I
117th CONGRESS
2d Session
H. R. 8693
IN THE HOUSE OF REPRESENTATIVES
August 9, 2022
Mr. Sean Patrick Maloney of New York (for himself, Mr. Cicilline, Mr. Jones, Mr. Takano, Mr. Torres of New York, Mr. Peters, Ms. Underwood, Mr. Tonko, Mr. Nadler, Mrs. Carolyn B. Maloney of New York, Ms. Jacobs of California, Mr. Bowman, Mr. Evans, Ms. Bass, Ms. Velázquez, and Mr. Krishnamoorthi) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, Veterans' Affairs, Oversight and Reform, and Natural Resources, 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 ensure access to cost-free monkeypox testing services.
Short title
This Act may be cited as the No Cost for Monkeypox Testing Act of 2022
.
Ensuring access to cost-free monkeypox testing services
Group health plans and group and individual health insurance coverage
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:
Coverage of monkeypox testing with no cost sharing
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 the period beginning on the date of the enactment of this section and ending on December 31, 2023:
Tests for the detection of the monkeypox virus or the diagnosis of monkeypox (including the administration of such testing).
Items and services furnished to an individual during health care provider office visits (which term in this paragraph includes in-person visits and telehealth visits), urgent care center visits, and emergency room visits that result in an order for or administration of a test described in paragraph (1), but only to the extent such items and services relate to the furnishing or administration of such test or to the evaluation of such individual for purposes of determining the need of such individual for such test.
.
Medicare
Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended—
in subsection (a)(1)—
by striking and
before (DD)
; and
by inserting before the semicolon at the end the following: and (EE) with respect to a specified monkeypox testing-related service described in paragraph (1) of subsection (ee) 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,
;
in subsection (b), in the first sentence—
by striking and
before (12)
; and
by inserting before the period at the end the following: , and (13) such deductible shall not apply with respect to any specified monkeypox testing-related service described in paragraph (1) of subsection (ee) for which payment may be made under a specified outpatient payment provision described in paragraph (2) of such subsection
; and
by adding at the end the following new subsection:
Specified monkeypox testing-Related services
For purposes of subsection (a)(1)(EE):
Description
In general
A specified monkeypox testing-related service described in this paragraph is a medical visit that—
is in any of the categories of HCPCS evaluation and management service codes described in subparagraph (B);
is furnished during any portion of the period that begins on the date of the enactment of this subsection and ends on December 31, 2023;
results in an order for or administration of a clinical diagnostic laboratory test described in section 1852(a)(1)(B)(iv)(IV); and
relates to the furnishing or administration of such test or to the evaluation of such individual for purposes of determining the need of such individual for such test.
Categories of HCPCS codes
For purposes of subparagraph (A), the categories of HCPCS evaluation and management services codes are the categories described in subsection (cc)(1)(B).
Specified outpatient payment provision
A specified outpatient payment provision described in this paragraph is any such provision described in subsection (cc)(2).
.
Medicare Advantage
Section 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended—
in clause (iv)—
by redesignating subclause (VII) as subclause (IX); and
by inserting after subclause (VI) the following new subclauses:
Clinical diagnostic laboratory tests administered during the period beginning on the date of the enactment of this subclause and ending on December 31, 2023, for the detection of the monkeypox virus or the diagnosis of monkeypox and the administration of such test.
Specified monkeypox testing-related services (as described in section 1833(ee)(1)) for which payment would be payable under a specified outpatient payment provision described in section 1833(ee)(2).
;
in clause (v), by striking subclauses (IV), (V), and (VI)
and inserting subclauses (IV) through (VIII)
; and
by adding at the end the following new clause:
Prohibition of application of certain requirements for monkeypox testing
In the case of a test or service described in subclause (VII) or (VIII) of clause (iv) that is administered or furnished during the period described in such subclause (VII), an MA plan may not impose any prior authorization or other utilization management requirements with respect to the coverage of such a test or service under such plan.
.
Medicaid and CHIP
Medicaid
In general
Section 1905(a)(3) of the Social Security Act (42 U.S.C. 1396d(a)(3)) is amended—
in subparagraph (A), by striking and
at the end;
in subparagraph (B), by striking the semicolon and inserting ; and
; and
by adding at the end the following new subparagraph:
tests administered during the period beginning on the date of the enactment of this subparagraph and ending on December 31, 2023, for the detection of the monkeypox virus or the diagnosis of monkeypox and the administration of such tests;
.
