[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3499 Introduced in Senate (IS)]
<DOC>
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. Harris, 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 following
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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Free COVID-19
Testing Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
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 relating to testing for COVID-19.
Sec. 4. Coverage of testing for COVID-19 at no cost sharing under the
Medicare 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
uninsured individuals.
Sec. 7. Application with respect to TRICARE, coverage for veterans, and
coverage for Federal civilians.
Sec. 8. Coverage of testing for COVID-19 at no cost sharing for Indians
receiving contract health services.
SEC. 2. COVERAGE OF TESTING FOR COVID-19.
(a) In General.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage (including a
grandfathered health plan (as defined in section 1251(e) of the Patient
Protection and Affordable Care Act)) shall provide coverage, and shall
not impose any cost sharing (including deductibles, copayments, and
coinsurance) requirements or prior authorization or other medical
management requirements, for the following items and services furnished
during any portion of the emergency period defined in paragraph (1)(B)
of section 1135(g) of the Social Security Act (42 U.S.C. 1320b-5(g))
beginning on or after the date of the enactment of this Act:
(1) In vitro diagnostic products (as defined in section
809.3(a) of title 21, Code of Federal Regulations) for the
detection of SARS-CoV-2 or the diagnosis of the virus that
causes COVID-19 that are approved, cleared, or authorized under
section 510(k), 513, 515, or 564 of the Federal Food, Drug, and
Cosmetic Act, and the administration of such in vitro
diagnostic products.
(2) Health care provider office visits, urgent care center
visits, and emergency room visits that result in an order for
or administration of an in vitro diagnostic product described
in paragraph (1).
(b) Enforcement.--The provisions of subsection (a) shall be applied
by the Secretary of Health and Human Services, Secretary of Labor, and
Secretary of the Treasury to group health plans and health insurance
issuers offering group or individual health insurance coverage as if
included in the provisions of part A of title XXVII of the Public
Health Service Act, part 7 of the Employee Retirement Income Security
Act of 1974, and subchapter B of chapter 100 of the Internal Revenue
Code of 1986, as applicable.
(c) Implementation.--The Secretary of Health and Human Services,
Secretary of Labor, and Secretary of the Treasury may implement the
provisions of this section through sub-regulatory guidance, program
instruction, or otherwise.
(d) Terms.--The terms ``group health plan'', ``health insurance
issuer'', ``group health insurance coverage'', and ``individual health
insurance coverage'' have the meanings given such terms in section 2791
of the Public Health Service Act (42 U.S.C. 300gg-91), section 733 of
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b),
and section 9832 of the Internal Revenue Code of 1986, as applicable.
SEC. 3. WAIVING COST SHARING UNDER THE MEDICARE PROGRAM FOR CERTAIN
VISITS RELATING TO TESTING FOR COVID-19.
(a) In General.--Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended--
(1) in subsection (a)(1)--
(A) by striking ``and'' before ``(CC)''; and
(B) by inserting before the period at the end the
following: ``, and (DD) with respect to a specified
COVID-19 testing-related service described in paragraph
(1) of subsection (cc) for which payment may be made
under a specified outpatient payment provision
described in paragraph (2) of such subsection, the
amounts paid shall be 100 percent of the payment amount
otherwise recognized under such respective specified
outpatient payment provision for such service,'';
(2) in subsection (b), in the first sentence--
(A) by striking ``and'' before ``(10)''; and
(B) by inserting before the period at the end the
following: ``, and (11) such deductible shall not apply
with respect to any specified COVID-19 testing-related
service described in paragraph (1) of subsection (cc)
for which payment may be made under a specified
outpatient payment provision described in paragraph (2)
of such subsection''; and
(3) by adding at the end the following new subsection:
``(cc) Specified COVID-19 Testing-Related Services.--For purposes
of subsection (a)(1)(DD):
``(1) Description.--
``(A) In general.--A specified COVID-19 testing-
related service described in this paragraph is a
medical visit that--
``(i) is in any of the categories of HCPCS
evaluation and management service codes
described in subparagraph (B);
``(ii) is furnished during any portion of
the emergency period (as defined in section
1135(g)(1)(B)) beginning on or after the date
of the enactment of this subsection; and
``(iii) results in an order for or
administration of a diagnostic test described
in section 1852(a)(1)(B)(iv)(IV).
``(B) Categories of hcpcs codes.--For purposes of
subparagraph (A), the categories of HCPCS evaluation
and management services codes are the following:
``(i) Office and other outpatient services.
``(ii) Hospital observation services.
``(iii) Emergency department services.
