Introduction The Coronavirus Aid, Relief, and Economic Security (CARES) Act ( P.L. 116-136 ) was passed by Congress and signed into law by President Donald Trump on March 27, 2020. The CARES Act provides over $2 trillion in relief to individuals; businesses; state, local, and federal agencies; and industry sectors impacted by the COVID-19 pandemic and the government-led effort to limit its public health impact. Given the scope of the relief provided, the variety of new and existing programs that are to provide this aid, and the number of individuals and entities receiving aid, the administration of the CARES Act is likely to be a complicated and significant undertaking by executive branch agencies and non-federal partners. These complexities may be made even greater by both pressure to provide relief as swiftly as possible and unique logistical challenges posed by the ongoing public health emergency. All of those factors make Congress's oversight role during the COVID-19 pandemic especially important and may make it more difficult for Congress to conduct timely oversight. Congress included a variety of oversight mechanisms in the CARES Act. In addition to requiring executive branch officers to submit reports on a variety of topics, provide notice before taking specified actions, and testify before certain committees, the CARES Act provides additional resources to the Government Accountability Office (GAO) and to Offices of Inspectors General (OIGs) that may have additional audit and investigative activity due to the CARES Act. In addition, the CARES Act creates three new oversight entities: a Congressional Oversight Commission, a Special Inspector General for Pandemic Recovery (SIGPR), and the Pandemic Recovery Accountability Committee (PRAC, a group of inspectors general). Each of those entities is empowered to provide oversight of significant aspects of the CARES Act. This report is a reference guide for congressional clients interested in understanding the congressional oversight tools built into the CARES Act. Oversight provisions are broadly organized into sections related to the nature of the oversight mechanism. Within each of these sections, agencies and entities are listed in alphabetical order. To the extent practicable, sections include citations to the CARES Act and to any other relevant laws and regulations. Scope of the Report This report identifies selected provisions in the CARES Act that may facilitate Congress's ability to provide oversight of its implementation. Congress's authority to oversee the executive branch extends beyond these explicit requirements and includes many additional tools and requirements. The fact that many provisions of the CARES Act do not have explicit reporting requirements or other more formal oversight mechanisms does not prevent Congress from engaging in oversight activities related to those programs by seeking information from the executive branch, engaging with stakeholders, holding hearings, and using legislation to direct activities with specificity. Requirements on agencies and entities are usually described in this report generally, with minimal discussion of detailed content requirements. The same is true for descriptions of new and altered programs. To the extent practicable, the text and footnotes of the report provide citations to the appropriate provisions of both the CARES Act and existing law to facilitate a more detailed review. The report captures those oversight tools that pertain to inspectors general (who already have obligations to report to Congress in the Inspector General Act of 1978 ) and provisions that explicitly provide for congressional involvement. For instance, the CARES Act requires certain agencies to make information publicly available but does not explicitly direct that this information be submitted to Congress or its committees. Such provisions are not identified in this report but may nevertheless be referred to in practice as congressional reporting requirements. Provisions included in the CARES Act may trigger reporting of information under other statutes. Interactions between the CARES Act and current law are not covered in this report. Oversight Provisions The CARES Act contains a number of oversight provisions. These include: the creation of a congressionally appointed oversight commission established in the legislative branch; provisions related to inspectors general, including the establishment of SIGPR, the PRAC within the Council of the Inspectors General on Integrity and Efficiency (CIGIE), and supplemental appropriations and additional duties provided for inspectors general across multiple agencies; additional funding and responsibilities provided to GAO; and requirements for agencies and entities and their leadership to provide reports to, consult with, provide notice to, and testify before Congress and its committees regarding a range of subjects. Each aforementioned category is discussed in greater detail below. Congressional Oversight Commission Section 4020 establishes a legislative branch entity called the Congressional Oversight Commission to conduct oversight of the Department of the Treasury and Federal Reserve Board's economic relief activities under Title IV, Subtitle A (Coronavirus Economic Stabilization Act of 2020) of the CARES Act. The commission is similar in structure to the Congressional Oversight Panel created to participate in the oversight of the Troubled Asset Relief Program in 2008. The commission is composed of five members selected by the majority and minority leadership of the House and the Senate. The commission is empowered to request staff to be detailed from agencies and departments, hire