,i #aafth ,,congress #b;d ,session ,h4 ,r4 #ffgd ,,in ,,the ,,house ,,of ,,representatives ,may #a1 #bjbj,ms4 ,jayapal 7for herself1 ,mr4 ,kennedy1 ,mr4 ,blumenauer1 ,ms4 ,clarke of ,new ,york1 ,mr4 ,cohen1 ,mrs4 ,dingell1 ,mr4 ,michael ,f4 ,doyle of ,pennsylvania1 ,mr4 ,espaillat1 ,mr4 ,hastings1 ,mrs4 ,hayes1 ,ms4 ,jackson ,lee1 ,mr4 ,khanna1 ,ms4 ,lee of ,california1 ,mr4 ,lowenthal1 ,mr4 ,mc,govern1 ,ms4 ,meng1 ,mrs4 ,napolitano1 ,mr4 ,neguse1 ,ms4 ,norton1 ,ms4 ,ocasio-,cortez1 ,ms4 ,omar1 ,ms4 ,pingree1 ,ms4 ,pressley1 ,mr4 ,raskin1 ,ms4 ,schakowsky1 ,mr4 ,soto1 ,mr4 ,takano1 ,ms4 ,tlaib1 ,mr4 ,vargas1 ,mr4 ,welch1 ,ms4 ,gabbard1 ,mr4 ,engel1 and ,ms4 ,velzquez7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 ,education and ,labor1 and ,armed ,services1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to ensure access to affordable1 comprehensive health insurance benefits for certain uninsured individuals during the ,,covid-#ai emergency1 and to ensure adequate coverage of treatments for ,,covid-#ai under the ,medicare and ,medicaid programs and under group health plans and group or individual health insurance coverage1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare ,crisis ,program ,act of #bjbj4 ,i ,medicare #aja4 ,,covid-#ai ,medicare enrollment option 7a7 ,in general ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,,covid-#ai ,medicare enrollment option 7a7 ,option 7#a7 ,eligibility ,every individual who meets the requirements described in paragraph 7#b7 shall be eligible to enroll under this section4 7#b7 ,requirements ,for purposes of paragraph 7#a71 the requirements described in this paragraph are the following3 7,a7 ,the individual-- 7i7 experienced a loss of1 or reduction in1 employment during the specified period 7as defined in subsection 7h77 and was approved for unemployment benefits relating to such loss or reduction in the ,state in which such individual resides2 or 7ii7 is the spouse1 child1 or other dependent of an individual described in clause 7i74 7,b7 ,the individual is not-- 7i7 otherwise entitled to benefits under part ,a or eligible to enroll under part ,a or part ,b2 7ii7 enrolled under a ,federal health care program 7as defined in section #aabh;,b7f77 or the program established under chapter #hi of title #e1 ,united ,states ,code2 7iii7 enrolled under an eligible employer-sponsored plan 7as defined in section #ejjj;,a7f77#b7 of the ,internal ,revenue ,code of #aihf71 but only if such plan-- 7,i7 includes the essential health benefits package 7as defined in section #acjb7;a7 of the ,patient ,protection and ,affordable ,care ,act72 and 7,,ii7 the employee's required contribution 7within the meaning of section #ejjj;,a7e77#a77;,b7 of such ,code1 except that such contribution shall be determined with respect to self-only or family coverage1 as applicable to the employee7 with respect to the plan does not exceed the percentage specified in section #cf;,b7c77#b77;,c77i77,,ii7 of such ,code for the applicable year2 or 7iv7 enrolled under a qualified health plan 7as defined in section #acja7;a7 of such ,act74 7#c7 ,benefits ,an individual enrolled under this section is entitled to the same benefits under this title as an individual who is entitled to benefits under part ,a and enrolled under part ,b and1 at the option of the individual1 eligible for prescription drug benefits under part ,d4 7b7 ,enrollment and coverage periods ,the ,secretary shall establish enrollment and coverage periods for individuals who enroll under this section4 ,a coverage period with respect to an individual enrolled under this section shall be retroactive to the date on which the individual experienced the loss or reduction described in subsection 7a77#b77;,a77i74 7c7 ,enrollment premium 7#a7 ,amount of monthly premiums ,there shall be no monthly premium for an individual enrolled under this section except as provided in paragraph 7#b74 7#b7 ,premium for optional part ,d benefits ,in the case an individual enrolled under this section elects to receive coverage under a prescription drug plan under part ,d1 there shall be a monthly premium with respect to such individual in an amount determined appropriate by the ,secretary4 7d7 ,payment of premiums 7#a7 ,payment ,premiums for enrollment under this section shall be paid to the ,secretary at such times1 and in such manner1 as the ,secretary determines appropriate4 7#b7 ,deposit ,amounts collected by the ,secretary under this section shall be deposited in the ,medicare ,,covid-#ai ,trust ,fund established under subsection 7e74 7e7 ,medicare ,,covid-#ai ,trust ,fund 7#a7 ,in general ,there is hereby created on the books of the ,treasury of the ,united ,states a trust fund to be known as the ,medicare ,,covid-#ai ,trust ,fund 7in this subsection referred to as the ,trust ,fund74 ,the ,trust ,fund shall consist of such gifts and bequests as may be made and such amounts as may be deposited in1 or appropriated to1 such fund as provided in this title4 7#b7 ,premiums ,premiums collected under subsection 7d7 shall be transferred to the ,trust ,fund4 7#c7 ,incorporation of ,provisions ,subsections 7b7 through 7i7 of section #ahda shall apply with respect to the ,trust ,fund and this title in the same manner as they apply with respect to the ,federal ,supplementary ,medical ,insurance ,trust ,fund and part ,b1 respectively1 except that in applying such section #ahda1 any reference in such section to this part shall be construed to be a reference to this section and any reference in section #ahda7;h7 to section #ahdj7;d7 and in section #ahda7;i7 to sections #ahdj7;b77#a7 and #ahdb7;g7 are deemed to be references to comparable authority exercised under this section4 7f7 ,termination of coverage ,coverage of an individual enrolled under this section shall terminate on the earliest of the following3 7#a7 ,the date on which the individual becomes entitled to benefits under part ,a or eligible to enroll under such part ,a or part ,b 7as determined without regard to this section74 7#b7 ,the date on which the individual becomes enrolled in coverage described in any of clauses 7ii7 through 7iv7 of subsection 7a77#b77;,b7 7as determined without regard to this section74 7#c7 ,the end of the specified period 7as defined in subsection 7h77 with respect to such individual4 7g7 ,enrollment information 7#a7 ,guidance ,the ,secretary of ,labor shall publish guidance for ,states with respect to information to be included by ,states on unemployment portals for purposes of facilitating enrollment of individuals under this section4 7#b7 ,provision of information to ,,cms ,in the case of a claim for unemployment benefits submitted to a ,state that indicates that the individual may be eligible for enrollment under this section1 the ,state shall provide such information regarding such individual as the ,secretary may specify to the ,secretary4 7#c7 ,online enrollment ,the ,secretary shall create an online application form to facilitate enrollment under this section4 7h7 ,specified period 7#a7 ,in general ,in this section1 the term specific period means1 with respect to an individual residing in a ,state1 the date beginning on the first day of the emergency period 7as described in section #aace7;g77#a77;,b77 and ending on the date that is #c months after the first day occurring on or after the date of the enactment of this section that the average unemployment rate for the #ab-month period ending on such first day-- 7,a7 in such ,state is not more than #b percentage points higher that the average unemployment rate in such ,state during the period consisting of ,october #a through ,december #ca of #bjai2 and 7,b7 in the ,united ,states is not more than #b percentage points higher than the average unemployment rate in the ,united ,states during the period consisting