``(iv) Nursing facility services.
``(v) Domiciliary, rest home, or custodial
care services.
``(vi) Home services.
``(2) Specified outpatient payment provision.--A specified
outpatient payment provision described in this paragraph is any
of the following:
``(A) The hospital outpatient prospective payment
system under subsection (t).
``(B) The physician fee schedule under section
1848.
``(C) The prospective payment system developed
under section 1834(o).
``(D) Section 1834(g), with respect to an
outpatient critical access hospital service.
``(E) The payment basis determined in regulations
pursuant to section 1833(a)(3) for rural health clinic
services.''.
(b) Claims Modifier.--The Secretary of Health and Human Services
shall provide for an appropriate modifier (or other identifier) to
include on claims to identify, for purposes of subparagraph (DD) of
section 1833(a)(1), as added by subsection (a), specified COVID-19
testing-related services described in paragraph (1) of section 1833(cc)
of the Social Security Act, as added by subsection (a), for which
payment may be made under a specified outpatient payment provision
described in paragraph (2) of such subsection.
(c) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the provisions
of, including amendments made by, this section through program
instruction or otherwise.
SEC. 4. COVERAGE OF TESTING FOR COVID-19 AT NO COST SHARING UNDER THE
MEDICARE ADVANTAGE PROGRAM.
(a) In General.--Section 1852(a)(1)(B) of the Social Security Act
(42 U.S.C. 1395w-22(a)(1)(B)) is amended--
(1) in clause (iv)--
(A) by redesignating subclause (IV) as subclause
(VI); and
(B) by inserting after subclause (III) the
following new subclauses:
``(IV) Clinical diagnostic
laboratory test administered during any
portion of the emergency period defined
in paragraph (1)(B) of section 1135(g)
beginning on or after the date of the
enactment of the Free COVID-19 Testing
Act for the detection of SARS-CoV-2 or
the diagnosis of the virus that causes
COVID-19 and the administration of such
test.
``(V) Specified COVID-19 testing-
related services (as described in
section 1833(cc)(1)) for which payment
would be payable under a specified
outpatient payment provision described
in section 1833(cc)(2).'';
(2) in clause (v), by inserting ``, other than subclauses
(IV) and (V) of such clause,'' after ``clause (iv)''; and
(3) by adding at the end the following new clause:
``(vi) Prohibition of application of
certain requirements for covid-19 testing.--In
the case of a product or service described in
subclause (IV) or (V), respectively, of clause
(iv) that is administered or furnished during
any portion of the emergency period described
in such subclause beginning on or after the
date of the enactment of this clause, an MA
plan may not impose any prior authorization or
other utilization management requirements with
respect to the coverage of such a product or
service under such plan.''.
(b) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by this section by program instruction or otherwise.
SEC. 5. COVERAGE AT NO COST SHARING OF COVID-19 TESTING UNDER MEDICAID
AND CHIP.
(a) Medicaid.--
(1) In general.--Section 1905(a)(3) of the Social Security
Act (42 U.S.C. 1396d(a)(3)) is amended--
(A) by striking ``other laboratory'' and inserting
``(a) other laboratory'';
(B) by inserting ``and'' after the semicolon; and
(C) by adding at the end the following new
subparagraph:
``(B) in vitro diagnostic products (as defined in section
809.3(a) of title 21, Code of Federal Regulations) administered
during any portion of the emergency period defined in paragraph
(1)(B) of section 1135(g) beginning on or after the date of the
enactment of this subparagraph for the detection of SARS-CoV-2
or the diagnosis of the virus that causes COVID-19 that are
approved, cleared, or authorized under section 510(k), 513,
515, or 564 of the Federal Food, Drug, and Cosmetic Act, and
the administration of such in vitro diagnostic products;''.
(2) No cost sharing.--
(A) In general.--Subsections (a)(2) and (b)(2) of
section 1916 of the Social Security Act (42 U.S.C.
1396o) are each amended--
(i) in subparagraph (D), by striking ``or''
at the end;
(ii) in subparagraph (E), by striking ``;
and'' and inserting a comma; and
(iii) by adding at the end the following
new subparagraphs:
``(F) any in vitro diagnostic product described in
section 1905(a)(3)(B) that is administered during any
portion of the emergency period described in such
section beginning on or after the date of the enactment
of this subparagraph (and the administration of such
product), or
``(G) any medical visit for which payment may be
made under the State plan, that is furnished during any
such portion of such emergency period, and that relates
to testing for COVID-19; and''.
