Sec. 9811. MANDATORY COVERAGE OF COVID-19 VACCINES AND ADMINISTRATION AND TREATMENT UNDER MEDICAID

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## SEC. 9811 MANDATORY COVERAGE OF COVID-19 VACCINES AND ADMINISTRATION AND TREATMENT UNDER MEDICAID ###

(a)Coverage ####

(1)In general Section 1905(a)(4) of the Social Security Act (42 U.S.C. 1396d(a)(4)) is amended by striking the semicolon at the end and inserting “; and

(E)during the period beginning on the date of the enactment of the American Rescue Plan Act of 2021 and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B), a COVID-19 vaccine and administration of the vaccine; and

(F)during the period beginning on the date of the enactment of the American Rescue Plan Act of 2021 and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B), testing and treatments for COVID-19, including specialized equipment and therapies (including preventive therapies), and, without regard to the requirements of section 1902(a)(10)(B) (relating to comparability), in the case of an individual who is diagnosed with or presumed to have COVID-19, during the period such individual has (or is presumed to have) COVID-19, the treatment of a condition that may seriously complicate the treatment of COVID-19, if otherwise covered under the State plan (or waiver of such plan);”. ####

(2)Making covid-19 vaccine available to additional eligibility groups and treatment available to certain uninsured Section 1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following subparagraph (G)— #####

(A)by striking “and to other conditions which may complicate pregnancy, (VIII)” and inserting “, medical assistance for services related to other conditions which may complicate pregnancy, and medical assistance for vaccines described in section 1905(a)(4)(E) and the administration of such vaccines during the period described in such section, (VIII)”; #####

(B)by inserting “and medical assistance for vaccines described in section 1905(a)(4)(E) and the administration of such vaccines during the period described in such section” after “(described in subsection (z)(2))”; #####

(C)by inserting “and medical assistance for vaccines described in section 1905(a)(4)(E) and the administration of such vaccines during the period described in such section” after “described in subsection (k)(1)”; #####

(D)by inserting “and medical assistance for vaccines described in section 1905(a)(4)(E) and the administration 135 STAT. 209 of such vaccines during the period described in such section” after “family planning setting”; #####

(E)by striking “and any visit described in section 1916(a)(2)(G) that is furnished during any such portion” and inserting “, any service described in section 1916(a)(2)(G) that is furnished during any such portion, any vaccine described in section 1905(a)(4)(E) (and the administration of such vaccine) that is furnished during any such portion, and testing and treatments for COVID-19, including specialized equipment and therapies (including preventive therapies), and, in the case of an individual who is diagnosed with or presumed to have COVID-19, during the period such individual has (or is presumed to have) COVID-19, the treatment of a condition that may seriously complicate the treatment of COVID-19, if otherwise covered under the State plan (or waiver of such plan)”; and #####

(F)by striking the semicolon at the end and inserting “, and

(XIX)medical assistance shall be made available during the period described in section 1905(a)(4)(E) for vaccines described in such section and the administration of such vaccines, for any individual who is eligible for and receiving medical assistance under the State plan or under a waiver of such plan (other than an individual who is eligible for medical assistance consisting only of payment of premiums pursuant to subparagraph

(E)or

(F)or section 1933), notwithstanding any provision of this title or waiver under section 1115 impacting such individual’s eligibility for medical assistance under such plan or waiver to coverage for a limited type of benefits and services that would not otherwise include coverage of a COVID-19 vaccine and its administration;”. ####

(3)Prohibition of cost sharing #####

(A)In general Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended— ######

(i)in subparagraph (F), by striking “or” at the end; ######

(ii)in subparagraph (G), by striking “; and”; and ######

(iii)by adding at the end the following subparagraphs: > > ##### “(H) > > during the period beginning on the date of the enactment of this subparagraph and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B), a COVID-19 vaccine and the administration of such vaccine (for any individual eligible for medical assistance for such vaccine (and administration)); or > > > ##### “(I) > > during the period beginning on the date of the enactment of this subparagraph and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B), testing and treatments for COVID-19, including specialized equipment and therapies (including preventive therapies), and, in the case of an individual who is diagnosed with or presumed to have COVID-19, during the period during which such individual has (or is presumed to have) COVID-19, the treatment of a condition that may seriously complicate the treatment of COVID-19, if otherwise covered under the State plan (or waiver of such plan); and” > . #####

(B)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— ######

(i)in clause (xi), by striking “any visit” and inserting “any service”; and ######

