Bill Summary
The Medicare Crisis Program Act of 2020 aims to address the effects of the COVID-19 pandemic on individuals by providing Medicare enrollment options, coverage of COVID-19 treatments at no cost sharing, and access to Medigap policies. It also establishes a national clearinghouse for medical supplies and increases federal support for state Medicaid programs during economic downturns. Additionally, it requires the Secretary of Health and Human Services to approve demonstration projects that allow for Medicaid enrollment of individuals with incomes up to 300% of the poverty line during the emergency period.
Possible Impacts
1. Under the "Medicare Crisis Program Act of 2020," individuals who have lost their job due to the COVID-19 pandemic will be eligible for Medicare coverage and will not have to pay any cost-sharing for specified COVID-19 treatment services.
2. The legislation guarantees access to Medigap policies for all Medicare-eligible individuals, regardless of age, and establishes a one-time enrollment period for those who would not otherwise be eligible.
3. The "Mandatory Approval of Waivers to Cover Certain Individuals Under Medicaid During the COVID-19 Emergency" section requires the Secretary to approve demonstration projects that allow individuals with income up to 300 percent of the poverty line to enroll in Medicaid during the emergency period.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6674 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 6674
To ensure access to affordable, comprehensive health insurance benefits
for certain uninsured individuals during the COVID-19 emergency, and to
ensure adequate coverage of treatments for COVID-19 under the Medicare
and Medicaid programs and under group health plans and group or
individual health insurance coverage, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 1, 2020
Ms. Jayapal (for herself, Mr. Kennedy, Mr. Blumenauer, Ms. Clarke of
New York, Mr. Cohen, Mrs. Dingell, Mr. Michael F. Doyle of
Pennsylvania, Mr. Espaillat, Mr. Hastings, Mrs. Hayes, Ms. Jackson Lee,
Mr. Khanna, Ms. Lee of California, Mr. Lowenthal, Mr. McGovern, Ms.
Meng, Mrs. Napolitano, Mr. Neguse, Ms. Norton, Ms. Ocasio-Cortez, Ms.
Omar, Ms. Pingree, Ms. Pressley, Mr. Raskin, Ms. Schakowsky, Mr. Soto,
Mr. Takano, Ms. Tlaib, Mr. Vargas, Mr. Welch, Ms. Gabbard, Mr. Engel,
and Ms. Velazquez) introduced the following bill; which was referred to
the Committee on Energy and Commerce, and in addition to the Committees
on Ways and Means, Education and Labor, and Armed Services, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To ensure access to affordable, comprehensive health insurance benefits
for certain uninsured individuals during the COVID-19 emergency, and to
ensure adequate coverage of treatments for COVID-19 under the Medicare
and Medicaid programs and under group health plans and group or
individual health insurance coverage, 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 ``Medicare Crisis Program Act of
2020''.
TITLE I--MEDICARE
SEC. 101. COVID-19 MEDICARE ENROLLMENT OPTION.
(a) In General.--Title XVIII of the Social Security Act (42 U.S.C.
1395c et seq.) is amended by adding at the end the following new
section:
``covid-19 medicare enrollment option
``Sec. 1899C. (a) Option.--
``(1) Eligibility.--Every individual who meets the
requirements described in paragraph (2) shall be eligible to
enroll under this section.
``(2) Requirements.--For purposes of paragraph (1), the
requirements described in this paragraph are the following:
``(A) The individual--
``(i) experienced a loss of, or reduction
in, employment during the specified period (as
defined in subsection (h)) and was approved for
unemployment benefits relating to such loss or
reduction in the State in which such individual
resides; or
``(ii) is the spouse, child, or other
dependent of an individual described in clause
(i).
``(B) The individual is not--
``(i) otherwise entitled to benefits under
part A or eligible to enroll under part A or
part B;
``(ii) enrolled under a Federal health care
program (as defined in section 1128B(f)) or the
program established under chapter 89 of title
5, United States Code;
``(iii) enrolled under an eligible
employer-sponsored plan (as defined in section
5000A(f)(2) of the Internal Revenue Code of
1986), but only if such plan--
``(I) includes the essential health
benefits package (as defined in section
1302(a) of the Patient Protection and
Affordable Care Act); and
``(II) the employee's required
contribution (within the meaning of
section 5000A(e)(1)(B) of such Code,
except that such contribution shall be
determined with respect to self-only or
family coverage, as applicable to the
employee) with respect to the plan does
not exceed the percentage specified in
section 36B(c)(2)(C)(i)(II) of such
Code for the applicable year; or
``(iv) enrolled under a qualified health
plan (as defined in section 1301(a) of such
Act).
``(3) Benefits.--An individual enrolled under this section
is entitled to the same benefits under this title as an
individual who is entitled to benefits under part A and
enrolled under part B and, at the option of the individual,
eligible for prescription drug benefits under part D.
``(b) Enrollment and Coverage Periods.--The Secretary shall
establish enrollment and coverage periods for individuals who enroll
under this section. A coverage period with respect to an individual
enrolled under this section shall be retroactive to the date on which
the individual experienced the loss or reduction described in
subsection (a)(2)(A)(i).
``(c) Enrollment Premium.--
``(1) Amount of monthly premiums.--There shall be no
monthly premium for an individual enrolled under this section
except as provided in paragraph (2).
``(2) Premium for optional part d benefits.--In the case an
individual enrolled under this section elects to receive
coverage under a prescription drug plan under part D, there
shall be a monthly premium with respect to such individual in
an amount determined appropriate by the Secretary.
``(d) Payment of Premiums.--
``(1) Payment.--Premiums for enrollment under this section
shall be paid to the Secretary at such times, and in such
manner, as the Secretary determines appropriate.
``(2) Deposit.--Amounts collected by the Secretary under
this section shall be deposited in the Medicare COVID-19 Trust
Fund established under subsection (e).
``(e) Medicare COVID-19 Trust Fund.--
``(1) In general.--There is hereby created on the books of
the Treasury of the United States a trust fund to be known as
the `Medicare COVID-19 Trust Fund' (in this subsection referred
to as the `Trust Fund'). The Trust Fund shall consist of such
gifts and bequests as may be made and such amounts as may be
deposited in, or appropriated to, such fund as provided in this
title.
``(2) Premiums.--Premiums collected under subsection (d)
shall be transferred to the Trust Fund.
``(3) Incorporation of provisions.--Subsections (b) through
(i) of section 1841 shall apply with respect to the Trust Fund
and this title in the same manner as they apply with respect to
the Federal Supplementary Medical Insurance Trust Fund and part
B, respectively, except that in applying such section 1841, any
reference in such section to `this part' shall be construed to
be a reference to this section and any reference in section
1841(h) to section 1840(d) and in section 1841(i) to sections
1840(b)(1) and 1842(g) are deemed to be references to
comparable authority exercised under this section.