of ,october #a through ,december #ca of #bjai4 7#b7 ,notice ,in the case of an individual enrolled under this section1 if the specified period with respect to such individual ends while such individual is so enrolled1 the ,secretary shall provide notice to such individual of the end of such period and an explanation that coverage under this section shall terminate with respect to such individual not later than the date that is #c months after the end of such period4 7i7 ,funding ,there is appropriated1 out of any monies in the ,treasury not otherwise obligated1 to the ,trust ,fund described in subsection 7e7 such sums as may be necessary to carry out this section 7including for the payment of part ,a and part ,b benefits for individuals enrolled under this section74 4 7b7 ,medigap ,section #ahhb of the ,social ,security ,act is amended by adding at the end the following new subsection3 7aa7 ,development of ,new ,standards for ,certain ,medicare ,supplemental ,policies relating to ,,covid-#ai enrollment option ,the ,secretary shall request the ,national ,association of ,insurance ,commissioners to review and revise the standards for benefit packages described in subsection 7p77#a71 to otherwise update standards to include requirements for each medicare supplemental policy that offers such a policy in a ,state1 with respect to each year1 to accept every individual in the ,state who is enrolled pursuant to section #ahii;,c and who applies for such coverage for such year if the individual applies for enrollment in such policy during the #cj-;day period following the date of enrollment pursuant to section #ahii;,c and to accept every such individual during a period of transition from enrollment pursuant to such section to enrollment under this title pursuant to eligibility other than under such section4 ,such revisions shall be made consistent with the rules applicable under subsection 7p77#a77;,e7 with the reference to the #aiia ,,naic ,model ,regulation deemed a reference to the ,,naic ,model ,regulation as published in the ,federal ,register on ,december #d1 #aiih1 and as subsequently updated by the ,national ,association of ,insurance ,commissioners to reflect previous changes in law and the reference to date of enactment of this subsection deemed a reference to the date of enactment of this subsection 7aa74 4 #ajb4 ,holding ,medicare beneficiaries harmless for specified ,,covid-#ai treatment services furnished under part ,a or part ,b of the ,medicare program 7a7 ,in general ,notwithstanding any other provision of law1 in the case of a specified ,,covid-#ai treatment service 7as defined in subsection 7b77 furnished to an individual entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or enrolled under section #ahii;,c of the ,social ,security ,act for which payment is made under such part ,a or such part ,b1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall provide that-- 7#a7 any cost sharing required 7including any deductible1 copayment1 or coinsurance7 applicable to such individual under such part ,a or such part ,b with respect to such item or service is paid by the ,secretary2 7#b7 the provider of services or supplier 7as defined in section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex77 does not hold such individual liable for such requirement2 and 7#c7 no prior authorization or other utilization management requirement is applied with respect to such service4 7b7 ,definition of specified ,,covid-#ai treatment services ,for purposes of this section1 the term specified ,,covid-#ai treatment service means any item or service-- 7#a7 relating to the treatment or diagnosis of ,,covid-#ai2 7#b7 furnished to an individual in an emergency department where such individual presents with ,,covid-#ai symptoms2 or 7#c7 in the case of an individual furnished a test for ,,covid-#ai or diagnosed with ,,covid-#ai1 furnished during the same episode of care as such test or diagnosis1 regardless of setting4 7c7 ,recovery of cost-,sharing amounts paid by the ,secretary in the case of supplemental insurance coverage 7#a7 ,in general ,in the case of any amount paid by the ,secretary pursuant to subsection 7a77#a7 that the ,secretary determines would otherwise have been paid by a group health plan or health insurance issuer 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia771 a private entity offering a medicare supplemental policy under section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess71 any other health plan offering supplemental coverage1 a ,state plan under title ,,xix of the ,social ,security ,act1 or the ,secretary of ,defense under the ,,tricare program1 such plan1 issuer1 private entity1 other health plan1 ,state plan1 or ,secretary of ,defense1 as applicable1 shall pay to the ,secretary1 not later than #a year after such plan1 issuer1 private entity1 other health plan1 ,state plan1 or ,secretary of ,defense receives a notice under paragraph 7#c71 such amount in accordance with this subsection4 7#b7 ,required information ,not later than #i months after the date of the enactment of this ,act1 each group health plan1 health insurance issuer1 private entity1 other health plan1 ,state plan1 and ,secretary of ,defense described in paragraph 7#a7 shall submit to the ,secretary such information as the ,secretary determines necessary for purposes of carrying out this subsection4 ,such information so submitted shall be updated by such plan1 issuer1 private entity1 other health plan1 ,state plan1 or ,secretary of ,defense1 as applicable1 at such time and in such manner as specified by the ,secretary4 7#c7 ,review of claims and notification ,the ,secretary shall establish a process under which claims for items and services for which the ,secretary has paid an amount pursuant to subsection 7a77#a7 are reviewed for purposes of identifying if such amount would otherwise have been paid by a plan1 issuer1 private entity1 other health plan1 ,state plan1 or ,secretary of ,defense described in paragraph 7#a74 ,in the case such a claim is so identified1 the ,secretary shall determine the amount that would have been otherwise payable by such plan1 issuer1 private entity1 other health plan1 ,state plan1 or ,secretary of ,defense and notify such plan1 issuer1 private entity1 other health plan1 ,state plan1 or ,secretary of ,defense of such amount4 7#d7 ,enforcement ,the ,secretary may impose a civil monetary penalty in an amount determined appropriate by the ,secretary in the case of a plan1 issuer1 private entity1 other health plan1 or ,state plan that fails to comply with a provision of this section4 ,the provisions of section #aabh;,a of the ,social ,security ,act shall apply to a civil monetary penalty imposed under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under subsection 7a7 or 7b7 of such section4 7d7 ,funding ,the ,secretary shall provide for the transfer to the ,centers for ,medicare ,medicaid ,program ,management ,account from the ,federal ,hospital ,insurance ,trust ,fund and the ,federal ,supplementary ,trust ,fund 7in such portions as the ,secretary determines appropriate7 #ajj1jjj1jjj for purposes of carrying out this section4 7e7 ,report ,not later than #c years after the date of the enactment of this ,act1 the ,inspector ,general of the ,department of ,health and ,human ,services shall submit to ,congress a report containing an analysis of amounts paid pursuant to subsection 7a77#a7 compared to amounts paid to the ,secretary pursuant to subsection 7c74 7f7 ,implementation ,notwithstanding any other provision of law1 the ,secretary may implement the provisions of this section by program instruction or otherwise4 #ajc4 ,coverage of treatments for ,,covid-#ai at no cost sharing under the ,medicare ,advantage program 7a7 ,in general ,section #aheb7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#a77;,b77 is amended by adding at the end the following new clause3 7vii7 ,special coverage rules for specified ,,covid-#ai treatment services ,notwithstanding clause 7i71 in the case of a specified ,,covid-#ai treatment service 7as defined in section #ajb7;b7 of the ,medicare ,crisis ,program ,act of #bjbj7 that is furnished during a plan year occurring during any portion of the emergency period defined in section #aace7;g77#a77;,b7 beginning on or after the date of the enactment of this clause1 a ,medicare ,advantage plan may not1 with respect to such service1 impose-- 7,i7 any cost-sharing requirement 7including a deductible1 copayment1 or coinsurance requirement72 and 7,,ii7 any prior authorization or other utilization management requirement4 ,a ,medicare ,advantage plan may not take the application of this clause into account for purposes of a bid amount submitted by such plan under section #ahed7;a77#f74 4 7b7 ,reimbursement of ,medicare ,advantage plans for elimination of cost sharing ,section #ahec of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7 is amended by adding at the end the following new subsection3 7p7 ,additional payment ,to account for cost sharing elimination for ,,covid-#ai treatment services 7#a7 ,in general ,a ,medicare ,advantage plan shall notify the ,secretary of the total dollar amount of cost sharing that1 but for the application of section #aheb7;a77#a77;,b77vii71 would have been required under such plan for specified ,,covid-#ai treatment services 7as defined in section #gjbjb7;b7 of the ,take ,responsibility for ,workers and ,families ,act7 furnished during a plan year described in such section to individuals enrolled in the plan4 ,the ,secretary shall make periodic and timely payments in accordance with this subsection to such plan that1 in the aggregate1 equal such total dollar amount4 7#b7 ,timing of payment ,payments by the ,secretary under this subsection shall be made beginning ,march #a1 #bjba1 for amounts described in such paragraph that would have been required under such plan for specified ,,covid-#ai treatment services furnished during plan year #bjbj4 ,payments by the ,secretary under this subsection for such amounts that would have been so required under such plan for such services furnished during a plan year subsequent to plan year #bjbj shall be made beginning ,march #a of the plan year following such subsequent plan year4 7#c7 ,non-application ,section #ahec7;c77#g7 shall not apply with respect to the application of this subsection4 7#d7 ,appropriation ,there are transferred to the ,centers for ,medicare ,medicaid ,program ,management ,fund1 out of any monies in the ,treasury not otherwise obligated1 such sums as may be necessary to the ,secretary for purposes of making payments under this subsection4 4 7c7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by this section by program instruction or otherwise4 #ajd4 ,guaranteed issue of certain ,medigap policies 7a7 ,guaranteed issue of ,medigap policies to all ,medigap-,eligible ,medicare beneficiaries 7#a7 ,in general ,section #ahhb7s7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77 is amended-- 7,a7 in paragraph 7#b77;,a71 by striking #fe years of age or older and is enrolled for benefits under part ,b and inserting entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b2 7,b7 in paragraph 7#b77;,d71 by striking who is #fe years of age or older as of the date of issuance and2 7,c7 in paragraph 7#c77;,b77ii71 by striking is #fe years of age or older and2 and 7,d7 in paragraph 7#c77;,b77vi71 by striking at age #fe4 7#b7 ,additional enrollment period for certain individuals 7,a7 ,one-time enrollment period 7i7 ,in general ,in the case of a specified individual1 the ,secretary shall establish a one-time enrollment period described in clause 7iii7 during which such an individual may enroll in any medicare supplemental policy of the individual's choosing4 7ii7 ,application ,the provisions of-- 7,i7 paragraph 7#b7 of section #ahhb7s7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77 shall apply with respect to a specified individual who is described in subclause 7,i7 of subparagraph 7,b77iii7 as if references in such paragraph 7#b7 to the #f-month period described in subparagraph 7,a7 of such paragraph were references to the one-time enrollment period established under clause 7i72 and 7,,ii7 paragraph 7#c7 of such section shall apply with respect to a specified individual who is described in subclause 7,,ii7 of subparagraph 7,b77iii7 as if references in such paragraph 7#c7 to the period specified in subparagraph 7,e7 of such paragraph were references to the one-time enrollment period established under clause 7i74 7iii7 ,period ,the enrollment period established under clause 7i7 shall be the #f-month period beginning on ,january #a1 #bjbd4 7,b7 ,specified individual ,for purposes of this paragraph1 the term specified individual means an individual who-- 7i7 is entitled to hospital insurance benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 pursuant to section #bbf7;b7 or section #bbf;,a of such ,act 7#db ,u4,s4,c4 #dbf7;b72 #dbf-a72 7ii7 is enrolled for benefits under part ,b of such ,act 7#db ,u4,s4,c4 #acie;j et seq472 and 7iii7 7,i7 would not1 but for the amendments made by subparagraphs 7,a7 and 7,b7 of paragraph 7#a7 and the provisions of this paragraph 7if such provisions applied to such individual71 be eligible for the guaranteed issue of a medicare supplemental policy under paragraph 7#b7 of section #ahhb7s7 of such ,act 7#db ,u4,s4,c4 #aciess7s772 or 7,,ii7 would not1 but for the amendments made by subparagraphs 7,c7 and 7,d7 of paragraph 7#a7 and the provisions of this paragraph 7if such provisions applied to such individual71 be eligible for the guaranteed issue of a medicare supplemental policy under paragraph 7#c7 of such section4 7,c7 ,outreach plan 7i7 ,in general ,the ,secretary shall develop an outreach plan to notify specified individuals of the one-time enrollment period established under subparagraph 7,a74 7ii7 ,consultation ,in implementing the outreach plan developed under clause 7i71 the ,secretary shall consult with consumer advocates1 brokers1 insurers1 the ,national ,association of ,insurance ,commissioners1 and ,state ,health ,insurance ,assistance ,programs4 7#c7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to medicare supplemental policies effective on or after the date of the enactment of this ,act4 7b7 ,guaranteed issue of ,medigap policies for ,medicare ,advantage enrollees 7#a7 ,in general ,section #ahhb7s77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c771 as amended by subsection 7a71 is further amended-- 7,a7 in subparagraph 7,b71 by adding at the end the following new clause3 7vii7 ,the individual-- 7,i7 was enrolled in a ,medicare ,advantage plan under part ,c for not less than #ab months2 7,,ii7 subsequently disenrolled from such plan2 7,,iii7 elects to receive benefits under this title through the original ,medicare fee-for-service program under parts ,a and ,b2 and 7,,iv7 has not previously elected to receive benefits under this title through the original ,medicare fee-for-service program pursuant to disenrollment from a ,medicare ,advantage plan under part ,c4 2 7,b7 by striking subparagraph 7,c77iii7 and inserting the following3 7iii7 ,subject to subsection 7v77#a71 for purposes of an individual described in clause 7vi7 or 7vii7 of subparagraph 7,b71 a medicare supplemental policy described in this subparagraph shall include any medicare supplemental policy4 2 and 7,c7 in subparagraph 7,e7-- 7i7 in clause 7iv71 by striking and at the end2 7ii7 in clause 7v71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new clause-- 7vi7 in the case of an individual described in subparagraph 