[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3536 Introduced in Senate (IS)]
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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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ensuring Coverage in Public Health
Emergencies Act of 2020''.
SEC. 2. SPECIAL ENROLLMENT PERIODS DURING PUBLIC HEALTH EMERGENCIES.
(a) Public Health Service Act.--Title XXVII of the Public Health
Service Act (42 U.S.C. 300gg et seq.) is amended--
(1) in section 2702(b)(2) (42 U.S.C. 300gg-1(b)(2)), by
inserting ``, which shall include a special enrollment period
of 30 days during a public health emergency declared under
section 319, which period may be extended for such time as the
Secretary may require'' before the period at the end; and
(2) in section 2704(f) (42 U.S.C. 300gg-3(f)), by adding at
the end the following:
``(4) Public health emergencies.--If the Secretary declares
a public health emergency under section 319, group health plan,
and a group health insurance issuer offering group health
insurance coverage in connection with a group health plan,
shall permit an employee who is eligible, but not enrolled, for
coverage under the terms of the plan or coverage (or a
dependent of such an employee if the dependent is eligible, but
not enrolled, for coverage under such terms) to enroll for
coverage under the terms of the plan or coverage during the
special enrollment period required under section 2702(b)(2) of
the Public Health Service Act (42 U.S.C. 300gg-1(b)(2)).''.
(b) ERISA.--Section 701(f) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1181(f)) is amended by adding at the
end the following:
``(4) Public health emergencies.--If the Secretary of
Health and Human Services declares a public health emergency
under section 319 of the Public Health Service Act (42 U.S.C.
247d), a group health plan, or a health insurance issuer
offering group health insurance coverage in connection with
such a plan, shall permit an employee who is eligible, but not
enrolled, for coverage under the terms of the plan or coverage
(or a dependent of such an employee if the dependent is
eligible, but not enrolled, for coverage under such terms) to
enroll for coverage under the terms of the plan or coverage
during the special enrollment period required under section
2702(b)(2) of the Public Health Service Act (42 U.S.C. 300gg-
1(b)(2)).''.
(c) IRC.--Section 9801(f) of the Internal Revenue Code of 1986 (26
U.S.C. 9801(f)) is amended by adding at the end the following new
paragraph:
``(4) Public health emergencies.--If the Secretary of
Health and Human Services declares a public health emergency
under section 319 of the Public Health Service Act (42 U.S.C.
247d), a group health plan shall permit an employee who is
eligible, but not enrolled, for coverage under the terms of the
plan (or a dependent of such an employee if the dependent is
eligible, but not enrolled, for coverage under such terms) to
enroll for coverage under the terms of the plan during the
special enrollment period required under section 2702(b)(2) of
the Public Health Service Act (42 U.S.C. 300gg-1(b)(2)).''.
(d) Rule of Construction.--Nothing in the amendments made by
subsections (a) and (b) shall be construed to prevent group health plan
or health insurance issuer from offering a special enrollment period in
addition to any such period required under Federal law.
SEC. 3. COVERAGE OF PREVENTION AND TREATMENT RELATED TO PUBLIC HEALTH
EMERGENCIES.
(a) Required Coverage.--
(1) In general.--Subpart II of part A of title XXVII of the
Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is
amended by adding at the end the following:
``SEC. 2729A. COVERAGE OF PREVENTION AND TREATMENT RELATED TO PUBLIC
HEALTH EMERGENCIES.
``(a) In General.--A group health plan or a health insurance issuer
offering group or individual health insurance coverage shall provide
coverage for such services related to a disease or condition relating
to a public health emergency declared under section 319, which, as
applicable, shall include any services for the prevention or treatment,
of the disease or condition.
``(b) Scope of Benefits.--The prevention and treatment measures for
which coverage is required under subsection (a) shall--
``(1) be at the same level as benefits for the prevention
or treatment of other similar or related diseases or
conditions, if applicable, under the plan or coverage; and
``(2) include, with respect to the disease or condition
reasonably related to the public health emergency, even if no
diagnosis has been made and even if the enrollee ultimately is
determined not to have the disease or condition, as
applicable--
``(A) vaccines to prevent the disease or condition,
if applicable;
``(B) testing for diagnosis of the disease or
condition, if applicable;
``(C) care related to symptoms an enrollee may
experience; and
``(D) treatments for the disease or condition.
``(c) Cost-Sharing.--Cost-sharing for services for which coverage
is required under subsection (a) shall be comparable to similar such
services that would be covered by the plan or coverage outside of a
public health emergency.
``(d) Waiver of Restrictions.--
``(1) In general.--A group health plan or health insurance
issuer offering group or individual health insurance coverage
shall waive any restriction (including any prior authorization
requirement, limitation on filling or refilling prescription
drugs, or other restrictions) on access to covered benefits
required under this section, if the service is determined by a
qualified health professional to be medically necessary by the
provider and the Secretary determines such restriction to be
unduly burdensome in the context of the applicable public
health emergency.