``(f) Termination of Coverage.--Coverage of an individual enrolled
under this section shall terminate on the earliest of the following:
``(1) The date on which the individual becomes entitled to
benefits under part A or eligible to enroll under such part A
or part B (as determined without regard to this section).
``(2) The date on which the individual becomes enrolled in
coverage described in any of clauses (ii) through (iv) of
subsection (a)(2)(B) (as determined without regard to this
section).
``(3) The end of the specified period (as defined in
subsection (h)) with respect to such individual.
``(g) Enrollment Information.--
``(1) Guidance.--The Secretary of Labor shall publish
guidance for States with respect to information to be included
by States on unemployment portals for purposes of facilitating
enrollment of individuals under this section.
``(2) Provision of information to cms.--In the case of a
claim for unemployment benefits submitted to a State that
indicates that the individual may be eligible for enrollment
under this section, the State shall provide such information
regarding such individual as the Secretary may specify to the
Secretary.
``(3) Online enrollment.--The Secretary shall create an
online application form to facilitate enrollment under this
section.
``(h) Specified Period.--
``(1) In general.--In this section, the term `specific
period' means, with respect to an individual residing in a
State, the date beginning on the first day of the emergency
period (as described in section 1135(g)(1)(B)) and ending on
the date that is 3 months after the first day occurring on or
after the date of the enactment of this section that the
average unemployment rate for the 12-month period ending on
such first day--
``(A) in such State is not more than 2 percentage
points higher that the average unemployment rate in
such State during the period consisting of October 1
through December 31 of 2019; and
``(B) in the United States is not more than 2
percentage points higher than the average unemployment
rate in the United States during the period consisting
of October 1 through December 31 of 2019.
``(2) Notice.--In the case of an individual enrolled under
this section, if the specified period with respect to such
individual ends while such individual is so enrolled, the
Secretary shall provide notice to such individual of the end of
such period and an explanation that coverage under this section
shall terminate with respect to such individual not later than
the date that is 3 months after the end of such period.
``(i) Funding.--There is appropriated, out of any monies in the
Treasury not otherwise obligated, to the Trust Fund described in
subsection (e) such sums as may be necessary to carry out this section
(including for the payment of part A and part B benefits for
individuals enrolled under this section).''.
(b) Medigap.--Section 1882 of the Social Security Act is amended by
adding at the end the following new subsection:
``(aa) Development of New Standards for Certain Medicare
Supplemental Policies Relating to COVID-19 Enrollment Option.--The
Secretary shall request the National Association of Insurance
Commissioners to review and revise the standards for benefit packages
described in subsection (p)(1), to otherwise update standards to
include requirements for each medicare supplemental policy that offers
such a policy in a State, with respect to each year, to accept every
individual in the State who is enrolled pursuant to section 1899C and
who applies for such coverage for such year if the individual applies
for enrollment in such policy during the 30-day period following the
date of enrollment pursuant to section 1899C and to accept every such
individual during a period of transition from enrollment pursuant to
such section to enrollment under this title pursuant to eligibility
other than under such section. Such revisions shall be made consistent
with the rules applicable under subsection (p)(1)(E) with the reference
to the `1991 NAIC Model Regulation' deemed a reference to the NAIC
Model Regulation as published in the Federal Register on December 4,
1998, and as subsequently updated by the National Association of
Insurance Commissioners to reflect previous changes in law and the
reference to `date of enactment of this subsection' deemed a reference
to the date of enactment of this subsection (aa).''.
SEC. 102. HOLDING MEDICARE BENEFICIARIES HARMLESS FOR SPECIFIED COVID-
19 TREATMENT SERVICES FURNISHED UNDER PART A OR PART B OF
THE MEDICARE PROGRAM.
(a) In General.--Notwithstanding any other provision of law, in the
case of a specified COVID-19 treatment service (as defined in
subsection (b)) furnished to an individual entitled to benefits under
part A or enrolled under part B of title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) or enrolled under section 1899C of the
Social Security Act for which payment is made under such part A or such
part B, the Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall provide that--
(1) any cost sharing required (including any deductible,
copayment, or coinsurance) applicable to such individual under
such part A or such part B with respect to such item or service
is paid by the Secretary;
(2) the provider of services or supplier (as defined in
section 1861 of the Social Security Act (42 U.S.C. 1395x)) does
not hold such individual liable for such requirement; and
(3) no prior authorization or other utilization management
requirement is applied with respect to such service.
(b) Definition of Specified COVID-19 Treatment Services.--For
purposes of this section, the term ``specified COVID-19 treatment
service'' means any item or service--
(1) relating to the treatment or diagnosis of COVID-19;
(2) furnished to an individual in an emergency department
where such individual presents with COVID-19 symptoms; or
(3) in the case of an individual furnished a test for
COVID-19 or diagnosed with COVID-19, furnished during the same
episode of care as such test or diagnosis, regardless of
setting.
(c) Recovery of Cost-Sharing Amounts Paid by the Secretary in the
Case of Supplemental Insurance Coverage.--
(1) In general.--In the case of any amount paid by the
Secretary pursuant to subsection (a)(1) that the Secretary
determines would otherwise have been paid by a group health
plan or health insurance issuer (as such terms are defined in
section 2791 of the Public Health Service Act (42 U.S.C. 300gg-
91)), a private entity offering a medicare supplemental policy
under section 1882 of the Social Security Act (42 U.S.C.
1395ss), any other health plan offering supplemental coverage,
a State plan under title XIX of the Social Security Act, or the
Secretary of Defense under the TRICARE program, such plan,
issuer, private entity, other health plan, State plan, or
Secretary of Defense, as applicable, shall pay to the
Secretary, not later than 1 year after such plan, issuer,
private entity, other health plan, State plan, or Secretary of
Defense receives a notice under paragraph (3), such amount in
accordance with this subsection.
(2) Required information.--Not later than 9 months after
the date of the enactment of this Act, each group health plan,
health insurance issuer, private entity, other health plan,
State plan, and Secretary of Defense described in paragraph (1)
shall submit to the Secretary such information as the Secretary
determines necessary for purposes of carrying out this
subsection. Such information so submitted shall be updated by
such plan, issuer, private entity, other health plan, State
plan, or Secretary of Defense, as applicable, at such time and
in such manner as specified by the Secretary.
(3) Review of claims and notification.--The Secretary shall
establish a process under which claims for items and services
for which the Secretary has paid an amount pursuant to
subsection (a)(1) are reviewed for purposes of identifying if
such amount would otherwise have been paid by a plan, issuer,
private entity, other health plan, State plan, or Secretary of
Defense described in paragraph (1). In the case such a claim is
so identified, the Secretary shall determine the amount that
would have been otherwise payable by such plan, issuer, private
entity, other health plan, State plan, or Secretary of Defense
and notify such plan, issuer, private entity, other health
plan, State plan, or Secretary of Defense of such amount.
