[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4840 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 4840

    To amend title XVIII of the Social Security Act to require the 
inclusion of certain audio-only diagnoses in the determination of risk 
    adjustment for Medicare Advantage plans, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

             October 21 (legislative day, October 19), 2020

    Mr. Roberts (for himself, Ms. Cortez Masto, Mr. Scott of South 
Carolina, and Mr. Casey) introduced the following bill; which was read 
             twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to require the 
inclusion of certain audio-only diagnoses in the determination of risk 
    adjustment for Medicare Advantage plans, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ensuring Parity in MA for Audio-Only 
Telehealth Act of 2020''.

SEC. 2. REQUIRING THE INCLUSION OF CERTAIN AUDIO-ONLY DIAGNOSES IN THE 
              DETERMINATION OF RISK ADJUSTMENT FOR MEDICARE ADVANTAGE 
              PLANS.

    Section 1853(a)(1) of the Social Security Act (42 U.S.C. 1395w-
23(a)(1)) is amended by adding at the end the following new 
subparagraph:
                    ``(J) Inclusion of certain audio-only diagnoses for 
                purposes of risk adjustment.--
                            ``(i) In general.--For purposes of 
                        determining the appropriate adjustment for 
                        health status under subparagraph (C)(i) for 
                        plan years 2020 and 2021 (and for such other 
                        plan years determined appropriate by the 
                        Secretary), the Secretary, in determining the 
                        diseases or conditions of an individual, shall 
                        take into account a qualified diagnosis (as 
                        defined in clause (ii)) made with respect to 
                        such individual by a qualified provider (as so 
                        defined) via telehealth regardless of whether 
                        such diagnosis so made included the use of 
                        video communications.
                            ``(ii) Definitions.--For purposes of this 
                        subparagraph:
                                    ``(I) Qualified diagnosis.--The 
                                term `qualified diagnosis' means a 
                                diagnosis made with respect to a 
                                chronic disease or condition of an 
                                individual during a plan year if such 
                                diagnosis was also made with respect to 
                                such individual in one of the last of 
                                the 3 plan years preceding such plan 
                                year.
                                    ``(II) Qualified provider.--The 
                                term `qualified provider' means, with 
                                respect to a qualified diagnosis made 
                                with respect to an individual during a 
                                plan year, a provider of services, 
                                clinician or supplier that--
                                            ``(aa) furnished an item or 
                                        service to such individual 
                                        during the 3-year period ending 
                                        on the date such diagnosis was 
                                        so made; or
                                            ``(bb) is in the same 
                                        practice (as determined by tax 
                                        identification number) of a 
                                        provider of services or 
                                        supplier who furnished such an 
                                        item or service to such 
                                        individual during such 
                                        period.''.

SEC. 3. REQUIRING PARITY IN TELEHEALTH PAYMENTS DURING THE COVID-19 
              EMERGENCY.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended by adding at the end the following new paragraph:
            ``(9) Special rule for telehealth payment parity during the 
        covid-19 emergency.--In the case of a telehealth service 
        furnished during the emergency period described in section 
        1135(g)(1)(B) for which payment may be made under this 
        subsection (including any service for which payment may be so 
        made due to application of a waiver made under section 
        1135(b)), the amount of such payment shall be equal to the 
        amount that would have been paid for such service had such 
        service been furnished in-person.''.
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