H.R. 7659 – Ensuring Parity in MA for Audio-Only Telehealth Act of 2020

AI-Generated Summary

Updated April 14, 2026 at 1:44 PM UTC

The Ensuring Parity in MA for Audio‑Only Telehealth Act of 2020 changes Medicare law so that diagnoses made through audio‑only telehealth visits count toward the health‑status risk adjustment of Medicare Advantage plans. It also makes sure that telehealth services provided during the COVID‑19 emergency are paid the same amount as in‑person services. The changes affect Medicare Advantage insurers, the Centers for Medicare & Medicaid Services, and patients who receive audio‑only telehealth care.

Key Provisions

Adds a new category that requires the Secretary to include diagnoses made via audio‑only telehealth when calculating risk‑adjustment payments for Medicare Advantage plans for 2020, 2021, and future years as determined.
Defines a “qualified diagnosis” as one for a chronic condition that was also diagnosed in any of the three prior plan years.
Defines a “qualified provider” as a clinician or supplier who has provided services to the patient in the past three years or works in the same practice as someone who has.
Amends the telehealth payment rules so that, during the COVID‑19 emergency, telehealth services are reimbursed at the same rate as comparable in‑person services.

Legislative Activity

Stay on top of the latest movement without scrolling through every action

1 earlier action

HouseIntro Referral Latest Action

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.

Ways and Means Committee

July 16, 2020

View full timeline

HouseIntro Referral

Introduced in House

July 16, 2020

HouseIntro Referral

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.

Ways and Means Committee

July 16, 2020

Bill Text

Latest available legislative text

Reading Mode

Raw Text PDF XML

Introduced in HouseIssued July 16, 2020

I

116th CONGRESS

2d Session

H. R. 7659

IN THE HOUSE OF REPRESENTATIVES

July 16, 2020

Ms. Sewell of Alabama (for herself, Mr. Bilirakis, Mr. Cárdenas, Mrs. Walorski, Mr. Kind, Mr. Smith of Missouri, Mr. Brindisi, and Mr. Fitzpatrick) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 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.

1.

Short title

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

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.

.

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.

.