(4) Enforcement.--The Secretary may impose a civil monetary
penalty in an amount determined appropriate by the Secretary in
the case of a plan, issuer, private entity, other health plan,
or State plan that fails to comply with a provision of this
section. The provisions of section 1128A of the Social Security
Act shall apply to a civil monetary penalty imposed under the
previous sentence in the same manner as such provisions apply
to a penalty or proceeding under subsection (a) or (b) of such
section.
(d) Funding.--The Secretary shall provide for the transfer to the
Centers for Medicare & Medicaid Program Management Account from the
Federal Hospital Insurance Trust Fund and the Federal Supplementary
Trust Fund (in such portions as the Secretary determines appropriate)
$100,000,000 for purposes of carrying out this section.
(e) Report.--Not later than 3 years after the date of the enactment
of this Act, the Inspector General of the Department of Health and
Human Services shall submit to Congress a report containing an analysis
of amounts paid pursuant to subsection (a)(1) compared to amounts paid
to the Secretary pursuant to subsection (c).
(f) Implementation.--Notwithstanding any other provision of law,
the Secretary may implement the provisions of this section by program
instruction or otherwise.
SEC. 103. COVERAGE OF TREATMENTS 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 by adding at the end the
following new clause:
``(vii) Special coverage rules for
specified covid-19 treatment services.--
Notwithstanding clause (i), in the case of a
specified COVID-19 treatment service (as
defined in section 102(b) of the Medicare
Crisis Program Act of 2020) that is furnished
during a plan year occurring during any portion
of the emergency period defined in section
1135(g)(1)(B) beginning on or after the date of
the enactment of this clause, a Medicare
Advantage plan may not, with respect to such
service, impose--
``(I) any cost-sharing requirement
(including a deductible, copayment, or
coinsurance requirement); and
``(II) any prior authorization or
other utilization management
requirement.
A Medicare Advantage plan may not take the
application of this clause into account for
purposes of a bid amount submitted by such plan
under section 1854(a)(6).''.
(b) Reimbursement of Medicare Advantage Plans for Elimination of
Cost Sharing.--Section 1853 of the Social Security Act (42 U.S.C.
1395w-23) is amended by adding at the end the following new subsection:
``(p) Additional Payment To Account for Cost Sharing Elimination
for COVID-19 Treatment Services.--
``(1) In general.--A Medicare Advantage plan shall notify
the Secretary of the total dollar amount of cost sharing that,
but for the application of section 1852(a)(1)(B)(vii), would
have been required under such plan for specified COVID-19
treatment services (as defined in section 70202(b) of the Take
Responsibility for Workers and Families Act) furnished during a
plan year described in such section to individuals enrolled in
the plan. The Secretary shall make periodic and timely payments
in accordance with this subsection to such plan that, in the
aggregate, equal such total dollar amount.
``(2) Timing of payment.--Payments by the Secretary under
this subsection shall be made beginning March 1, 2021, for
amounts described in such paragraph that would have been
required under such plan for specified COVID-19 treatment
services furnished during plan year 2020. Payments by the
Secretary under this subsection for such amounts that would
have been so required under such plan for such services
furnished during a plan year subsequent to plan year 2020 shall
be made beginning March 1 of the plan year following such
subsequent plan year.
``(3) Non-application.--Section 1853(c)(7) shall not apply
with respect to the application of this subsection.
``(4) Appropriation.--There are transferred to the Centers
for Medicare & Medicaid Program Management Fund, out of any
monies in the Treasury not otherwise obligated, such sums as
may be necessary to the Secretary for purposes of making
payments under this subsection.''.
(c) 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. 104. GUARANTEED ISSUE OF CERTAIN MEDIGAP POLICIES.
(a) Guaranteed Issue of Medigap Policies to All Medigap-Eligible
Medicare Beneficiaries.--
(1) In general.--Section 1882(s) of the Social Security Act
(42 U.S.C. 1395ss(s)) is amended--
(A) in paragraph (2)(A), by striking ``65 years of
age or older and is enrolled for benefits under part
B'' and inserting ``entitled to, or enrolled for,
benefits under part A and enrolled for benefits under
part B'';
(B) in paragraph (2)(D), by striking ``who is 65
years of age or older as of the date of issuance and'';
(C) in paragraph (3)(B)(ii), by striking ``is 65
years of age or older and''; and
(D) in paragraph (3)(B)(vi), by striking ``at age
65''.
(2) Additional enrollment period for certain individuals.--
(A) One-time enrollment period.--
(i) In general.--In the case of a specified
individual, the Secretary shall establish a
one-time enrollment period described in clause
(iii) during which such an individual may
enroll in any medicare supplemental policy of
the individual's choosing.
(ii) Application.--The provisions of--
(I) paragraph (2) of section
1882(s) of the Social Security Act (42
U.S.C. 1395ss(s)) shall apply with
respect to a specified individual who
is described in subclause (I) of
subparagraph (B)(iii) as if references
in such paragraph (2) to the 6-month
period described in subparagraph (A) of
such paragraph were references to the
one-time enrollment period established
under clause (i); and
(II) paragraph (3) of such section
shall apply with respect to a specified
individual who is described in
subclause (II) of subparagraph (B)(iii)
as if references in such paragraph (3)
to the period specified in subparagraph
(E) of such paragraph were references
to the one-time enrollment period
established under clause (i).
(iii) Period.--The enrollment period
established under clause (i) shall be the 6-
month period beginning on January 1, 2024.
(B) Specified individual.--For purposes of this
paragraph, the term ``specified individual'' means an
individual who--
(i) is entitled to hospital insurance
benefits under part A of title XVIII of the
Social Security Act (42 U.S.C. 1395c et seq.)
pursuant to section 226(b) or section 226A of
such Act (42 U.S.C. 426(b); 426-1);
(ii) is enrolled for benefits under part B
of such Act (42 U.S.C. 1395j et seq.); and
(iii)(I) would not, but for the amendments
made by subparagraphs (A) and (B) of paragraph
(1) and the provisions of this paragraph (if
such provisions applied to such individual), be
eligible for the guaranteed issue of a medicare
supplemental policy under paragraph (2) of
section 1882(s) of such Act (42 U.S.C.
1395ss(s)); or
(II) would not, but for the amendments made
by subparagraphs (C) and (D) of paragraph (1)
and the provisions of this paragraph (if such
provisions applied to such individual), be
eligible for the guaranteed issue of a medicare
supplemental policy under paragraph (3) of such
section.
(C) Outreach plan.--
(i) In general.--The Secretary shall
develop an outreach plan to notify specified
individuals of the one-time enrollment period
established under subparagraph (A).
(ii) Consultation.--In implementing the
outreach plan developed under clause (i), the
Secretary shall consult with consumer
advocates, brokers, insurers, the National
Association of Insurance Commissioners, and
State Health Insurance Assistance Programs.
(3) Effective date.--The amendments made by paragraph (1)
shall apply to medicare supplemental policies effective on or
after the date of the enactment of this Act.