experts and consultants, conduct hearings, and obtain information from agencies to support its oversight activities. The commission is required to report to Congress on the relevant activities of Treasury and the Federal Reserve Board, the impact of the programs on the financial well-being of the nation, whether required disclosures in the CARES Act provides market transparency, and the effectiveness of the Coronavirus Economic Stabilization Act of 2020 in minimizing costs and maximizing benefits for taxpayers. The first report of the commission is due within 30 days of Treasury and the Federal Reserve Board's first exercise of authority under the act. Additional reports are then due every 30 days thereafter. The commission terminates on September 30, 2025. Provisions Pertaining to Inspectors General20 Special Inspector General for Pandemic Recovery Section 4018 establishes a Special Inspector General for Pandemic Recovery within the Treasury. The SIGPR is nominated by the President with the advice and consent of the Senate and may be removed from office according to Section 3(b) of the Inspector General Act of 1978. The SIGPR is tasked with conducting audits and investigations of the activities of the Treasury pursuant to the CARES Act, including the collection of detailed information regarding loans provided by Treasury. The SIGPR is empowered to hire staff and enter into contracts and has broadly the same authority and status as inspectors general under the Inspector General Act of 1978. The SIGPR is required to report to the "appropriate committees of Congress" within 60 days of Senate confirmation, and quarterly thereafter, on the activities of the office over the preceding three months, including detailed information on Treasury loan programs. The SIGPR terminates five years after the enactment of the CARES Act (i.e., March 27, 2025). Section 4027 appropriates a total of $500 billion to Treasury. Of that amount, Section 4018 directs that $25 million shall be made available to the SIGPR as no-year funds (i.e., funds that are available until expended). Pandemic Response Accountability Committee Section 15010 establishes the PRAC within the CIGIE. The PRAC is directed to "promote transparency and conduct and support oversight" of the government's coronavirus response in order to "prevent and detect fraud, waste, abuse, and mismanagement" and "mitigate major risks that cut across program and agency boundaries." In addition, the PRAC is tasked with conducting oversight and audits of the coronavirus response as well as coordinating and supporting related oversight by inspectors general across the federal government. The PRAC is composed of the inspectors general of identified agencies as well as any other inspectors general for agencies involved at the coronavirus response as designated by the chairperson of the council. The CIGIE chairperson designates the PRAC chairperson. In addition, the PRAC is required to appoint an executive director selected in consultation with the majority and minority leadership of the House and the Senate. The PRAC has the same authority to conduct audits and investigations as inspectors general under the Inspector General Act of 1978. The PRAC is required to provide management alerts to the President and Congress on "management, risk, and funding" issues that may require immediate attention. The PRAC is also required to report to the President and Congress biannually with a summary of PRAC activity and, to the extent practicable, a quantification of the impact of tax expenditures in the CARES Act. Finally the PRAC is required to provide other reports and periodic updates to Congress as it considers appropriate. In addition, the PRAC is directed to establish and maintain a "user-friendly, public-facing website to foster greater accountability and transparency in the use of covered funds." The PRAC is required to post specified information, including agencies' use of funds provided in the act. The PRAC terminates on September 30, 2025. Section 15003 appropriates $80 million in no-year funds to support the activities of the PRAC. The PRAC's organization and duties have similarities to those of the Recovery Accountability and Transparency Board that was established as part of the American Recovery and Reinvestment Act to conduct oversight of the use of funds in that act. Supplemental Appropriations and Additional Duties for Inspector General Offices The CARES Act appropriates $148 million for established inspector general offices in addition to the $25 million for the SIGPR and $80 million for the PRAC discussed above. In total, therefore, the CARES Act provides $253 million to the inspector general community to oversee the federal government's coronavirus response. Department of Agriculture Title I of Division B, under the heading "Office of the Inspector General," provides $750,000 to the Department of Agriculture OIG. The appropriation expires September 30, 2021, and may be used only to oversee funds appropriated to the department under the CARES Act. Department of Commerce Title II of Division B, under the heading "Department of CommerceâEconomic Development Administration," provides that of the $1.5 billion appropriated to the Department of Commerce, $3 million is to be transferred to the department's OIG to oversee the use of funds appropriated to the department under the CARES Act. The appropriation expires September 30, 2022. Department of Defense Title III of Division B, under the heading "Office of the Inspector General," provides $20 million for the Department of Defense OIG. This appropriation may be used only to oversee the use of funds appropriated to the