Sec. 2. Requiring the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs
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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: 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 diagnoses obtained through a telehealth encounter, and in the case of a qualified diagnosis (as defined in clause (ii)) made with respect to such individual by a qualified provider (as so defined), shall not require the use of video communications with respect to such telehealth encounter.
For purposes of this subparagraph: 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. 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— furnished an item or service to such individual during the 3-year period ending on the date such diagnosis was so made; or 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. .
Section 1894(d)(2) of the Social Security Act ( 42 U.S.C. 1395eee(d)(2) ) is amended by adding at the end the following new sentence: For purposes of applying the adjustment under subparagraph (C)(i) of section 1853(a)(1) to such amounts, subparagraph
(J)of such section shall be applied as if each reference to . plan year and plan years 2020 and 2021 were instead a reference to year and 2020 and 2021 , respectively.
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- 42 USC 1395w–23(a)(1)
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Sec. 2
Requiring the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs
Cite42 USC 1395w–23(a)(1)
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