(b) Guaranteed Issue of Medigap Policies for Medicare Advantage
Enrollees.--
(1) In general.--Section 1882(s)(3) of the Social Security
Act (42 U.S.C. 1395ss(s)(3)), as amended by subsection (a), is
further amended--
(A) in subparagraph (B), by adding at the end the
following new clause:
``(vii) The individual--
``(I) was enrolled in a Medicare Advantage plan
under part C for not less than 12 months;
``(II) subsequently disenrolled from such plan;
``(III) elects to receive benefits under this title
through the original Medicare fee-for-service program
under parts A and B; and
``(IV) has not previously elected to receive
benefits under this title through the original Medicare
fee-for-service program pursuant to disenrollment from
a Medicare Advantage plan under part C.'';
(B) by striking subparagraph (C)(iii) and inserting
the following:
``(iii) Subject to subsection (v)(1), for purposes of an individual
described in clause (vi) or (vii) of subparagraph (B), a medicare
supplemental policy described in this subparagraph shall include any
medicare supplemental policy.''; and
(C) in subparagraph (E)--
(i) in clause (iv), by striking ``and'' at
the end;
(ii) in clause (v), by striking the period
at the end and inserting ``; and''; and
(iii) by adding at the end the following
new clause--
``(vi) in the case of an individual described in
subparagraph (B)(vii), the annual, coordinated election period
(as defined in section 1851(e)(3)(B)) or a continuous open
enrollment period (as defined in section 1851(e)(2)) during
which the individual disenrolls from a Medicare Advantage plan
under part C.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to medicare supplemental policies effective on or
after the date of the enactment of this Act.
SEC. 105. REQUIRING COVERAGE UNDER MEDICARE PDPS AND MA-PD PLANS,
WITHOUT THE IMPOSITION OF COST SHARING OR UTILIZATION
MANAGEMENT REQUIREMENTS, OF DRUGS INTENDED TO TREAT
COVID-19 DURING CERTAIN EMERGENCIES.
(a) Coverage Requirement.--
(1) In general.--Section 1860D-4(b)(3) of the Social
Security Act (42 U.S.C. 1395w-104(b)(3)) is amended by adding
at the end the following new subparagraph:
``(I) Required inclusion of drugs intended to treat
covid-19.--
``(i) In general.--Notwithstanding any
other provision of law, a PDP sponsor offering
a prescription drug plan shall, with respect to
a plan year, any portion of which occurs during
the period described in clause (ii), be
required to--
``(I) include in any formulary--
``(aa) all covered part D
drugs with a medically accepted
indication (as defined in
section 1860D-2(e)(4)) to treat
COVID-19 that are marketed in
the United States; and
``(bb) all drugs authorized
under section 564 or 564A of
the Federal Food, Drug, and
Cosmetic Act to treat COVID-19;
and
``(II) not impose any prior
authorization or other utilization
management requirement with respect to
such drugs described in item (aa) or
(bb) of subclause (I) (other than such
a requirement that limits the quantity
of drugs due to safety).
``(ii) Period described.--For purposes of
clause (i), the period described in this clause
is the period during which there exists the
public health emergency declared by the
Secretary pursuant to section 319 of the Public
Health Service Act on January 31, 2020,
entitled `Determination that a Public Health
Emergency Exists Nationwide as the Result of
the 2019 Novel Coronavirus' (including any
renewal of such declaration pursuant to such
section).''.
(b) Elimination of Cost Sharing.--
(1) Elimination of cost sharing for drugs intended to treat
covid-19 under standard and alternative prescription drug
coverage.--Section 1860D-2 of the Social Security Act (42
U.S.C. 1395w-102) is amended--
(A) in subsection (b)--
(i) in paragraph (1)(A), by striking ``The
coverage'' and inserting ``Subject to paragraph
(8), the coverage'';
(ii) in paragraph (2)--
(I) in subparagraph (A), by
inserting after ``Subject to
subparagraphs (C) and (D)'' the
following: ``and paragraph (8)'';
(II) in subparagraph (C)(i), by
striking ``paragraph (4)'' and
inserting ``paragraphs (4) and (8)'';
and
(III) in subparagraph (D)(i), by
striking ``paragraph (4)'' and
inserting ``paragraphs (4) and (8)'';
(iii) in paragraph (4)(A)(i), by striking
``The coverage'' and inserting ``Subject to
paragraph (8), the coverage''; and
(iv) by adding at the end the following new
paragraph:
``(8) Elimination of cost-sharing for drugs intended to
treat covid-19.--The coverage does not impose any deductible,
copayment, coinsurance, or other cost-sharing requirement for
drugs described in section 1860D-4(b)(3)(I)(i)(I) with respect
to a plan year, any portion of which occurs during the period
during which there exists the public health emergency declared
by the Secretary pursuant to section 319 of the Public Health
Service Act on January 31, 2020, entitled `Determination that a
Public Health Emergency Exists Nationwide as the Result of the
2019 Novel Coronavirus' (including any renewal of such
declaration pursuant to such section).''; and
(B) in subsection (c), by adding at the end the
following new paragraph:
``(4) Same elimination of cost-sharing for drugs intended
to treat covid-19.--The coverage is in accordance with
subsection (b)(8).''.
(2) Elimination of cost sharing for drugs intended to treat
covid-19 dispensed to individuals who are subsidy eligible
individuals.--Section 1860D-14(a) of the Social Security Act
(42 U.S.C. 1395w-114(a)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (D)--
(I) in clause (ii), by striking
``In the case of'' and inserting
``Subject to subparagraph (F), in the
case of''; and
(II) in clause (iii), by striking
``In the case of'' and inserting
``Subject to subparagraph (F), in the
case of''; and
(ii) by adding at the end the following new
subparagraph:
``(F) Elimination of cost-sharing for drugs
intended to treat covid-19.--Coverage that is in
accordance with section 1860D-2(b)(8).''; and
(B) in paragraph (2)--
(i) in subparagraph (B), by striking ``A
reduction'' and inserting ``Subject to
subparagraph (F), a reduction'';
(ii) in subparagraph (D), by striking ``The
substitution'' and inserting ``Subject to
subparagraph (F), the substitution'';
(iii) in subparagraph (E), by inserting
after ``Subject to'' the following:
``subparagraph (F) and''; and
(iv) by adding at the end the following new
subparagraph:
``(F) Elimination of cost-sharing for drugs
intended to treat covid-19.--Coverage that is in
accordance with section 1860D-2(b)(8).''.
(c) LIS Eligibility.--Section 1860D-14(a)(3)(C)(i) of the Social
Security Act (42 U.S.C. 1395w-114(a)(3)(C)(i)) is amended by inserting
``and any amounts received from a State as unemployment benefits''
after ``furnished in kind''.
(d) 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. 106. MEDICARE SPECIAL ENROLLMENT PERIOD FOR INDIVIDUALS RESIDING
IN COVID-19 EMERGENCY AREAS.