department under the CARES Act. Department of Education Title VII of Division B, under the heading "Office of the Inspector General," provides $7 million to Department of Education OIG. These funds expire on September 30, 2022. This appropriation may be used only to respond to COVID-19 generally and to oversee the use of funds appropriated to the department under the CARES Act. Department of Health and Human Services Title VII of Division B, under the heading "Office of the Secretary," requires the Department of Health and Human Services (HHS) OIG to provide a final audit report to the House and Senate Appropriations Committees on payments from $100 billion appropriated to the Public Health and Social Services Emergency Fund to support eligible health care providers with their expenses related to the COVID-19 pandemic. The audit report is due three years after the final payment is made under the program. Section 18113 provides that, of the $27 billion appropriated to the Public Health and Social Services Emergency Fund, up to $4 million shall be transferred to the HHS OIG. Appropriated funds are available until expended and may be used only to oversee the use of funds appropriated to HHS under the CARES Act. In addition, the HHS inspector general is required to consult with the House and Senate Appropriations Committees prior to obligating these funds. Department of Homeland Security Title VI of Division B, under the heading "Disaster Relief Fund," provides a total of $45 billion in no-year funds for the Disaster Relief Fund with the Federal Emergency Management Agency (FEMA). Of the total appropriation, $3 million is to be transferred to the Department of Homeland Security (DHS) OIG to oversee the funds appropriated for the Disaster Relief Fund in the CARES Act. Department of Housing and Urban Development Title XII of Division B, under the heading "Office of the Inspector General," provides $5 million in no-year funds to the Department of Housing and Urban Development OIG. This appropriation may be used only to oversee the use of funds appropriated to the department under the CARES Act. Department of the Interior Title VII of Division B, under the heading "Departmental Offices," provides $158.4 million for the Office of the Secretary, Department of the Interior. This appropriation expires September 30, 2021. Of that appropriation, $1 million is to be transferred to the department's OIG to oversee the use of funds appropriated to the department under the CARES Act. Department of Justice Title II of Division B, under the heading "Office of the Inspector General," provides $2 million in no-year funds for the Department of Justice OIG. The appropriation is to be used to oversee funds provided to the department in the CARES Act and the general impact of COVID-19 on the department's activities. Department of Labor Section 2115 provides $25 million for the Department of Labor (DOL) OIG. The appropriation does not expire and may be used only to conduct oversight activity related to provisions in the CARES Act. Title XIII of Division B, under the heading "Departmental Management," appropriates $15 million to respond to COVID-19 generally and to support enforcement of the Families First Coronavirus Response Act ( P.L. 116-127 ). Of that appropriation, $1 million in no-year funds are to be transferred to the DOL OIG. Department of Transportation Title XII of Division B, under the heading "Office of Inspector General," provides $5 million in no-year funds to the Department of Transportation OIG. This appropriation may be used only to oversee the use of funds appropriated to the department under the CARES Act. Department of the Treasury Section 5001 provides $35 million in no-year funds for the Treasury OIG. The appropriation may be used only to conduct oversight and recoupment activities related to the Coronavirus Relief Fund established by Title V of the CARES Act. Section 5001 also requires the Treasury OIG to oversee the Coronavirus Relief Fund established by the section, which provides funding to state, local, and tribal governments. If the Treasury OIG determines that a state, tribal government, or unit of local government fails to comply with the requirements for the program, the section provides for the recoupment of the funds. Section 4113(d) requires the Treasury OIG to conduct audits of certifications related to employee compensation provided by air carriers in order to receive financial assistance under Section 4113(a). Department of Veterans Affairs Title X of Division B, under the heading "Office of Inspector General," provides $12.5 million for the Department of Veterans Affairs (VA) OIG. These funds expire on September 30, 2022. This appropriation may be used only to oversee the use of funds appropriated to the VA under the CARES Act. Small Business Administration Section 1107(a)(3) provides $25 million for the Small Business Administration (SBA) OIG. These funds expire September 30, 2024. Provisions Pertaining to the Government Accountability Office Title IX of Division B of the CARES Act, under the heading "Government Accountability Office," appropriates $20 million to GAO to conduct additional oversight and provide Congress with several reports. GAO is required to report to House and Senate Appropriations Committees within 90 days of enactment of the CARES Act with a spending plan for the funds and a timeline for audits and investigations. GAO Reporting Requirements and Additional Responsibilities Healthy Start Program : Section 3225 reauthorizes the Healthy Start Program. The section includes a requirement that GAO "review, access, and provide recommendations" on the program within four years of