No cost sharing
In general
Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—
in subparagraph (H), by striking or
at the end;
in subparagraph (I), by striking ; and
and inserting a comma; and
by adding at the end the following new subparagraphs:
any test described in section 1905(a)(3)(C) that is administered during the period described in such section (and the administration of such test), or
monkeypox testing-related services for which payment may be made under the State plan; and
.
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:
Any test described in section 1905(a)(3)(C) that is administered during the period described in such section (and the administration of such test) and any service described in section 1916(a)(2)(K) that is furnished during any such period.
.
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.
Expansion of State option to provide coverage of uninsured individuals to include monkeypox testing
Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended—
in subparagraph (A)(ii)(XXIII), by striking 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
and inserting the period beginning on the date of the enactment of this subclause and ending on December 31, 2022 (or, if latter, on the last day of the emergency period described in section 1135(g)(1)(B)),
; and
in the matter following subparagraph (G) designated as subclause (XVIII)—
by striking the period at the end of the emergency sentence described in such section
and inserting the emergency period described in such section
;
by striking and testing and treatments
and inserting testing and treatments
; and
by inserting any test described in section 1905(a)(3)(C) (and the administration of such test) that is administered during the period beginning on the date of the enactment of the No Cost for Monkeypox Testing Act of 2022 and ending on January 1, 2023, and any service described in section 1916(a)(2)(K) that is furnished during such period
after (or waiver of such plan)
.
CHIP
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:
Certain monkeypox testing
The child health assistance provided to a targeted low-income child shall include coverage of any test described in section 1905(a)(3)(C) that is administered during the period beginning on the date of the enactment of this paragraph and ending on December 31, 2023 (and the administration of such test).
.
Prohibition of cost sharing
Section 2103(e)(2) of the Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended—
in the header, by inserting monkeypox testing,
after covid–19 treatment
; and
by inserting tests described in subsection (c)(12) (and administration of such tests) furnished during the period described in such section, services described in section 1916(a)(2)(K) furnished during such period
before , or for pregnancy-related assistance
.
Application with respect to Tricare, coverage for veterans, and coverage for Federal civilians
Tricare
The Secretary of Defense may not require any copayment or other cost sharing under chapter 55 of title 10, United States Code, for tests described in paragraph (1) of section 2730 of the Public Health Service Act (or the administration of such tests) or item and services described in paragraph (2) of such section furnished during the period beginning on the date of the enactment of this Act and ending on December 31, 2023.
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 tests described in paragraph (1) of section 2730 of the Public Health Service Act (or the administration of such tests) or items and services described in paragraph (2) of such section furnished during the period described in paragraph (1).
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 tests described in paragraph (1) of section 2730 of the Public Health Service Act (or the administration of such tests) or items and services described in paragraph (2) of such section furnished during the period described in paragraph (1).
Coverage of testing for monkeypox at no cost sharing for Indians receiving purchased/Referred care
The Secretary of Health and Human Services shall cover, without the imposition of any cost sharing requirements, the cost of providing any test described in paragraph (1) of section 2730 of the Public Health Service Act (or the administration of such tests) or items and services described in paragraph (2) of such section furnished during the period described in subsection (e)(1) 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, including through an Urban Indian Organization, regardless of whether such items or services have been authorized under the purchased/referred care system funded by the Indian Health Service or is covered as a health service of the Indian Health Service.
Access for certain uninsured individuals
In general
The Secretary of Health and Human Services shall establish a program under which—
program-registered providers submit claims to the Secretary with respect to the furnishing, during the period described in subsection (e)(1), of tests described in paragraph (1) of section 2730 of the Public Health Service Act (or the administration of such tests) or items and services described in paragraph (2) of such section furnished to uninsured individuals; and
the Secretary, subject to the availability of appropriations, pays each such provider for such tests, items, and services in an amount determined appropriate by the Secretary.
Definitions
In this section:
Program-registered provider
The term program-registered provider
means a health care provider that—
enters into an agreement with the Secretary under which the provider agrees not to hold an uninsured individual liable for the cost of tests, items, and services described in paragraph (1) with respect to which a payment is made under subparagraph (B) of such paragraph; and
meets such other requirements as the Secretary may specify.
Secretary
The term Secretary
means the Secretary of Health and Human Services.
Uninsured individual
The term uninsured individual
means, with respect to an individual and a test, item, or service described in paragraph (1), an individual who—
is not enrolled in—
a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f)));
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; or
is enrolled in a program, plan, or coverage described in subparagraph (A) that does not provide any benefits for such test, item, or service under such program, plan, or coverage (as applicable).