``(2) Term of waiver.--Any waiver of restrictions pursuant
to paragraph (1) shall apply only for the duration of the
public health emergency, as declared under section 319.''.
(2) ERISA.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1181 et. seq.) is amended by
adding at the end the following:
``SEC. 716. COVERAGE OF PREVENTION AND TREATMENT RELATED TO PUBLIC
HEALTH EMERGENCIES.
``(a) In General.--A group health plan or a health insurance issuer
offering group health insurance coverage, shall provide coverage for
such services related to a disease or condition relating to a public
health emergency declared under section 319 of the Public Health
Service Act, which, as applicable, shall include any services for the
prevention or treatment, of the disease or condition.
``(b) Scope of Benefits.--The prevention and treatment measures for
which coverage is required under subsection (a) shall--
``(1) be at the same level as benefits for the prevention
or treatment of other similar or related diseases or
conditions, if applicable, under the plan or coverage; and
``(2) include, with respect to the disease or condition
reasonably related to the public health emergency, even if no
diagnosis has been made and even if the enrollee ultimately is
determined not to have the disease or condition, as
applicable--
``(A) vaccines to prevent the disease or condition,
if applicable;
``(B) testing for diagnosis of the disease or
condition, if applicable;
``(C) care related to symptoms an enrollee may
experience; and
``(D) treatments for the disease or condition.
``(c) Cost-Sharing.--Cost-sharing for services for which coverage
is required under subsection (a) shall be comparable to similar such
services that would be covered by the plan or coverage outside of a
public health emergency.
``(d) Waiver of Restrictions.--
``(1) In general.--A group health plan or health insurance
issuer offering group health insurance coverage shall waive any
restriction (including any prior authorization requirement,
limitation on filling or refilling prescription drugs, or other
restrictions) on access to covered benefits required under this
section, if the service is determined by a qualified health
professional to be medically necessary by the provider and the
Secretary determines such restriction to be unduly burdensome
in the context of the applicable public health emergency.
``(2) Term of waiver.--Any waiver of restrictions pursuant
to paragraph (1) shall apply only for the duration of the
public health emergency, as declared under section 319 of the
Public Health Service Act.''.
(B) Clerical amendment.--The table of sections for
subpart B of part 7 of subtitle B of title I of the
Employee Retirement Income Security Act of 1974 is
amended by adding at the end the following:
``Sec. 715. Additional market reforms.
``Sec. 716. Coverage of prevention and treatment related to public
health emergencies.''.
(3) IRC.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following new section:
``SEC. 9816. COVERAGE OF PREVENTION AND TREATMENT RELATED TO PUBLIC
HEALTH EMERGENCIES.
``(a) In General.--A group health plan shall provide coverage for
such services related to a disease or condition relating to a public
health emergency declared under section 319 of the Public Health
Service Act, which, as applicable, shall include any services for the
prevention or treatment, of the disease or condition.
``(b) Scope of Benefits.--The prevention and treatment measures for
which coverage is required under subsection (a) shall--
``(1) be at the same level as benefits for the prevention
or treatment of other similar or related diseases or
conditions, if applicable, under the plan; and
``(2) include, with respect to the disease or condition
reasonably related to the public health emergency, even if no
diagnosis has been made and even if the enrollee ultimately is
determined not to have the disease or condition, as
applicable--
``(A) vaccines to prevent the disease or condition,
if applicable;
``(B) testing for diagnosis of the disease or
condition, if applicable;
``(C) care related to symptoms an enrollee may
experience; and
``(D) treatments for the disease or condition.
``(c) Cost-Sharing.--Cost-sharing for services for which coverage
is required under subsection (a) shall be comparable to similar such
services that would be covered by the plan outside of a public health
emergency.
``(d) Waiver of Restrictions.--
``(1) In general.--A group health plan shall waive any
restriction (including any prior authorization requirement,
limitation on filling or refilling prescription drugs, or other
restrictions) on access to covered benefits required under this
section, if the service is determined by a qualified health
professional to be medically necessary by the provider and the
Secretary determines such restriction to be unduly burdensome
in the context of the applicable public health emergency.
``(2) Term of waiver.--Any waiver of restrictions pursuant
to paragraph (1) shall apply only for the duration of the
public health emergency, as declared under section 319 of the
Public Health Service Act.''.
(B) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of such Code is amended by
adding at the end the following new item:
``Sec. 9816. Coverage of prevention and treatment related to public
health emergencies.''.
SEC. 4. EFFECTIVE DATE; APPLICATION.
The amendments made by this Act shall take effect on the date of
enactment of this Act and shall apply with respect to plans years in
effect on the date of enactment of this Act, and plan years beginning
on or after such date.
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