(ii)by adding at the end the following clauses: > > ###### “(xii) > > During the period beginning on the date of the enactment of this clause and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B), a COVID-19 vaccine and the administration of such vaccine (for any individual eligible for medical assistance for such vaccine (and administration)). > > > ###### “(xiii) > > During the period beginning on the date of the enactment of this clause and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B), testing and treatments for COVID-19, including specialized equipment and therapies (including preventive therapies), and, in the case of an individual who is diagnosed with or presumed to have COVID-19, during the period during which such individual has (or is presumed to have) COVID-19, the treatment of a condition that may seriously complicate the treatment of COVID-19, if otherwise covered under the State plan (or waiver of such plan).” > . ####

(4)Inclusion in the medicaid drug rebate program of covered outpatient drugs used for covid-19 treatment #####

(A)In general **[**[42 U.S.C. 1396r-8 note](/us/usc/t42/s1396r-8)**]** The requirements of section 1927 of the Social Security Act (42 U.S.C. 1396r-8) shall apply to any drug or biological product to which subparagraph

(F)of section 1905(a)(4) of such Act, as added by paragraph (1), applies or to which the subclause (XVIII) in the matter following subparagraph

(G)of section 1902(a)(10) of such Act, as added by paragraph (2), applies that is— ######

(i)furnished as medical assistance in accordance with section 1902(a)(10)(A) of such Act and such subparagraph

(F)or subclause (XVIII) and section 1902(a)(10)(A) of such Act, as applicable, for the treatment, or prevention, of COVID-19, as described in such subparagraph or subclause, respectively; and ######

(ii)a covered outpatient drug (as defined in section 1927(k) of such Act, except that, in applying paragraph (2)(A) of such section to a drug to which such subparagraph

(F)or such subclause (XVIII) applies, such drug shall be deemed a prescribed drug for purposes of section 1905(a)(12) of such Act). #####

(B)Conforming amendment Section 1927(d)(7) of the Social Security Act (42 U.S.C. 1396r-8(d)(7)) is amended by adding at the end the following new subparagraph: > > ##### “(E) > > Drugs and biological products to which section 1905(a)(4)(F) and subclause (XVIII) in the matter following subparagraph

(G)of section 1902(a)(10) apply that are furnished as medical assistance in accordance with such section or clause, respectively, for the treatment or prevention, of COVID-19, as described in such subparagraph or subclause, respectively, and section 1902(a)(10)(A).” > . ####

(5)Alternative benefit plans Section 1937(b) of the Social Security Act (42 U.S.C. 1396u-7(b)) is amended by adding at the end the following new paragraph: > > #### “(8) COVID-19 vaccines, testing, and treatment > > Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless, during the period beginning on the date of the enactment of the American Rescue Plan Act of 2021 and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B), such coverage includes (and does not impose any deduction, cost sharing, or similar charge for)— > > > ##### “(A) > > COVID-19 vaccines and administration of the vaccines; and > > > ##### “(B) > > testing and treatments for COVID-19, including specialized equipment and therapies (including preventive therapies), and, in the case of such an individual who is diagnosed with or presumed to have COVID-19, during the period such individual has (or is presumed to have) COVID-19, the treatment of a condition that may seriously complicate the treatment of COVID-19, if otherwise covered under the State plan (or waiver of such plan).” > . ###

(b)Temporary Increase in Federal Payments for Coverage and Administration of COVID-19 Vaccines Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— ####

(1)in subsection (b), by striking “and (ff)” and inserting “(ff), and (hh)”; ####

(2)in subsection (ff), in the matter preceding paragraph (1), by inserting “, subject to subsection (hh)” after “or (z)(2)” and ####

(3)by adding at the end the following new subsection: > > ### “(hh) Temporary Increased FMAP for Medical Assistance for Coverage and Administration of COVID-19 Vaccines > > > #### “(1) In general > > Notwithstanding any other provision of this title, during the period described in paragraph (2), the Federal medical assistance percentage for a State, with respect to amounts expended by the State for medical assistance for a vaccine described in subsection (a)(4)(E) (and the administration of such a vaccine), shall be equal to 100 percent. > > > #### “(2) Period described > > The period described in this paragraph is the period that— > > > ##### “(A) > > begins on the first day of the first quarter beginning after the date of the enactment of this subsection; and > > > ##### “(B) > > ends on the last day of the first quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B). > > > #### “(3) Exclusion of expenditures from territorial caps > > Any payment made to a territory for expenditures for medical assistance under subsection (a)(4)(E) that are subject to the Federal medical assistance percentage specified under paragraph

(1)shall not be taken into account for purposes of applying payment limits under subsections

(f)and

(g)of section 1108.” > .

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