[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3499 Introduced in Senate (IS)]

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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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