(a) In General.--Section 1837(i) of the Social Security Act (42
U.S.C. 1395p(i)) is amended by adding at the end the following new
paragraph:
``(5)(A) In the case of an individual who--
``(i) is eligible under section 1836 to enroll in
the medical insurance program established by this part;
``(ii) has elected not to enroll (or to be deemed
enrolled) under such section during an enrollment
period; and
``(iii) during the emergency period (as described
in section 1135(g)(1)(B)), is residing in an emergency
area (as described in such section),
there shall be a special enrollment period described in
subparagraph (B).
``(B) The special enrollment period referred to in
subparagraph (A) is, with respect to an individual
residing in a State, the period that begins on the date
of the enactment of this paragraph and ends on the date
that is 3 months after the first day occurring on or
after the date of the enactment of this paragraph that
the average unemployment rate for the 12-month period
ending on such first day--
``(i) in such State is not more than 2
percentage points higher that the average
unemployment rate in such State during the
period consisting of October 1 through December
31 of 2019; and
``(ii) in the United States is not more
than 2 percentage points higher that the
average unemployment rate in the United States
during the period consisting of October 1
through December 31 of 2019.''.
(b) Coverage Period for Individuals Transitioning From Other
Coverage.--Section 1838(e) of the Social Security Act (42 U.S.C.
1395q(e)) is amended--
(1) by striking ``pursuant to section 1837(i)(3) or
1837(i)(4)(B)--'' and inserting the following: ``pursuant to--
``(1) section 1837(i)(3) or 1837(i)(4)(B)--'';
(2) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively, and moving the
indentation of each such subparagraph 2 ems to the right;
(3) by striking the period at the end of the subparagraph
(B), as so redesignated, and inserting ``; or''; and
(4) by adding at the end the following new paragraph:
``(2) section 1837(i)(5), the coverage period shall begin
on the first day of the month following the month in which the
individual so enrolls.''.
(c) No Increase in Premiums.--Section 1839(b) of such Act (42
U.S.C. 1395r(b)) is amended in the first sentence, by inserting ``,
(i)(5),'' after ``subsection (i)(4)''.
SEC. 107. SPECIAL MEDICARE RULES DURING THE COVID-19 EMERGENCY.
(a) Premiums.--Notwithstanding any other provision of law, the
Secretary shall provide that an individual entitled to benefits under
part A or enrolled under part B of title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) is not required to pay any premium under
such part A or part B (if any would otherwise be applicable) for any
month occurring during the emergency period described in section
1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-5(g)(1)(B)).
(b) Cost-Sharing Requirements.--Notwithstanding any other provision
of law, with respect to items and services furnished during a month
occurring during the emergency period described in section
1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-5(g)(1)(B))
to an individual entitled to benefits under part A or enrolled under
part B of title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.), including an individual enrolled under section 1899C of such
Act, the Secretary of Health and Human Services shall ensure that the
aggregate amount of any cost-sharing requirements (including any
deductibles, copayments, or coinsurance) applicable under such part A
or part B (or, in the case of an individual enrolled under part C of
such title, under such part C if such item or service would have been
covered under such part A or B) to such individual with respect to such
items and services furnished during such month does not exceed 5
percent of such individual's income during such month. The Secretary
shall pay to the entity furnishing such item or service the amount of
any such requirement that would be payable to such entity but for
application of the previous sentence.
SEC. 108. NATIONAL CLEARINGHOUSE FOR COVID-19 PERSONAL PROTECTIVE
EQUIPMENT AND OTHER MEDICAL SUPPLIES.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish a
national clearinghouse for COVID-19 personal protective equipment and
other medical supplies (in this section referred to as the
``clearinghouse'') through which the Secretary shall provide for the
purchase, in accordance with subsection (b), of personal protective
equipment and other medical items necessary for the diagnosis or
treatment of COVID-19 (including respirator masks, ventilators, gloves,
bodysuits, safety glasses, eye protection, and isolation gowns) and the
distribution of such equipment and items in accordance with subsection
(c).
(b) Purchase of Equipment and Items.--The Secretary shall provide
for the purchase of equipment and items described in subsection (a) for
the clearinghouse through direct negotiations with entities selling
such equipment or items. Any such purchase shall be made at a rate not
exceeding the amount payable for such equipment or items by the
Secretary of Veterans Affairs.
(c) Distribution.--The Secretary shall provide for the distribution
of equipment and items purchased for the clearinghouse to health care
providers enrolled under section 1866(j) of the Social Security Act (42
U.S.C. 1395cc(j)) based on the demonstrated need of such providers for
such equipment and items.
(d) Report.--The Secretary shall submit to Congressional Oversight
Commission established under section 4020 of division A of the CARES
Act and publish on a public website a monthly report on expenditures
under this section and distribution of equipment and items made through
the clearinghouse. Such report shall include a breakdown of the
geographic distribution of such equipment and items and a specification
of the types of expenditures made under this section.
TITLE II--MEDICAID AND CHIP
SEC. 201. MEDICAID COVERAGE AT NO COST SHARING OF COVID-19 VACCINE AND
TREATMENT.
(a) Medicaid.--
(1) In general.--Section 1905(a)(4) of the Social Security
Act (42 U.S.C. 1396d(a)(4)) is amended--
(A) by striking ``and (D)'' and inserting ``(D)'';
and
(B) by striking the semicolon at the end and
inserting ``; (E) a COVID-19 vaccine licensed under
section 351 of the Public Health Service Act and the
administration of such vaccine; and (F) specified
COVID-19 treatment services (as defined in section
102(b) of the Medicare Crisis Program Act of 2020);''.
(2) Prohibition of 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 (F), by striking ``or''
at the end;
(ii) in subparagraph (G), by striking ``;
and'' and inserting ``, or''; and
(iii) by adding at the end the following
subparagraphs:
``(H) a COVID-19 vaccine licensed under section 351
of the Public Health Service Act and the administration
of such vaccine; or
``(I) any specified COVID-19 treatment service (as
defined in section 102(b) of the Medicare Crisis
Program Act of 2020); 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--
(i) in clause (xi), by striking ``any
visit'' and inserting ``any service''; and
(ii) by adding at the end the following
clauses:
``(xii) A COVID-19 vaccine licensed under
section 351 of the Public Health Service Act
and the administration of such vaccine.
``(xiii) A specified COVID-19 treatment
service (as defined in section 102(b) of the
Medicare Crisis Program Act of 2020).''.
(C) Clarification.--The amendments made by this
subsection 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.