enactment of the CARES Act (i.e., March 27, 2024) and report its findings to the appropriate committees. Nurse Loan Repayment Programs : Section 3404 requires the comptroller general to study "nurse loan repayment programs" administered by the Health Resources and Services Administration and report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions, within 18 months of enactment of the CARES Act (i.e., September 27, 2021). Community and Mental Health Services Demonstration Program : Section 3814 extends the end date for the Community Mental Health Services Demonstration Program P.L. 93-288 and directs GAO to provide a report on the program to the House Committee on Energy and Commerce and Senate Committee on Finance. This report is due 18 months after enactment of the CARES Act (i.e., September 27, 2021). Regulation of Over the Counter Drugs : Section 3851 requires GAO to conduct a study on the effectiveness and impact of exclusivity under Sections 505G and 586C of the Federal Food, Drug, and Cosmetic Act. The study is to be submitted to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions within four years of enactment of the CARES Act (i.e., March 27, 2024). Coronavirus Economic Stabilization Act of 2020 : Section 4026(f) directs the comptroller general to conduct a study on "loans, loan guarantees, and other investments" made under Section 4003 of the CARES Act and report to the House Committee on Financial Services; the House Committee on Transportation and Infrastructure; the House Committee on Appropriations; the House Committee on the Budget; the Senate Committee on Banking, Housing, and Urban Affairs; the Senate Committee on Commerce, Science, and Transportation; the Senate Committee on Appropriations; and the Senate Committee on the Budget. The initial report under this provision is due nine months after enactment of the CARES Act (i.e., December 27, 2020), and additional reports are required annually thereafter through the "year succeeding the last year for which loans, loan guarantees, and other investments made under Section 4003 are outstanding." Monitoring and Audits by Comptroller General : Section 19010 requires the comptroller general to conduct monitoring and oversight of federal spending in response to the COVID-19 pandemic. The section empowers the comptroller general to access relevant records, make copies of those records, and conduct pertinent interviews. The comptroller general is to offer briefings at least once per month to the House Committee on Appropriations; the House Committee on Homeland Security; the House Committee on Oversight and Reform; the House Committee on Energy and Commerce; the Senate Committee on Appropriations; the Senate Committee on Homeland Security and Governmental Affairs; and the Senate Committee on Health, Education, Labor, and Pensions. The comptroller general is also required to report on GAO's relevant activities to the same committees within 90 days of enactment of the CARES Act (i.e., June 25, 2020), then monthly until one year after enactment (i.e., March 27, 2021), and periodically thereafter. Agency Reporting, Notice, and Consultation Requirements for Federal Entities and Sub-Entities Architect of the Capitol Title IX of Division B, under the heading "Architect of the Capitol," appropriates $25 million to the Architect of the Capitol for expenses related to the COVID-19 pandemic. The Architect of the Capitol is required to provide an expenditure report within 30 days of enactment of the CARES Act (i.e., April 26, 2020) and every 30 days thereafter to the House and Senate Appropriations Committees, the House Committee on House Administration, and the Senate Committee on Rules and Administration. Armed Forces Retirement Home Trust Fund Title X of Division B, under the heading "Armed Forces Retirement Home Trust Fund," appropriates $2.8 million from the available funds of the trust fund for expenses related to the COVID-19 pandemic. The chief executive officer of the Armed Forces Retirement Home is required to submit monthly spending reports to the House and Senate Appropriations Committees. Board of Governors of the Federal Reserve System Section 4026(b)(2)(A) requires the Board of Governors of the Federal Reserve System to report to the House Committee on Financial Services and the Senate Committee on Banking, Housing, and Urban Affairs whenever it exercises its purchase and loan-making authority under Section 4003(b)(4). Reports are to be submitted within seven days and are required to contain the same information as reports required under Title 12, Section 343(3)(C)(i), of the United States Code . In addition, reports are to be submitted every 30 days regarding outstanding loans and financial assistance under Section 4003(b)(4) in accordance with Title 12, Section 343(3)(C)(ii), of the U.S. Code . Centers for Disease Control and Prevention Title VII of Division B, under the heading "Centers for Disease Control and Prevention," appropriates a total of $4.3 billion to the Centers for Disease Control and Prevention (CDC). Of that total, $500 million is directed to "public health data surveillance and analytics infrastructure modernization." Within 30 days of enactment of the CARES Act (i.e., April 26, 2020), CDC is required to report to the House and Senate Appropriations Committees on the development of a "public health surveillance and data collection system for coronavirus." Department of Commerce Section 1108(d) requires the Minority Small Business Development Agency of the Department of Commerce to submit reports to the House Committee on Small Business; the House Committee on Energy and Commerce; the Senate Committee on Commerce, Science, and