Prohibiting a group health plan and a health insurance issuer offering group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with health care providers during a public health emergency

(a)

PHSA

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 new section:

2730.

Prohibition on reduction of rates and termination of contracts during public health emergencies

(a)

In general

A group health plan and a health insurance issuer offering group or individual health insurance coverage may not, with respect to a health care provider located in an emergency area during an emergency period that, as of the day before the date of the beginning of such period, had in effect a contractual relationship for furnishing items and services under such plan or coverage— (1)provide for an amount of reimbursement for any such item or service furnished by such provider during such period that is less than the amount of such reimbursement that would have been payable under such plan or coverage had such item or service been furnished by such provider on such day; or (2)terminate such relationship during such period;

unless such lesser reimbursement or such termination is based on fraud, abuse, or other quality concerns with respect to such provider or such provider being placed on the exclusion list maintained by the Inspector General of the Department of Health and Human Services.

(b)

Definitions

For purposes of this section, an emergency area is a geographical area in which, and an emergency period is the period during which, there exists a public health emergency declared by the Secretary pursuant to section 319.

(b)

ERISA

(1)

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. 1185 et seq.) is amended by adding at the end the following new section:

716.

Prohibition on reduction of rates and termination of contracts during public health emergencies

(a)

In general

A group health plan and a health insurance issuer offering group health insurance coverage may not, with respect to a health care provider located in an emergency area during an emergency period that, as of the day before the date of the beginning of such period, had in effect a contractual relationship for furnishing items and services under such plan or coverage— (1)provide for an amount of reimbursement for any such item or service furnished by such provider during such period that is less than the amount of such reimbursement that would have been payable under such plan or coverage had such item or service been furnished by such provider on such day; or (2)terminate such relationship during such period;

(b)

Definitions

(2)

Clerical amendment

The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 is amended by inserting after the item relating to section 714 the following new items:

Sec. 715. Additional market reforms.

Sec. 716. Prohibition on reduction of rates and termination of contracts during public health emergencies.

(c)

IRC

(1)

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:

9816.

Prohibition on reduction of rates and termination of contracts during public health emergencies

(a)

In general

A group health plan may not, with respect to a health care provider located in an emergency area during an emergency period that, as of the day before the date of the beginning of such period, had in effect a contractual relationship for furnishing items and services under such plan— (1)provide for an amount of reimbursement for any such item or service furnished by such provider during such period that is less than the amount of such reimbursement that would have been payable under such plan had such item or service been furnished by such provider on such day; or (2)terminate such relationship during such period;

(b)

Definitions

(2)

Clerical amendment

The table of sections for such subchapter is amended by adding at the end the following new items:

Sec. 9815. Additional market reforms.

Sec. 9816. Prohibition on reduction of rates and termination of contracts during public health emergencies.

(d)

Effective date

The amendment made by this section shall apply with respect to public health emergencies declared by the Secretary of Health and Human Services on or after January 31, 2020, and items and services furnished, and terminations occurring, on or after the date of the enactment of this Act.