(b) State Pediatric Vaccine Distribution Program.--Section 1928 of
the Social Security Act (42 U.S.C. 1396s) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (A), by striking ``; and'' and
inserting a semicolon;
(B) in subparagraph (B), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following
subparagraph:
``(C) each vaccine-eligible child (as defined in
subsection (b)) is entitled to receive a COVID-19
vaccine from a program-registered provider (as defined
in subsection (h)(8)) without charge for--
``(i) the cost of such vaccine; or
``(ii) the administration of such
vaccine.'';
(2) in subsection (c)(2)--
(A) in subparagraph (C)(ii), by inserting ``, but
may not impose a fee for the administration of a COVID-
19 vaccine'' before the period; and
(B) by adding at the end the following
subparagraph:
``(D) The provider will provide and administer an
approved COVID-19 vaccine to a vaccine-eligible child
in accordance with the same requirements as apply under
the preceding subparagraphs to the provision and
administration of a qualified pediatric vaccine to such
a child.''; and
(3) in subsection (d)(1), in the first sentence, by
inserting ``, including with respect to a COVID-19 vaccine
licensed under section 351 of the Public Health Service Act''
before the period.
(c) CHIP.--
(1) In general.--Section 2103(c) of the Social Security Act
(42 U.S.C. 1397cc(c)), as amended by section 6004(b)(1) of the
Families First Coronavirus Response Act, is amended by adding
at the end the following paragraph:
``(11) Coverage of covid-19 vaccines and treatment.--The
child health assistance provided to a targeted low-income child
shall include coverage of--
``(A) any COVID-19 vaccine licensed under section
351 of the Public Health Service Act and the
administration of such vaccine; and
``(B) a specified COVID-19 treatment service (as
defined in section 102(b) of the Medicare Crisis
Program Act of 2020).''.
(2) Prohibition of cost sharing.--Section 2103(e)(2) of the
Social Security Act (42 U.S.C. 1397cc(e)(2)), as amended by
section 6004(b)(3) of the Families First Coronavirus Response
Act, is amended--
(A) in the paragraph header, by inserting ``a
covid-19 vaccine, covid-19 treatment,'' before ``or
pregnancy-related assistance''; and
(B) by striking ``visits described in section
1916(a)(2)(G), or'' and inserting ``services described
in section 1916(a)(2)(G), vaccines described in section
1916(a)(2)(H), items or services described in section
1916(a)(2)(I), or''.
(d) Conforming Amendments.--Section 1937 of the Social Security Act
(42 U.S.C. 1396u-7) is amended--
(1) in subsection (a)(1)(B), by inserting ``, under
subclause (XXIII) of section 1902(a)(10)(A)(ii),'' after
``section 1902(a)(10)(A)(i)''; and
(2) in subsection (b)(5), by adding before the period the
following: ``, and, effective on the date of the enactment of
the Medicare Crisis Program Act of 2020, must comply with
subparagraphs (F) through (I) of subsections (a)(2) and (b)(2)
of sections 1916 and 1916A''.
(e) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act and shall apply with
respect to a COVID-19 vaccine beginning on the date that such vaccine
is licensed under section 351 of the Public Health Service Act (42
U.S.C. 262).
SEC. 202. INCREASING THE TEMPORARY INCREASE OF MEDICAID FMAP DURING THE
COVID-19 EMERGENCY.
(a) In General.--Section 6008(a) of the Families First Coronavirus
Response Act (Public Law 116-127) is amended by striking ``6.2'' and
inserting ``13''.
(b) Extension of Period of Applicability.--Section 6008 of such Act
is amended--
(1) in subsection (a), by striking ``such emergency
period'' and inserting ``the specified period (as defined in
subsection (d))'';
(2) in subsection (b)(3)--
(A) by striking ``the emergency period'' and
inserting ``the specified period (as defined in
subsection (d))''; and
(B) by striking ``such emergency period'' and
inserting ``such specified period''; and
(3) by adding at the end the following new subsection:
``(d) Specified Period.--In this section, the term `specified
period' means, with respect to a State, including the District of
Columbia, American Samoa, Guam, the Commonwealth of the Northern
Mariana Islands, Puerto Rico, and the United States Virgin Islands, the
period beginning on the first day of the emergency period described in
subsection (a) and ending on the date that is 3 months after the first
day occurring on or after the date of the enactment of this section
that the average unemployment rate for the 12-month period ending on
such first day--
``(1) in such State is not more than 2 percentage points
higher that the average unemployment rate in such State during
the period consisting of October 1 through December 31 of 2019;
and
``(2) in the United States is not more than 2 percentage
points higher that the average unemployment rate in the United
States during the period consisting of October 1 through
December 31 of 2019.''.
SEC. 203. INCREASING FEDERAL SUPPORT TO STATE MEDICAID PROGRAMS DURING
ECONOMIC DOWNTURNS.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (b), by striking ``and (ff)'' and
inserting ``(ff), and (gg)''; and
(2) by adding at the end the following new subsection:
``(gg) Increased FMAP During Economic Downturns.--
``(1) In general.--Notwithstanding subsection (b), (y), or
(z)(2), if a fiscal quarter that begins on or after January 1,
2020, is an economic downturn quarter (as defined in paragraph
(2)) with respect to a State, then the Federal medical
assistance percentage applicable to amounts expended by the
State for medical assistance for services furnished during such
quarter shall be increased in accordance with paragraphs (3)
and (4).
``(2) Economic downturn quarter.--
``(A) In general.--
``(i) In general.--In this subsection, the
term `economic downturn quarter' means, with
respect to a State, a fiscal quarter during
which the State's unemployment rate for the
quarter exceeds the percentage determined for
the State and quarter under clause (ii).
``(ii) Threshold percentage.--The
percentage determined under this clause for a
State and fiscal quarter is the percentage
equal to the lower of--
``(I) the State unemployment rate
at the 20th percentile of the
distribution of the State's quarterly
unemployment rates for the 60-quarter
period preceding the quarter involved,
increased by 1 percentage point; and
``(II) the State's average
quarterly unemployment rate for the 12-
quarter period preceding the quarter
involved, increased by 1 percentage
point.
``(B) Unemployment data.--
``(i) In general.--Except as provided in
clause (ii), for purposes of determining
unemployment rates for a State and a quarter
under this paragraph, the Secretary shall use
data from the Local Area Unemployment
Statistics from the Bureau of Labor Statistics.
``(ii) Application to certain
territories.--In the case of the Virgin
Islands, Guam, the Northern Mariana Islands, or
American Samoa, the Secretary shall use data
from the U-6 unemployment measure of the Bureau
of Labor Statistics to make any necessary
determinations under subparagraph (A).
``(3) FMAP increase during economic downturn quarter.--
``(A) In general.--During a fiscal quarter that is
an economic downturn quarter with respect to a State,
the Federal medical assistance percentage otherwise
determined for the State and quarter under subsection
(b) and, if applicable, the Federal medical assistance
percentage applicable under subsection (y), (z)(2), or
(ff) with respect to medical assistance furnished by
the State during such quarter to individuals described
in either such subsection shall be increased by the
number of percentage points (rounded to the nearest
tenth of a percentage point) equal to the product of--
``(i) the number of percentage points
(rounded to the nearest tenth of a percentage
point) by which the unemployment rate for the
State and quarter exceeds the percentage
determined for the State and quarter under
paragraph (2)(A)(ii); and
``(ii) 4.8.
