S. 4840 – Ensuring Parity in MA for Audio-Only Telehealth Act of 2020

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Updated April 14, 2026 at 3:38 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 count toward the health‑status risk adjustment used for Medicare Advantage plans. It also requires that telehealth services provided during the COVID‑19 emergency be paid at the same rate as in‑person services. The bill affects Medicare Advantage insurers, health‑care providers, and Medicare beneficiaries who receive telehealth care.

Key Provisions

Adds a new subparagraph to the risk‑adjustment rules (Section 1853) requiring the Secretary to include qualified diagnoses made via audio‑only telehealth when calculating a plan’s risk score.
Defines a “qualified diagnosis” as a chronic disease diagnosis made during the current plan year that was also made in one 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 (Section 1834) to require payment parity during the COVID‑19 emergency, meaning telehealth services are reimbursed at the same amount they would receive if delivered in person.

Legislative Activity

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1 earlier action

SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance.

Finance Committee

October 21, 2020

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SenateIntro Referral

Introduced in Senate

October 21, 2020

SenateIntro Referral

Read twice and referred to the Committee on Finance.

Finance Committee

October 21, 2020

Bill Text

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Introduced in SenateIssued October 21, 2020

II

116th CONGRESS

2d Session

S. 4840

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.

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.

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