Technology; and the Senate Committee on Small Business and Entrepreneurship regarding the programs developed pursuant to Section 1108(b). Reports are due six months after enactment of the CARES Act (i.e., September 27, 2020) and annually thereafter. Department of Defense Section 13006(a) authorizes the delegation of select procurement authorities within the Department of Defense for transactions related to the COVID-19 pandemic. In the event that a transaction of this type does occur, either the Under Secretary of Defense for Research and Engineering or the Under Secretary of Defense for Acquisition and Sustainment, as applicable, is required to notify the House and Senate Appropriations and Armed Services Committees "as soon as is practicable." Department of Education Section 3510(a) allows foreign institutions to use distance education during the declared COVID-19 emergency under certain circumstances. Section 3510(c) requires that the Secretary of Education submit a report to the House Committee on Education and Labor and the Senate Committee on Health, Education, Labor, and Pensions identifying foreign institutions that use distance education under Section 3510(a). The report is due not later than 180 days after enactment of the CARES Act (i.e., September 23, 2020). Additional reports are due every 180 days for the duration of the declared emergency. Section 3510(d) allows foreign institutions to enter written agreements with certain institutions of higher education in the United States to allow students to take courses at the American institutions. Section 3510(d)(4) requires that the Secretary of Education submit a report identifying the foreign institutions using such arrangements to the House Committee on Education and Labor and the Senate Committee on Health, Education, Labor, and Pensions. The report is due not later than 180 days after enactment of the CARES Act (i.e., September 23, 2020). Additional reports are due every 180 days for the duration of the declared emergency. Section 3511(b) authorizes the Secretary of Education to waive certain statutory requirements identified in the section upon the request of a state or Indian tribe. Section 3511(d)(2) requires the Secretary of Education to notify the House Committee on Education and Labor; the Senate Committee on Health, Education, Labor, and Pensions; and the House and Senate Appropriations Committee within seven days of granting any waiver. In addition, Section 3511(d)(4) requires the Secretary of Education to submit a report to the same committees within 30 days of enactment of the CARES Act (i.e., April 26, 2020) with recommendations for additional necessary waivers of statutory requirements. Section 3512(a) authorizes the Secretary of Education to defer payments on loans made to historically black colleges and universities under Title 20, Section 1066, of the U.S. Code . Section 3512(c) requires the Secretary of Education to report to the House Committee on Education and Labor and the Senate Committee on Health, Education, Labor, and Pensions within 180 days of enactment of the CARES Act (i.e., September 23, 2020) and every 180 days thereafter on any institutions receiving this relief. Section 3517(c) requires the Secretary of Education to submit a report to the House Committee on Education and Labor and the Senate Committee on Health, Education, Labor, and Pensions identifying all institutions of higher education receiving waivers of statutory requirements identified in Section 3517(a). Reports are due within 180 days of enactment of the CARES Act (i.e., September 23, 2020) and every 180 days thereafter until the end of the fiscal year following the end of the declared emergency. Section 3518(c) requires the Secretary of Education to submit a report to the House Committee on Education and Labor and the Senate Committee on Health, Education, Labor, and Pensions identifying all institutions of higher education and other recipients who receive grant modifications as authorized in Section 3518(a). Reports are due within 180 days of enactment of the CARES Act (i.e., September 23, 2020) and every 180 days thereafter until the end of the fiscal year following the end of the declared emergency. Department of Health and Human Services Section 3212 amends the Public Health Service Act to require that the Secretary of HHS submit a report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions within four years of enactment of the CARES Act (i.e., March 27, 2024) and every five years thereafter on the "activities and outcomes" of the Telehealth Network Grant Program and the Telehealth Resource Centers Grant Program. Section 3213 amends the Public Health Service Act to require the Secretary of HHS to submit a report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions within four years of enactment of the CARES Act (i.e., March 27, 2024), and every five years thereafter, on the "activities and outcomes" of the Rural Health Care Services Outreach Grant Program, the Rural Health Network Development Grant Program, and the Small Health Care Provider Quality Improvement Grant Program. Section 3226(d) requires the Secretary of HHS to submit a report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions within two years of enactment of the CARES Act (i.e., March 27, 2022) on HHS's efforts to support the blood donation system. Section 3301 amends the Public Health Service Act to, during a public health emergency, eliminate a cap on the value of certain transactions related to the Biomedical Advanced Research and Development Authority that may be entered into by the Secretary of HHS. After the termination of the public health emergency, the