``(B) Application of covid-19 fmap increase.--Any
increase applicable to the Federal medical assistance
percentage of a State for a fiscal quarter under
subparagraph (A) shall be in addition to any increase
to such percentage for such quarter made pursuant to
section 6008(a) of the Families First Coronavirus
Response Act.
``(C) Limitation.--In no case shall an increase to
the Federal medical assistance percentage of a State
under this paragraph result in a Federal medical
assistance percentage that exceeds 95 percent.
``(D) Scope of application.--Any increase to the
Federal medical assistance percentage of a State for a
fiscal quarter under this paragraph shall only apply
with respect to payments for amounts expended by the
State for medical assistance for services furnished
during such quarter and shall not apply with respect
to--
``(i) disproportionate share hospital
payments described in section 1923;
``(ii) payments under title IV or XXI;
``(iii) any payments under this title that
are based on the enhanced FMAP described in
section 2105(b); or
``(iv) any payments under this title that
are based on a Federal medical assistance
percentage determined for a State under
subsection (aa) (but only to the extent that
such Federal medical assistance percentage is
higher than the economic recovery FMAP).
``(4) Advance payment; retrospective adjustment.--
``(A) In general.--Prior to the beginning of each
fiscal quarter that begins on or after July 1, 2020,
the Secretary shall, with respect to each State--
``(i) determine the increase (if any) that
is expected to apply to the Federal medical
assistance percentage of such State for such
quarter under this subsection based on the
projections made for the State and quarter
under subparagraph (B); and
``(ii) shall apply such increase to the
Federal medical assistance percentage of the
State for purposes of making payments to the
State for amounts expended during such quarter
as medical assistance under the State plan.
``(B) Projection of state unemployment rates.--
Prior to the beginning of each fiscal quarter that
begins on or after July 1, 2020, the Secretary, acting
through the Chief Actuary of the Centers for Medicare &
Medicaid Services, shall, using the most recently
available data described in paragraph (2)(B), make
projections with respect to--
``(i) the unemployment rates for each State
for such quarter;
``(ii) the threshold percentages described
in paragraph (2)(A)(ii) for each State for such
quarter; and
``(iii) the national unemployment rate for
such quarter.
``(C) Retrospective adjustment.--As soon as
practicable after final unemployment data becomes
available for a fiscal quarter that begins on or after
July 1, 2020, the Secretary shall, with respect to each
State--
``(i) make a final determination of the
increase (if any) applicable to the Federal
medical assistance percentage of the State for
the quarter under this subsection; and
``(ii) in accordance with subsection (d)(2)
of section 1903, reduce or increase the amount
payable to the State under subsection (a) of
such section for a subsequent fiscal quarter to
the extent of any overpayment or underpayment
which the Secretary determines was made as a
result of a miscalculation of the increase
applicable to the Federal medical assistance
percentage of the State for such prior fiscal
quarter under this subsection.
``(5) Retrospective application of over-the-limit fmap
increases.--
``(A) In general.--If a State has excess percentage
points with respect to an economic downturn quarter and
an applicable FMAP (as determined under subparagraph
(B)), the State may elect to apply such excess
percentage points to increase such applicable FMAP for
one or more quarters during the look-back period for
the State and economic downturn quarter in accordance
with this paragraph.
``(B) Excess percentage points.--For purposes of
this paragraph, the number of excess percentage points
for a State, economic downturn quarter, and an
applicable FMAP shall be equal to the number of
percentage points by which--
``(i) the applicable FMAP for the State and
quarter (after application of paragraph (3) but
without regard to subparagraph (C) of such
paragraph); exceeds
``(ii) 95 percent.
``(C) Effect of application of excess percentage
points.--If a State elects to apply excess percentage
points to an applicable FMAP to a quarter during a
look-back period under this paragraph, the Secretary
shall determine the additional amount of payment under
section 1903(a) to which the State would have been
entitled for such quarter if the applicable FMAP (as so
increased) had been in effect for such quarter, and
shall treat such additional amount as an underpayment
for such quarter.
``(D) Distribution of excess percentage points.--A
State that has excess percentage points with respect to
an economic downturn quarter and applicable FMAP may
elect to divide such points among more than 1 quarter
during the look-back period for such State and quarter
provided that no excess percentage point (or fraction
of an excess percentage point) is applied to the
applicable FMAP of more than 1 quarter.
``(E) Limitations.--
``(i) No increases over 100 percent.--A
State may not increase an applicable FMAP for
any quarter during a look-back period under
this paragraph if such increase would result in
the applicable FMAP for such quarter exceeding
100 percent.
``(ii) Scope of application.--Any increase
to an applicable FMAP of a State for a fiscal
quarter under this paragraph--
``(I) shall only apply with respect
to payments for amounts expended by the
State for medical assistance for
services furnished during such quarter
to which such applicable FMAP is
applicable; and
``(II) shall not apply with respect
to payments described in paragraph
(3)(D).
``(F) Definitions.--In this paragraph:
``(i) Applicable fmap.--The term
`applicable FMAP' means, with respect to a
State and fiscal quarter--
``(I) the Federal medical
assistance percentage determined for
the State and quarter under subsection
(b);
``(II) the Federal medical
assistance percentage applicable under
subsection (y);
``(III) the Federal medical
assistance percentage applicable under
subsection (z)(2); or
``(IV) the Federal medical
assistance percentage determined for
the State and quarter under subsection
(ff).
``(ii) Look-back period.--The term `look-
back period' means, with respect to a State and
a fiscal quarter that is an economic downturn
quarter for the State, the period of 4 fiscal
quarters that ends with the fourth quarter
which precedes the most recent fiscal quarters
that was not an economic downturn quarter for
the State.
``(6) Requirement for all states.--A State may not receive
an increase in the Federal medical assistance percentage for
such State under this subsection, with respect to a fiscal
quarter, if--
``(A) eligibility standards, methodologies, or
procedures under the State plan or a waiver of such
plan are more restrictive during such quarter than the
eligibility standards, methodologies, or procedures,
respectively, under such plan (or waiver) as in effect
on the last day of the most recent fiscal quarter that
was not an economic downturn quarter for the State;
``(B) the amount of any premium imposed by the
State pursuant to section 1916 or 1916A during such
quarter, with respect to an individual enrolled under
such plan (or waiver), exceeds the amount of such
premium as of the date described in subparagraph (A);
or
``(C) the State fails to provide that an individual
who is enrolled for benefits under such plan (or
waiver) as of the date described in subparagraph (A) or
enrolls for benefits under such plan (or waiver) during
the period beginning with such date and ending with the
day before the first day of the next quarter that is
not an economic downturn quarter for the State shall be
treated as eligible for such benefits for not less than
12 months (or, if such period is less than 12 months,
throughout such period) unless the individual requests
a voluntary termination of eligibility or the
individual ceases to be a resident of the State.''.