7,b77vii71 the annual1 coordinated election period 7as defined in section #ahea7;e77#c77;,b77 or a continuous open enrollment period 7as defined in section #ahea7;e77#b77 during which the individual disenrolls from a ,medicare ,advantage plan under part ,c4 4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to medicare supplemental policies effective on or after the date of the enactment of this ,act4 #aje4 ,requiring coverage under ,medicare ,p,d,ps and ,,ma-,,pd plans1 without the imposition of cost sharing or utilization management requirements1 of drugs intended to treat ,,covid-#ai during certain emergencies 7a7 ,coverage requirement 7#a7 ,in general ,section #ahfj;,d-#d7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;b77#c77 is amended by adding at the end the following new subparagraph3 7,i7 ,required inclusion of drugs intended to treat ,,covid-#ai 7i7 ,in general ,notwithstanding any other provision of law1 a ,,pdp sponsor offering a prescription drug plan shall1 with respect to a plan year1 any portion of which occurs during the period described in clause 7ii71 be required to-- 7,i7 include in any formulary-- 7aa7 all covered part ,d drugs with a medically accepted indication 7as defined in section #ahfj;,d-#b7;e77#d77 to treat ,,covid-#ai that are marketed in the ,united ,states2 and 7bb7 all drugs authorized under section #efd or #efd;,a of the ,federal ,food1 ,drug1 and ,cosmetic ,act to treat ,,covid-#ai2 and 7,,ii7 not impose any prior authorization or other utilization management requirement with respect to such drugs described in item 7aa7 or 7bb7 of subclause 7,i7 7other than such a requirement that limits the quantity of drugs due to safety74 7ii7 ,period described ,for purposes of clause 7i71 the period described in this clause is the period during which there exists the public health emergency declared by the ,secretary pursuant to section #cai of the ,public ,health ,service ,act on ,january #ca1 #bjbj1 entitled ,determination that a ,public ,health ,emergency ,exists ,nationwide as the ,result of the #bjai ,novel ,coronavirus 7including any renewal of such declaration pursuant to such section74 4 7b7 ,elimination of cost sharing 7#a7 ,elimination of cost sharing for drugs intended to treat ,,covid-#ai under standard and alternative prescription drug coverage ,section #ahfj;,d-#b of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7 is amended-- 7,a7 in subsection 7b7-- 7i7 in paragraph 7#a77;,a71 by striking ,the coverage and inserting ,subject to paragraph 7#h71 the coverage2 7ii7 in paragraph 7#b7-- 7,i7 in subparagraph 7,a71 by inserting after ,subject to subparagraphs 7,c7 and 7,d7 the following3 and paragraph 7#h72 7,,ii7 in subparagraph 7,c77i71 by striking paragraph 7#d7 and inserting paragraphs 7#d7 and 7#h72 and 7,,iii7 in subparagraph 7,d77i71 by striking paragraph 7#d7 and inserting paragraphs 7#d7 and 7#h72 7iii7 in paragraph 7#d77;,a77i71 by striking ,the coverage and inserting ,subject to paragraph 7#h71 the coverage2 and 7iv7 by adding at the end the following new paragraph3 7#h7 ,elimination of cost-sharing for drugs intended to treat ,,covid-#ai ,the coverage does not impose any deductible1 copayment1 coinsurance1 or other cost-sharing requirement for drugs described in section #ahfj;,d-#d7;b77#c77;,i77i77,i7 with respect to a plan year1 any portion of which occurs during the period during which there exists the public health emergency declared by the ,secretary pursuant to section #cai of the ,public ,health ,service ,act on ,january #ca1 #bjbj1 entitled ,determination that a ,public ,health ,emergency ,exists ,nationwide as the ,result of the #bjai ,novel ,coronavirus 7including any renewal of such declaration pursuant to such section74 2 and 7,b7 in subsection 7c71 by adding at the end the following new paragraph3 7#d7 ,same elimination of cost-sharing for drugs intended to treat ,,covid-#ai ,the coverage is in accordance with subsection 7b77#h74 4 7#b7 ,elimination of cost sharing for drugs intended to treat ,,covid-#ai dispensed to individuals who are subsidy eligible individuals ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,d7-- 7,i7 in clause 7ii71 by striking ,in the case of and inserting ,subject to subparagraph 7,f71 in the case of2 and 7,,ii7 in clause 7iii71 by striking ,in the case of and inserting ,subject to subparagraph 7,f71 in the case of2 and 7ii7 by adding at the end the following new subparagraph3 7,f7 ,elimination of cost-sharing for drugs intended to treat ,,covid-#ai ,coverage that is in accordance with section #ahfj;,d-#b7;b77#h74 2 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,b71 by striking ,a reduction and inserting ,subject to subparagraph 7,f71 a reduction2 7ii7 in subparagraph 7,d71 by striking ,the substitution and inserting ,subject to subparagraph 7,f71 the substitution2 7iii7 in subparagraph 7,e71 by inserting after ,subject to the following3 subparagraph 7,f7 and2 and 7iv7 by adding at the end the following new subparagraph3 7,f7 ,elimination of cost-sharing for drugs intended to treat ,,covid-#ai ,coverage that is in accordance with section #ahfj;,d-#b7;b77#h74 4 7c7 ,,lis eligibility ,section #ahfj;,d-#ad7;a77#c77;,c77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,c77i77 is amended by inserting and any amounts received from a ,state as unemployment benefits after furnished in kind4 7d7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by this section by program instruction or otherwise4 #ajf4 ,medicare special enrollment period for individuals residing in ,,covid-#ai emergency areas 7a7 ,in general ,section #ahcg7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7i77 is amended by adding at the end the following new paragraph3 7#e7 7,a7 ,in the case of an individual who-- 7i7 is eligible under section #ahcf to enroll in the medical insurance program established by this part2 7ii7 has elected not to enroll 7or to be deemed enrolled7 under such section during an enrollment period2 and 7iii7 during the emergency period 7as described in section #aace7;g77#a77;,b771 is residing in an emergency area 7as described in such section71 there shall be a special enrollment period described in subparagraph 7,b74 7,b7 ,the special enrollment period referred to in subparagraph 7,a7 is1 with respect to an individual residing in a ,state1 the period that begins on the date of the enactment of this paragraph and ends on the date that is #c months after the first day occurring on or after the date of the enactment of this paragraph that the average unemployment rate for the #ab-month period ending on such first day-- 7i7 in such ,state is not more than #b percentage points higher that the average unemployment rate in such ,state during the period consisting of ,october #a through ,december #ca of #bjai2 and 7ii7 in the ,united ,states is not more than #b percentage points higher that the average unemployment rate in the ,united ,states during the period consisting of ,october #a through ,december #ca of #bjai4 4 7b7 ,coverage period for individuals transitioning from other coverage ,section #ahch7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieq7e77 is amended-- 7#a7 by striking pursuant to section #ahcg7;i77#c7 or #ahcg7;i77#d77;,b7-- and inserting the following3 pursuant to-- 7#a7 section #ahcg7;i77#c7 or #ahcg7;i77#d77;,b7-- 2 7#b7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively1 and moving the indentation of each such subparagraph #b ems to the right2 7#c7 by striking the period at the end of the subparagraph 7,b71 as so redesignated1 and inserting 2 or2 and 7#d7 by adding at the end the following new paragraph3 7#b7 section #ahcg7;i77#e71 the coverage period shall begin on the first day of the month following the month in which the individual so enrolls4 4 7c7 ,no increase in