(B) Application to alternative cost sharing.--
Section 1916A(b)(3)(B) of the Social Security Act (42
U.S.C. 1396o-1(b)(3)(B)) is amended by adding at the
end the following new clause:
``(xi) Any in vitro diagnostic product
described in section 1905(a)(3)(B) that is
administered during any portion of the
emergency period described in such section
beginning on or after the date of the enactment
of this clause (and the administration of such
product) and any visit described in section
1916(a)(2)(G) that is furnished during any such
portion.''.
(C) Clarification.--The amendments made this
paragraph shall apply with respect to a State plan of a
territory in the same manner as a State plan of one of
the 50 States.
(3) State option to provide coverage for uninsured
individuals.--
(A) In general.--Section 1902(a)(10) of the Social
Security Act (42 U.S.C. 1396a(a)(10)) is amended--
(i) in subparagraph (A)(ii)--
(I) in subclause (XXI), by striking
``or'' at the end;
(II) in subclause (XXII), by adding
``or'' at the end; and
(III) by adding at the end the
following new subclause:
``(XXIII) during any portion of the
emergency period defined in paragraph
(1)(B) of section 1135(g) beginning on
or after the date of the enactment of
this subclause, who are uninsured
individuals (as defined in subsection
(ss));''; and
(ii) in the matter following subparagraph
(G)--
(I) by striking ``and (XVII)'' and
inserting ``, (XVII)''; and
(II) by inserting after ``instead
of through subclause (VIII)'' the
following: ``, and (XVIII) the medical
assistance made available to an
uninsured individual (as defined in
subsection (ss)) who is eligible for
medical assistance only because of
subparagraph (A)(ii)(XXIII) shall be
limited to medical assistance for any
in vitro diagnostic product described
in section 1905(a)(3)(B) that is
administered during any portion of the
emergency period described in such
section beginning on or after the date
of the enactment of this subclause (and
the administration of such product) and
any visit described in section
1916(a)(2)(G) that is furnished during
any such portion''.
(B) Receipt and initial processing of applications
at certain locations.--Section 1902(a)(55) of the
Social Security Act (42 U.S.C. 1396a(a)(55)) is
amended, in the matter preceding subparagraph (A), by
striking ``or (a)(10)(A)(ii)(IX)'' and inserting
``(a)(10)(A)(ii)(IX), or (a)(10)(A)(ii)(XXIII)''.
(C) Uninsured individual defined.--Section 1902 of
the Social Security Act (42 U.S.C. 1396a) is amended by
adding at the end the following new subsection:
``(ss) Uninsured Individual Defined.--For purposes of this section,
the term `uninsured individual' means, notwithstanding any other
provision of this title, any individual who is--
``(1) not described in subsection (a)(10)(A)(i); and
``(2) not enrolled in a Federal health care program (as
defined in section 1128B(f)), a group health plan, group or
individual health insurance coverage offered by a health
insurance issuer (as such terms are defined in section 2791 of
the Public Health Service Act), or a health plan offered under
chapter 89 of title 5, United States Code.''.
(D) Federal medical assistance percentage.--Section
1905(b) of the Social Security Act (42 U.S.C. 1396d(b))
is amended by adding at the end the following new
sentence: ``Notwithstanding the first sentence of this
subsection, the Federal medical assistance percentage
shall be 100 per centum with respect to (and,
notwithstanding any other provision of this title,
available for) medical assistance provided to uninsured
individuals (as defined in section 1902(ss)) who are
eligible for such assistance only on the basis of
section 1902(a)(10)(A)(ii)(XXIII) and with respect to
expenditures described in section 1903(a)(7) that a
State demonstrates to the satisfaction of the Secretary
are attributable to administrative costs related to
providing for such medical assistance to such
individuals under the State plan.''.
(b) CHIP.--
(1) In general.--Section 2103(c) of the Social Security Act
(42 U.S.C. 1397cc(c)) is amended by adding at the end the
following paragraph:
``(9) Certain in vitro diagnostic products for covid-19
testing.--The child health assistance provided to a targeted
low-income child shall include coverage of any in vitro
diagnostic product described in section 1905(a)(3)(B) that is
administered during any portion of the emergency period
described in such section beginning on or after the date of the
enactment of this subparagraph (and the administration of such
product).''.
(2) Coverage for targeted low-income pregnant women.--
Section 2112(b)(4) of the Social Security Act (42 U.S.C.
1397ll(b)(4)) is amended by inserting ``under section 2103(c)''
after ``same requirements''.
