or services are ordinarily covered under
13
the terms of a group health plan or group or indi-
14
vidual health insurance coverage offered by a health
15
insurance issuer.
16
(c) REIMBURSEMENT TO PLANS AND COVERAGE FOR
17
WAIVING COST SHARING.—
18
(1) IN GENERAL.—A group health plan or a
19
health insurance issuer offering group or individual
20
health insurance coverage (including a grandfathered
21
health plan (as defined in section 1251(e) of the Pa-
22
tient Protection and Affordable Care Act)) that does
23
not impose cost sharing requirements as described in
24
subsection (a) shall notify the Secretary of Health
25
VerDate Sep 11 2014
00:18 Apr 21, 2020
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
9
•HR 6486 IH
and Human Services, Secretary of Labor, and Sec-
1
retary of the Treasury (through a joint process es-
2
tablished jointly by the Secretaries) of the total dol-
3
lar amount of cost sharing that, but for the applica-
4
tion of subsection (a), would have been required
5
under such plans and coverage for items and serv-
6
ices related to COVID-19 furnished during the pe-
7
riod to which subsection (a) applies to enrollees, par-
8
ticipants, and beneficiaries in the plan or coverage to
9
whom such subsection applies, but which was not
10
imposed for such items and services so furnished
11
pursuant to such subsection and the Secretary of
12
Health and Human Services, in coordination with
13
the Secretary of Labor and the Secretary of the
14
Treasury, shall make payments in accordance with
15
this subsection to the plan or issuer equal to such
16
total dollar amount.
17
(2) METHODOLOGY FOR PAYMENTS.—The Sec-
18
retary of Health and Human Services, in coordina-
19
tion with the Secretary of Labor and the Secretary
20
of the Treasury shall establish a payment system for
21
making payments under this subsection. Any such
22
system shall make payment for the value of cost
23
sharing not imposed by the plan or issuer involved.
24
VerDate Sep 11 2014
00:18 Apr 21, 2020
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
10
•HR 6486 IH
(3) TIMING
OF
PAYMENTS.—Payments made
1
under paragraph (1) shall be made no later than
2
May 1, 2021, for amounts of cost sharing waivers
3
with respect to 2020. Payments under this sub-
4
section with respect to such waivers with respect to
5
a year subsequent to 2020 that begins during the
6
period to which subsection (a) applies shall be made
7
no later than May of the year following such subse-
8
quent year.
9
(4) APPROPRIATIONS.—There is authorized to
10
be appropriated, and there is appropriated, out of
11
any monies in the Treasury not otherwise appro-
12
priated, such funds as are necessary to carry out
13
this subsection.
14
(d) ENFORCEMENT.—
15
(1) APPLICATION
WITH
RESPECT
TO
PHSA,
16
ERISA, AND
IRC.—The provisions of this section
17
shall be applied by the Secretary of Health and
18
Human Services, Secretary of Labor, and Secretary
19
of the Treasury to group health plans and health in-
20
surance issuers offering group or individual health
21
insurance coverage as if included in the provisions of
22
part A of title XXVII of the Public Health Service
23
Act, part 7 of the Employee Retirement Income Se-
24
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS
11
•HR 6486 IH
curity Act of 1974, and subchapter B of chapter 100
1
of the Internal Revenue Code of 1986, as applicable.
2
(2) PRIVATE RIGHT OF ACTION.—An individual
3
with respect to whom an action is taken by a group
4
health plan or health insurance issuer offering group
5
or individual health insurance coverage in violation
6
of subsection (a) may commence a civil action
7
against the plan or issuer for appropriate relief. The
8
previous sentence shall not be construed as limiting
9
any enforcement mechanism otherwise applicable
10
pursuant to paragraph (1).
11
(e) IMPLEMENTATION.—The Secretary of Health and
12
Human Services, Secretary of Labor, and Secretary of the
13
Treasury may implement the provisions of this section
14
through sub-regulatory guidance, program instruction, or
15
otherwise.
16
(f) TERMS.—The terms ‘‘group health plan’’, ‘‘health
17
insurance issuer’’, ‘‘group health insurance coverage’’, and
18
‘‘individual health insurance coverage’’ have the meanings
19
given such terms in section 2791 of the Public Health
20
Service Act (42 U.S.C. 300gg–91), section 733 of the Em-
21
ployee Retirement Income Security Act of 1974 (29
22
U.S.C. 1191b), and section 9832 of the Internal Revenue
23
Code of 1986, as applicable.
24
Æ
VerDate Sep 11 2014
21:17 Apr 20, 2020
Jkt 099200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6301
E:\BILLS\H6486.IH
H6486
pamtmann on DSKBC07HB2PROD with BILLS