premiums ,section #ahci7;b7 of such ,act 7#db ,u4,s4,c4 #acier7b77 is amended in the first sentence1 by inserting 1 7i77#e71 after subsection 7i77#d74 #ajg4 ,special ,medicare rules during the ,,covid-#ai emergency 7a7 ,premiums ,notwithstanding any other provision of law1 the ,secretary shall provide that an individual entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is not required to pay any premium under such part ,a or part ,b 7if any would otherwise be applicable7 for any month occurring during the emergency period described in section #aace7;g77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b774 7b7 ,cost-,sharing requirements ,notwithstanding any other provision of law1 with respect to items and services furnished during a month occurring during the emergency period described in section #aace7;g77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b77 to an individual entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including an individual enrolled under section #ahii;,c of such ,act1 the ,secretary of ,health and ,human ,services shall ensure that the aggregate amount of any cost-sharing requirements 7including any deductibles1 copayments1 or coinsurance7 applicable under such part ,a or part ,b 7or1 in the case of an individual enrolled under part ,c of such title1 under such part ,c if such item or service would have been covered under such part ,a or ,b7 to such individual with respect to such items and services furnished during such month does not exceed #e percent of such individual's income during such month4 ,the ,secretary shall pay to the entity furnishing such item or service the amount of any such requirement that would be payable to such entity but for application of the previous sentence4 #ajh4 ,national clearinghouse for ,,covid-#ai personal protective equipment and other medical supplies 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish a national clearinghouse for ,,covid-#ai personal protective equipment and other medical supplies 7in this section referred to as the clearinghouse7 through which the ,secretary shall provide for the purchase1 in accordance with subsection 7b71 of personal protective equipment and other medical items necessary for the diagnosis or treatment of ,,covid-#ai 7including respirator masks1 ventilators1 gloves1 bodysuits1 safety glasses1 eye protection1 and isolation gowns7 and the distribution of such equipment and items in accordance with subsection 7c74 7b7 ,purchase of equipment and items ,the ,secretary shall provide for the purchase of equipment and items described in subsection 7a7 for the clearinghouse through direct negotiations with entities selling such equipment or items4 ,any such purchase shall be made at a rate not exceeding the amount payable for such equipment or items by the ,secretary of ,veterans ,affairs4 7c7 ,distribution ,the ,secretary shall provide for the distribution of equipment and items purchased for the clearinghouse to health care providers enrolled under section #ahff7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77 based on the demonstrated need of such providers for such equipment and items4 7d7 ,report ,the ,secretary shall submit to ,congressional ,oversight ,commission established under section #djbj of division ,a of the ,,cares ,act and publish on a public website a monthly report on expenditures under this section and distribution of equipment and items made through the clearinghouse4 ,such report shall include a breakdown of the geographic distribution of such equipment and items and a specification of the types of expenditures made under this section4 ,,ii ,medicaid and ,,chip #bja4 ,medicaid coverage at no cost sharing of ,,covid-#ai vaccine and treatment 7a7 ,medicaid 7#a7 ,in general ,section #aije7;a77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#d77 is amended-- 7,a7 by striking and 7,d7 and inserting 7,d72 and 7,b7 by striking the semicolon at the end and inserting 2 7,e7 a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act and the administration of such vaccine2 and 7,f7 specified ,,covid-#ai treatment services 7as defined in section #ajb7;b7 of the ,medicare ,crisis ,program ,act of #bjbj724 7#b7 ,prohibition of cost sharing 7,a7 ,in general ,subsections 7a77#b7 and 7b77#b7 of section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 are each amended-- 7i7 in subparagraph 7,f71 by striking or at the end2 7ii7 in subparagraph 7,g71 by striking 2 and and inserting 1 or2 and 7iii7 by adding at the end the following subparagraphs3 7,h7 a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act and the administration of such vaccine2 or 7,i7 any specified ,,covid-#ai treatment service 7as defined in section #ajb7;b7 of the ,medicare ,crisis ,program ,act of #bjbj72 and 4 7,b7 ,application to alternative cost sharing ,section #aiaf;,a7b77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is amended-- 7i7 in clause 7xi71 by striking any visit and inserting any service2 and 7ii7 by adding at the end the following clauses3 7xii7 ,a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act and the administration of such vaccine4 7xiii7 ,a specified ,,covid-#ai treatment service 7as defined in section #ajb7;b7 of the ,medicare ,crisis ,program ,act of #bjbj74 4 7,c7 ,clarification ,the amendments made by this subsection shall apply with respect to a ,state plan of a territory in the same manner as a ,state plan of one of the #ej ,states4 7b7 ,state pediatric vaccine distribution program ,section #aibh of the ,social ,security ,act 7#db ,u4,s4,c4 #acifs7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,a71 by striking 2 and and inserting a semicolon2 7,b7 in subparagraph 7,b71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following subparagraph3 7,c7 each vaccine-eligible child 7as defined in subsection 7b77 is entitled to receive a ,,covid-#ai vaccine from a program-registered provider 7as defined in subsection 7h77#h77 without charge for-- 7i7 the cost of such vaccine2 or 7ii7 the administration of such vaccine4 2 7#b7 in subsection 7c77#b7-- 7,a7 in subparagraph 7,c77ii71 by inserting 1 but may not impose a fee for the administration of a ,,covid-#ai vaccine before the period2 and 7,b7 by adding at the end the following subparagraph3 7,d7 ,the provider will provide and administer an approved ,,covid-#ai vaccine to a vaccine-eligible child in accordance with the same requirements as apply under the preceding subparagraphs to the provision and administration of a qualified pediatric vaccine to such a child4 2 and 7#c7 in subsection 7d77#a71 in the first sentence1 by inserting 1 including with respect to a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act before the period4 7c7 ,,chip 7#a7 ,in general ,section #bajc7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c771 as amended by section #fjjd7;b77#a7 of the ,families ,first ,coronavirus ,response ,act1 is amended by adding at the end the following paragraph3 7#aa7 ,coverage of ,,covid-#ai vaccines and treatment ,the child health assistance provided to a targeted low-income child shall include coverage of-- 7,a7 any ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act and the administration of such vaccine2 and 7,b7 a specified ,,covid-#ai treatment service 7as defined in section #ajb7;b7 of the ,medicare ,crisis ,program ,act of #bjbj74 4 7#b7 ,prohibition of cost sharing ,section #bajc7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7e77#b771 as amended by section #fjjd7;b77#c7 of the ,families ,first ,coronavirus ,response ,act1 is amended-- 7,a7 in the paragraph header1 by inserting a ,,covid-#ai vaccine1 ,,covid-#ai treatment1 before or pregnancy-related assistance2 and 7,b7 by striking visits described in section #aiaf7;a77#b77;,g71 or and inserting services described in