(3) Prohibition of cost sharing.--Section 2103(e)(2) of the
Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the paragraph header, by inserting ``,
covid-19 testing,'' before ``or pregnancy-related
assistance''; and
(B) by striking ``category of services described in
subsection (c)(1)(D) or'' and inserting ``categories of
services described in subsection (c)(1)(D), in vitro
diagnostic products described in subsection (c)(9) (and
administration of such products), visits described in
section 1916(a)(2)(G), or''.
SEC. 6. LABORATORY REIMBURSEMENT FOR DIAGNOSTIC TESTING FOR COVID-19 IN
UNINSURED INDIVIDUALS.
(a) Reimbursement.--Through the National Disaster Medical System
under section 2812 of the Public Health Service Act (42 U.S.C. 300hh-
11), and in coordination with the Administrator of the Centers for
Medicare & Medicaid Services, the Secretary of Health and Human
Services shall, subject to the availability of appropriations under
subsection (c), pay the claims of laboratories for reimbursement, as
described in subsection (a)(3)(D) of such section 2812, for health
services consisting of diagnostic testing to detect or diagnose COVID-
19 in uninsured individuals. The amount that will be paid shall be
equal to the amount that would have been paid to a physician or
laboratory under Clinical Laboratory Fee Schedule under section
1833(h)(8) of the Social Security Act.
(b) Definition.--In this section, the term ``uninsured individual''
means an individual who is not enrolled in--
(1) a Federal health care program (as defined under section
1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)));
or
(2) a group health plan or health insurance coverage
offered by a health insurance issuer in the group or individual
market (as such terms are defined in section 2791 of the Public
Health Service Act (42 U.S.C. 300gg-91)) or a health plan
offered under chapter 89 of title 5, United States Code.
(c) Funding.--To carry out this section, there is authorized to be
appropriated, and there is hereby appropriated, out of amounts in the
Treasury not otherwise obligated, $1,000,000,000, to remain available
until expended.
SEC. 7. APPLICATION WITH RESPECT TO TRICARE, COVERAGE FOR VETERANS, AND
COVERAGE FOR FEDERAL CIVILIANS.
(a) TRICARE.--The Secretary of Defense may not require any
copayment or other cost sharing under chapter 55 of title 10, United
States Code, for in vitro diagnostic products described in paragraph
(1) of section 2(a) (or the administration of such products) or visits
described in paragraph (2) of such section furnished during any portion
of the emergency period defined in paragraph (1)(B) of section 1135(g)
of the Social Security Act (42 U.S.C. 1320b-5(g)) beginning on or after
the date of the enactment of this Act.
(b) Veterans.--The Secretary of Veterans Affairs may not require
any copayment or other cost sharing under chapter 17 of title 38,
United States Code, for in vitro diagnostic products described in
paragraph (1) of section 2(a) (or the adminsitration of such products)
or visits described in paragraph (2) of such section furnished during
any portion of the emergency period defined in paragraph (1)(B) of
section 1135(g) of the Social Security Act (42 U.S.C. 1320b-5(g))
beginning on or after the date of the enactment of this Act.
(c) Federal Civilians.--No copayment or other cost sharing may be
required for any individual occupying a position in the civil service
(as that term is defined in section 2101(1) of title 5, United States
Code) enrolled in a health benefits plan, including any plan under
chapter 89 of title 5, United States Code, or for any other individual
currently enrolled in any plan under chapter 89 of title 5 for
diagnostic tests'' after ``including any plan under chapter 89 of title
5, United States Code), for in vitro diagnostic products described in
paragraph (1) of section 2(a) (or the administration of such products)
or visits described in paragraph (2) of such section furnished during
any portion of the emergency period defined in paragraph (1)(B) of
section 1135(g) of the Social Security Act (42 U.S.C. 1320b-5(g))
beginning on or after the date of the enactment of this Act.
SEC. 8. COVERAGE OF TESTING FOR COVID-19 AT NO COST SHARING FOR INDIANS
RECEIVING CONTRACT HEALTH SERVICES.
The Secretary of Health and Human Services shall cover, without the
imposition of any cost sharing requirements, the cost of providing any
COVID-19 related items and services as described in paragraph (1) of
section 2(a) (or the administration of such products) or visits
described in paragraph (2) of such section furnished during any portion
of the emergency period defined in paragraph (1)(B) of section 1135(g)
of the Social Security Act (42 U.S.C. 320b-5(g)) beginning on or after
the date of the enactment of this Act to Indians (as defined in section
4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) receiving
health services through the Indian Health Service, regardless of
whether such items or services have been authorized under the contract
health services system funded by the Indian Health Service or is
covered as a health service of the Indian Health Service.
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