(b) Exclusion of Economic Downturn FMAP Increases From Territorial
Caps.--Section 1108 of the Social Security Act (42 U.S.C. 1308) is
amended--
(1) in subsection (f), in the matter preceding paragraph
(1), by striking ``subsection (g) and section 1935(e)(1)(B)''
and inserting ``subsections (g) and (h) and section
1935(e)(1)(B)''; and
(2) by adding at the end the following:
``(h) Exclusion From Caps of Amounts Attributable to Economic
Downturn FMAP.--The portion of any payment made to a territory for a
fiscal year that is attributable to an increase in the Federal medical
assistance percentage for a fiscal quarter during such year under
section 1905(gg) shall not be taken into account for purposes of
applying payment limits under subsections (f) and (g).''.
SEC. 204. 100 PERCENT FMAP FOR INDIVIDUALS ENROLLING UNDER MEDICAID
DURING THE COVID-19 EMERGENCY.
(a) In General.--Notwithstanding any other provision of law, the
Federal medical assistance percentage otherwise determined under
section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) with
respect to medical assistance furnished during a specified period to a
specified individual under a State plan (or waiver of such plan) under
title XIX of such Act shall be 100 percent.
(b) Definitions.--In this section:
(1) Specified individual.--The term ``specified
individual'' means an individual who enrolls under the State
plan (or waiver of such plan) under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) during the emergency
period described in section 1135(g)(1)(B) of such Act (42
U.S.C. 1320b-5(g)(1)(B)).
(2) Specified period.--The term ``specified period'' means,
with respect to a State, including the District of Columbia,
American Samoa, Guam, the Commonwealth of the Northern Mariana
Islands, Puerto Rico, and the United States Virgin Islands, the
period beginning on the first day of the emergency period
described in subsection (a) and ending on the date that is 3
months after the first day occurring on or after the date of
the enactment of this section that the average unemployment
rate for the 12-month period ending on such first day--
(A) in such State is not more than 2 percentage
points higher that the average unemployment rate in
such State during the period consisting of October 1
through December 31 of 2019; and
(B) in the United States is not more than 2
percentage points higher that the average unemployment
rate in the United States during the period consisting
of October 1 through December 31 of 2019.
SEC. 205. MANDATORY APPROVAL OF WAIVERS TO COVER CERTAIN INDIVIDUALS
UNDER MEDICAID DURING THE COVID-19 EMERGENCY.
Section 1115(d) of the Social Security Act (42 U.S.C. 1315(d)) is
amended by adding at the end the following new paragraph:
``(4) Notwithstanding any other provision of this section, the
Secretary shall approve an application for a demonstration project
under this section to the extent that such project allows an individual
whose income (as determined under section 1902(e)(14)) does not exceed
300 percent of the poverty line (as defined in section 2110(c)(5))
applicable to a family of the size involved, to enroll under the State
plan (or waiver of such plan) under title XIX of the State submitting
such application.''.
TITLE III--MISCELLANEOUS
SEC. 301. GROUP HEALTH PLAN AND HEALTH INSURANCE ISSUER COVERAGE OF
COVID-19 RELATED TREATMENT AT NO COST SHARING.
(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, for specified COVID-19 treatment services
(as defined in section 102(b)) 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) Reimbursement to Plans and Coverage for Waiving Cost Sharing.--
(1) In general.--A group health plan or 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))
that does not impose cost sharing requirements as described in
subsection (a) shall notify the Secretary of Health and Human
Services, Secretary of Labor, and Secretary of the Treasury
(through a joint process established jointly by the
Secretaries) of the total dollar amount of cost sharing that,
but for the application of subsection (a), would have been
required under such plans and coverage for items and services
related to COVID-19 furnished during the period to which
subsection (a) applies to enrollees, participants, and
beneficiaries in the plan or coverage to whom such subsection
applies, but which was not imposed for such items and services
so furnished pursuant to such subsection and the Secretary of
Health and Human Services, in coordination with the Secretary
of Labor and the Secretary of the Treasury, shall make payments
in accordance with this subsection to the plan or issuer equal
to such total dollar amount.
(2) Methodology for payments.--The Secretary of Health and
Human Services, in coordination with the Secretary of Labor and
the Secretary of the Treasury shall establish a payment system
for making payments under this subsection. Any such system
shall make payment for the value of cost sharing not imposed by
the plan or issuer involved.
(3) Timing of payments.--Payments made under paragraph (1)
shall be made no later than May 1, 2021, for amounts of cost
sharing waivers with respect to 2020. Payments under this
subsection with respect to such waivers with respect to a year
subsequent to 2020 that begins during the period to which
subsection (a) applies shall be made no later than May of the
year following such subsequent year.
(4) Appropriations.--There is authorized to be
appropriated, and there is appropriated, out of any monies in
the Treasury not otherwise appropriated, such funds as are
necessary to carry out this subsection.
(c) Enforcement.--
(1) Application with respect to phsa, erisa, and irc.--The
provisions of this section 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.
(2) Private right of action.--An individual with respect to
whom an action is taken by a group health plan or health
insurance issuer offering group or individual health insurance
coverage in violation of subsection (a) may commence a civil
action against the plan or issuer for appropriate relief. The
previous sentence shall not be construed as limiting any
enforcement mechanism otherwise applicable pursuant to
paragraph (1).
(d) 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.
(e) Terms.--In this section, 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. 302. PAYMENT FOR SPECIFIED COVID-19 TREATMENT SERVICES FURNISHED
TO THE UNINSURED.
(a) In General.--The Secretary of Health and Human Services shall
pay to a health care provider that furnishes a specified COVID-19
treatment service (as defined in section 102) to an uninsured
individual (as defined in subsection (b)) an amount equal to the amount
that would have been payable (including any cost-sharing requirement)
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
had such service been furnished to an individual entitled to benefits
under part A and enrolled under part B of such title.
(b) Uninsured Individual.--For purposes of this section, the term
``uninsured individual'' means an individual who--
(1) is not enrolled in a group health plan or in group or
individual health insurance coverage (as defined in section
2791 of the Public Health Service Act (42 U.S.C. 300gg-91));
and
(2) is not enrolled in a Federal health care program (as
defined in section 1128B(f) of the Social Security Act (42
U.S.C. 1320a-7b(f))) or under the program established under
chapter 89 of title 5, United States Code.
(c) Holding Uninsured Individual Harmless for Specified COVID-19
Treatment Services.--
(1) In general.--A health care provider receiving payment
under subsection (a) for a specified COVID-19 treatment service
furnished to an individual may not hold such individual liable
for any amount for such service.
(2) Enforcement.--A health care provider who violates
subsection (a) shall be subject to a civil monetary penalty
determined appropriate by the Secretary of Health and Human
Services. The provision of section 1128A of the Social Security
Act (42 U.S.C. 1320a-7a) (other than subsections (a) and (b))
shall apply with respect to a civil monetary penalty imposed
under the previous sentence in the same manner as such
provisions apply with respect to a penalty or proceeding under
subsection (a) of such section.
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