section #aiaf7;a77#b77;,g71 vaccines described in section #aiaf7;a77#b77;,h71 items or services described in section #aiaf7;a77#b77;,i71 or4 7d7 ,conforming amendments ,section #aicg of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7 is amended-- 7#a7 in subsection 7a77#a77;,b71 by inserting 1 under subclause 7,,xxiii7 of section #aijb7;a77#aj77;,a77ii71 after section #aijb7;a77#aj77;,a77i72 and 7#b7 in subsection 7b77#e71 by adding before the period the following3 1 and1 effective on the date of the enactment of the ,medicare ,crisis ,program ,act of #bjbj1 must comply with subparagraphs 7,f7 through 7,i7 of subsections 7a77#b7 and 7b77#b7 of sections #aiaf and #aiaf;,a4 7e7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act and shall apply with respect to a ,,covid-#ai vaccine beginning on the date that such vaccine is licensed under section #cea of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb74 #bjb4 ,increasing the temporary increase of ,medicaid ,,fmap during the ,,covid-#ai emergency 7a7 ,in general ,section #fjjh7;a7 of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg7 is amended by striking #f4b and inserting #ac4 7b7 ,extension of period of applicability ,section #fjjh of such ,act is amended-- 7#a7 in subsection 7a71 by striking such emergency period and inserting the specified period 7as defined in subsection 7d772 7#b7 in subsection 7b77#c7-- 7,a7 by striking the emergency period and inserting the specified period 7as defined in subsection 7d772 and 7,b7 by striking such emergency period and inserting such specified period2 and 7#c7 by adding at the end the following new subsection3 7d7 ,specified period ,in this section1 the term specified period means1 with respect to a ,state1 including the ,district of ,columbia1 ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 ,puerto ,rico1 and the ,united ,states ,virgin ,islands1 the period beginning on the first day of the emergency period described in subsection 7a7 and ending on the date that is #c months after the first day occurring on or after the date of the enactment of this section that the average unemployment rate for the #ab-month period ending on such first day-- 7#a7 in such ,state is not more than #b percentage points higher that the average unemployment rate in such ,state during the period consisting of ,october #a through ,december #ca of #bjai2 and 7#b7 in the ,united ,states is not more than #b percentage points higher that the average unemployment rate in the ,united ,states during the period consisting of ,october #a through ,december #ca of #bjai4 4 #bjc4 ,increasing ,federal support to ,state ,medicaid programs during economic downturns 7a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7b71 by striking and 7ff7 and inserting 7ff71 and 7gg72 and 7#b7 by adding at the end the following new subsection3 7gg7 ,increased ,,fmap during economic downturns 7#a7 ,in general ,notwithstanding subsection 7b71 7y71 or 7z77#b71 if a fiscal quarter that begins on or after ,january #a1 #bjbj1 is an economic downturn quarter 7as defined in paragraph 7#b77 with respect to a ,state1 then the ,federal medical assistance percentage applicable to amounts expended by the ,state for medical assistance for services furnished during such quarter shall be increased in accordance with paragraphs 7#c7 and 7#d74 7#b7 ,economic downturn quarter 7,a7 ,in general 7i7 ,in general ,in this subsection1 the term economic downturn quarter means1 with respect to a ,state1 a fiscal quarter during which the ,state's unemployment rate for the quarter exceeds the percentage determined for the ,state and quarter under clause 7ii74 7ii7 ,threshold percentage ,the percentage determined under this clause for a ,state and fiscal quarter is the percentage equal to the lower of-- 7,i7 the ,state unemployment rate at the #bjth percentile of the distribution of the ,state's quarterly unemployment rates for the #fj-quarter period preceding the quarter involved1 increased by #a percentage point2 and 7,,ii7 the ,state's average quarterly unemployment rate for the #ab-quarter period preceding the quarter involved1 increased by #a percentage point4 7,b7 ,unemployment data 7i7 ,in general ,except as provided in clause 7ii71 for purposes of determining unemployment rates for a ,state and a quarter under this paragraph1 the ,secretary shall use data from the ,local ,area ,unemployment ,statistics from the ,bureau of ,labor ,statistics4 7ii7 ,application to certain territories ,in the case of the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa1 the ,secretary shall use data from the ,u-#f unemployment measure of the ,bureau of ,labor ,statistics to make any necessary determinations under subparagraph 7,a74 7#c7 ,,fmap increase during economic downturn quarter 7,a7 ,in general ,during a fiscal quarter that is an economic downturn quarter with respect to a ,state1 the ,federal medical assistance percentage otherwise determined for the ,state and quarter under subsection 7b7 and1 if applicable1 the ,federal medical assistance percentage applicable under subsection 7y71 7z77#b71 or 7ff7 with respect to medical assistance furnished by the ,state during such quarter to individuals described in either such subsection shall be increased by the number of percentage points 7rounded to the nearest tenth of a percentage point7 equal to the product of-- 7i7 the number of percentage points 7rounded to the nearest tenth of a percentage point7 by which the unemployment rate for the ,state and quarter exceeds the percentage determined for the ,state and quarter under paragraph 7#b77;,a77ii72 and 7ii7 #d4h4 7,b7 ,application of ,,covid-#ai ,,fmap increase ,any increase applicable to the ,federal medical assistance percentage of a ,state for a fiscal quarter under subparagraph 7,a7 shall be in addition to any increase to such percentage for such quarter made pursuant to section #fjjh7;a7 of the ,families ,first ,coronavirus ,response ,act4 7,c7 ,limitation ,in no case shall an increase to the ,federal medical assistance percentage of a ,state under this paragraph result in a ,federal medical assistance percentage that exceeds #ie percent4 7,d7 ,scope of application ,any increase to the ,federal medical assistance percentage of a ,state for a fiscal quarter under this paragraph shall only apply with respect to payments for amounts expended by the ,state for medical assistance for services furnished during such quarter and shall not apply with respect to-- 7i7 disproportionate share hospital payments described in section #aibc2 7ii7 payments under title ,,iv or ,,xxi2 7iii7 any payments under this title that are based on the enhanced ,,fmap described in section #baje7;b72 or 7iv7 any payments under this title that are based on a ,federal medical assistance percentage determined for a ,state under subsection 7aa7 7but only to the extent that such ,federal medical assistance percentage is higher than the economic recovery ,,fmap74 7#d7 ,advance payment2 retrospective adjustment 7,a7 ,in general ,prior to the beginning of each fiscal quarter that begins on or after ,july #a1 #bjbj1 the ,secretary shall1 with respect to each ,state-- 7i7 determine the increase 7if any7 that is expected to apply to the ,federal medical assistance percentage of such ,state for such quarter under this subsection based on the projections made for the ,state and quarter under subparagraph 7,b72 and 7ii7 shall apply such increase to the ,federal medical assistance percentage of the ,state for purposes of making payments to the ,state for amounts expended during such quarter as medical assistance under the ,state plan4 7,b7 ,projection of ,state unemployment rates ,prior to the beginning of each fiscal quarter that begins on or after ,july #a1 #bjbj1 the ,secretary1 acting through the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services1 shall1 using the most recently available data described in paragraph 7#b77;,b71 make projections with respect to-- 7i7 the unemployment rates for each ,state for such quarter2 7ii7 the threshold percentages described in paragraph 7#b77;,a77ii7 for each ,state for such quarter2 and 7iii7 the national unemployment rate for such quarter4 7,c7 ,retrospective adjustment ,as soon as practicable after final unemployment data becomes available for a fiscal quarter that begins on or after ,july #a1 #bjbj1 the ,secretary shall1 with respect to each ,state-- 7i7 make a final determination of the increase 7if any7 applicable to the ,federal medical assistance percentage of the ,state for the quarter under this subsection2 and 7ii7 in accordance with subsection 7d77#b7 of section #aijc1 reduce or increase the amount payable to the ,state under subsection 7a7 of such section for a subsequent fiscal quarter to the extent of any overpayment or underpayment which the ,secretary determines was made as a result of a miscalculation of the increase applicable to the ,federal medical assistance percentage of the ,state for such prior fiscal quarter under this subsection4 7#e7 ,retrospective application of over-the-limit ,,fmap increases 7,a7 ,in general ,if a ,state has excess percentage points with respect to an economic downturn quarter and an applicable ,,fmap 7as determined under subparagraph 7,b771 the ,state may elect to apply such excess percentage points to increase such applicable ,,fmap for one or more quarters during the look-back period for the ,state and economic downturn quarter in accordance with this paragraph4 7,b7 ,excess percentage points ,for purposes of this paragraph1 the number of excess percentage points for a ,state1 economic downturn quarter1 and an applicable ,,fmap shall be equal to the number of percentage points by which-- 7i7 the applicable ,,fmap for the ,state and quarter 7after application of paragraph 7#c7 but without regard to subparagraph 7,c7 of such paragraph72 exceeds 7ii7 #ie percent4 7,c7 ,effect of application of excess percentage points ,if a ,state elects to apply excess percentage points to an applicable ,,fmap to a quarter during a look-back period under this paragraph1 the ,secretary shall determine the additional amount of payment under section #aijc7;a7 to which the ,state would have been entitled for such quarter if the applicable ,,fmap 7as so increased7 had been in effect for such quarter1 and shall treat such additional amount as an underpayment for such quarter4 7,d7 ,distribution of excess percentage points ,a ,state that has excess percentage points with respect to an economic downturn quarter and applicable ,,fmap may elect to divide such points among more than #a quarter during the look-back period for such ,state and quarter provided that no excess percentage point 7or fraction of an excess percentage point7 is applied to the applicable ,,fmap of more than #a quarter4 7,e7 ,limitations 7i7 ,no increases over #ajj percent ,a ,state may not increase an applicable ,,fmap for any quarter during a look-back period under this paragraph if such increase would result in the applicable ,,fmap for such quarter exceeding #ajj percent4 7ii7 ,scope of application ,any increase to an applicable ,,fmap of a ,state for a fiscal quarter under this paragraph-- 7,i7 shall only apply with respect to payments for amounts expended by the ,state for medical assistance for services furnished during such quarter to which such applicable ,,fmap is applicable2 and 7,,ii7 shall not apply with respect to payments described in paragraph 7#c77;,d74 7,f7 ,definitions ,in this paragraph3 7i7 ,applicable ,,fmap ,the term applicable ,,fmap means1 with respect to a ,state and fiscal quarter-- 7,i7 the ,federal medical assistance percentage determined for the ,state and quarter under subsection 7b72 7,,ii7 the ,federal medical assistance percentage applicable under subsection 7y72 7,,iii7 the ,federal medical assistance percentage applicable under subsection 7z77#b72 or 7,,iv7 the ,federal medical assistance percentage determined for the ,state and quarter under subsection 7ff74 7ii7 ,look-back period ,the term look-back period means1 with respect to a ,state and a fiscal quarter that is an economic downturn quarter for the ,state1 the period of #d fiscal quarters that ends with the fourth quarter which precedes the most recent fiscal quarters that was not an economic downturn quarter for the ,state4 7#f7 ,requirement for all ,states ,a ,state may not receive an increase in the ,federal medical assistance percentage for such ,state under this subsection1 with respect to a fiscal quarter1 if-- 7,a7 eligibility standards1 methodologies1 or procedures under the ,state plan or a waiver of such plan are more restrictive during such quarter than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 as in effect on the last day of the most recent fiscal quarter that was not an economic downturn quarter for the ,state2 7,b7 the amount of any premium imposed by the ,state pursuant to section #aiaf or #aiaf;,a during such quarter1 with respect to an individual enrolled under such plan 7or waiver71 exceeds the amount of such premium as of the date described in subparagraph 7,a72 or 7,c7 the ,state fails to provide that an individual who is enrolled for benefits under such plan 7or waiver7 as of the date described in subparagraph 7,a7 or enrolls for benefits under such plan 7or waiver7 during the period beginning with such date and ending with the day before the first day of the next quarter that is not an economic downturn quarter for the ,state shall be treated as eligible for such benefits for not less than #ab months 7or1 if such period is less than #ab months1 throughout such period7 unless the individual requests a voluntary termination of eligibility or the individual ceases to be a resident of the ,state4 4 7b7 ,exclusion of economic downturn ,,fmap increases from territorial caps ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is amended-- 7#a7 in subsection 7f71 in the matter preceding paragraph 7#a71 by striking subsection 7g7 and section #aice7;e77#a77;,b7 and inserting subsections 7g7 and 7h7 and section #aice7;e77#a77;,b72 and 7#b7 by adding at the end the following3 7h7 ,exclusion from caps of amounts attributable to economic downturn ,,fmap ,the portion of any payment made to a territory for a fiscal year that is attributable to an increase in the ,federal medical assistance percentage for a fiscal quarter during such year under section #aije7;gg7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g74 4 #bjd4 #ajj percent ,,fmap for individuals enrolling under ,medicaid during the ,,covid-#ai emergency 7a7 ,in general ,notwithstanding any other provision of law1 the ,federal medical assistance percentage otherwise determined under section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 with respect to medical assistance furnished during a specified period to a specified individual under a ,state plan 7or waiver of such plan7 under title ,,xix of such ,act shall be #ajj percent4 7b7 ,definitions ,in this section3 7#a7 ,specified individual ,the term specified individual means an individual who enrolls under the ,state plan 7or waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 during the emergency period described in section #aace7;g77#a77;,b7 of such ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b774 7#b7 ,specified period ,the term specified period means1 with respect to a ,state1 including the ,district of ,columbia1 ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 ,puerto ,rico1 and the ,united ,states ,virgin ,islands1 the period beginning on the first day of the emergency period described in subsection 7a7 and ending on the date that is #c months after the first day occurring on or after the date of the enactment of this section that the average unemployment rate for the #ab-month period ending on such first day-- 7,a7 in such ,state is not more than #b percentage points higher that the average unemployment rate in such ,state during the period consisting of ,october #a through ,december #ca of #bjai2 and 7,b7 in the ,united ,states is not more than #b percentage points higher that the average unemployment rate in the ,united ,states during the period consisting of ,october #a through ,december #ca of #bjai4 #bje4 ,mandatory approval of waivers to cover certain individuals under ,medicaid during the ,,covid-#ai emergency ,section #aaae7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7;d77 is amended by adding at the end the following new paragraph3 7#d7 ,notwithstanding any other provision of this section1 the ,secretary shall approve an application for a demonstration project under this section to the extent that such project allows an individual whose income 7as determined under section #aijb7;e77#ad77 does not exceed #cjj percent of the poverty line 7as defined in section #baaj7;c77#e77 applicable to a family of the size involved1 to enroll under the ,state plan 7or waiver of such plan7 under title ,,xix of the ,state submitting such application4 4 ,,iii ,miscellaneous #cja4 ,group health plan and health insurance issuer coverage of ,,covid-#ai related treatment at no cost sharing 7a7 ,in general ,a group health plan and a health insurance issuer offering group or individual health insurance coverage 7including a grandfathered health plan 7as defined in section #abea7;e7 of the ,patient ,protection and ,affordable ,care ,act77 shall provide coverage1 and shall not impose any cost sharing 7including deductibles1 copayments1 and coinsurance7 requirements1 for specified ,,covid-#ai treatment services 7as defined in section #ajb7;b77 furnished during any portion of the emergency period defined in paragraph 7#a77;,b7 of section #aace7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77 beginning on or after the date of the enactment of this ,act4 7b7 ,reimbursement to plans and coverage for waiving cost sharing 7#a7 ,in general ,a group health plan or a health insurance issuer offering group or individual health insurance coverage 7including a grandfathered health plan 7as defined in section #abea7;e7 of the ,patient ,protection and ,affordable ,care ,act77 that does not impose cost sharing requirements as described in subsection 7a7 shall notify the ,secretary of ,health and ,human ,services1 ,secretary of ,labor1 and ,secretary of the ,treasury 7through a joint process established jointly by the ,secretaries7 of the total dollar amount of cost sharing that1 but for the application of subsection 7a71 would have been required under such plans and coverage for items and services related to ,,covid-#ai furnished during the period to which subsection 7a7 applies to enrollees1 participants1 and beneficiaries in the plan or coverage to whom such subsection applies1 but which was not imposed for such items and services so furnished pursuant to such subsection and the ,secretary of ,health and ,human ,services1 in coordination with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall make payments in accordance with this subsection to the plan or issuer equal to such total dollar amount4 7#b7 ,methodology for payments ,the ,secretary of ,health and ,human ,services1 in coordination with the ,secretary of ,labor and the ,secretary of the ,treasury shall establish a payment system for making payments under this subsection4 ,any such system shall make payment for the value of cost sharing not imposed by the plan or issuer involved4 7#c7 ,timing of payments ,payments made under paragraph 7#a7 shall be made no later than ,may #a1 #bjba1 for amounts of cost sharing waivers with respect to #bjbj4 ,payments under this subsection with respect to such waivers with respect to a year subsequent to #bjbj that begins during the period to which subsection 7a7 applies shall be made no later than ,may of the year following such subsequent year4 7#d7 ,appropriations ,there is authorized to be appropriated1 and there is appropriated1 out of any monies in the ,treasury not otherwise appropriated1 such funds as are necessary to carry out this subsection4 7c7 ,enforcement 7#a7 ,application with respect to ,,phsa1 ,,erisa1 and ,,irc ,the provisions of this section shall be applied by the ,secretary of ,health and ,human ,services1 ,secretary of ,labor1 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 ,act1 part #g of the ,employee ,retirement ,income ,security ,act of #aigd1 and subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf1 as applicable4 7#b7 ,private right of action ,an individual with respect to whom an action is taken by a group health plan or health insurance issuer offering group or individual health insurance coverage in violation of subsection 7a7 may commence a civil action against the plan or issuer for appropriate relief4 ,the previous sentence shall not be construed as limiting any enforcement mechanism otherwise applicable pursuant to paragraph 7#a74 7d7 ,implementation ,the ,secretary of ,health and ,human ,services1 ,secretary of ,labor1 and ,secretary of the ,treasury may implement the provisions of this section through sub-regulatory guidance1 program instruction1 or otherwise4 7e7 ,terms ,in this section1 the terms group health plan1 health insurance issuer1 group health insurance coverage1 and individual health insurance coverage have the meanings given such terms in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia71 section #gcc of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaia;b71 and section #ihcb of the ,internal ,revenue ,code of #aihf1 as applicable4 #cjb4 ,payment for specified ,,covid-#ai treatment services furnished to the uninsured 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall pay to a health care provider that furnishes a specified ,,covid-#ai treatment service 7as defined in section #ajb7 to an uninsured individual 7as defined in subsection 7b77 an amount equal to the amount that would have been payable 7including any cost-sharing requirement7 under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 had such service been furnished to an individual entitled to benefits under part ,a and enrolled under part ,b of such title4 7b7 ,uninsured individual ,for purposes of this section1 the term uninsured individual means an individual who-- 7#a7 is not enrolled in a group health plan or in group or individual health insurance coverage 7as defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia772 and 7#b7 is not enrolled in a ,federal health care program 7as defined in section #aabh;,b7f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777 or under the program established under chapter #hi of title #e1 ,united ,states ,code4 7c7 ,holding uninsured individual harmless for specified ,,covid-#ai treatment services 7#a7 ,in general ,a health care provider receiving payment under subsection 7a7 for a specified ,,covid-#ai treatment service furnished to an individual may not hold such individual liable for any amount for such service4 7#b7 ,enforcement ,a health care provider who violates subsection 7a7 shall be subject to a civil monetary penalty determined appropriate by the ,secretary of ,health and ,human ,services4 ,the provision of section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7 7other than subsections 7a7 and 7b77 shall apply with respect to a civil monetary penalty imposed under the previous sentence in the same manner as such provisions apply with respect to a penalty or proceeding under subsection 7a7 of such section4