Secretary of HHS is required to submit a report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions that details the use of funds, including a discussion of outcome measures for such transactions. Section 3401 amends the Public Health Service Act and renews a previously enacted requirement that the Secretary of HHS submit reports to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions concerning the need for underrepresented minorities on medical peer review councils. The first report is due September 30, 2025, and subsequent reports are due every five years thereafter. Section 3401 further amends the Public Health Service Act to require the Advisory Council on Graduate Medical Education to submit a report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions (as well as the Secretary of HHS) no later than September 30, 2023, and every five years thereafter. In these reports, the Advisory Council is directed to discuss its recommendations on the issues outlined in Title 42, Section 294o(a)(1), of the U.S. Code . Section 3402(a) requires the Secretary of HHS to develop a comprehensive and coordinated plan for the health care workforce development programs within one year of enactment of the CARES Act (i.e., March 27, 2021). Section 3402(c) requires the Secretary of HHS to submit a report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions describing the plan and how it is being implemented within two years of passage of the CARES Act (i.e., March 27, 2022). Section 3403(c) amends the Public Health Service Act to require the Secretary of HHS to submit a report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions on outcomes associated with the Geriatrics Workforce Enhancement Program. The report is due within four years of the enactment of the Title VII Health Care Workforce Reauthorization Act of 2019 and then every five years thereafter. Section 3404(a)(4)(D) amends the Public Health Service Act to require the Secretary of HHS to submit reports to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions assessing HHS programs to enhance the nursing workforce. Reports are due by September 30, 2020, and biennially thereafter. Further, Section 3404(a)(6)(F) incorporates additional requirements for these reports that are codified in Title 42, Section 296p, of the U.S. Code . Section 3854(c)(2) requires the Secretary of HHS to submit a report to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions when a revised sunscreen order under the Section 3854(c)(1) does not include certain efficacy information. Section 3855(a) requires the Secretary of HHS to submit a letter to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions describing the Food and Drug Administration's (FDA's) evaluations and revisions to the cough and cold monograph for children under the age of six. The letter is due one year after enactment of the CARES Act (i.e., March 27, 2021) and annually thereafter. Section 3862 adds a new part to the Federal Food, Drug, and Cosmetic Act to alter the FDA's management of monographs for over-the-counter drugs. This new part includes two additional reporting requirements on the implementation and impact of the new provisions. The Secretary of HHS is required to report on each of those issues to the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions within 120 calendar days after the end of FY2021 and within 120 days after the end of each fiscal year thereafter. In addition, the Secretary of HHS is required, by January 15, 2025, to transmit to Congress recommendations to revise the goals of the program. While developing those recommendations, the Secretary of HHS is required to consult with the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions, among others. Title VIII of Division B, under the heading "Centers for Disease Control and Prevention," requires the Secretary of HHS, in consultation with the director of the CDC, to report to the House and Senate Appropriations Committees every 14 days for one year if the HHS Secretary declares an infectious disease emergency and seeks to use the Infections Diseases Rapid Response Fund (as authorized by the third proviso of Section 231 of Division B of P.L. 115-245 ) "as long as such report[s] would detail obligations in excess of $5,000,000" or upon request. Title VIII of Division B, under the heading "Office of the Secretary," appropriates $27 billion to the Public Health and Social Services Emergency Fund. Among other things, the provision allows for funds to be used to reimburse the VA for expenses related to the COVID-19 pandemic and for care for certain patients. To provide this reimbursement, the Secretary of HHS must certify to the House and Senate Appropriations Committees that funds available under the Stafford Act are insufficient to cover expenses incurred by the VA. In addition, the Secretary of HHS must notify the House and Senate Appropriations Committees three days prior to making such a certification. Title VIII of Division B, also under the heading "Office of the Secretary," appropriates $100 billion to the Public Health and Social Services Emergency Fund to support eligible health care providers with their expenses related to the COVID-19 pandemic. The Secretary of HHS is required to submit a report to the House and Senate Appropriations Committees within 60 days of enactment of the CARES Act (i.e., May 26, 2020), and every 60 days thereafter, on the obligation of these funds, including state-level data. Section 18111 provides that funds appropriated under the heading "Department of Health and Human Services" in Title VII of Division B may be transferred or merged with appropriations to other specified HHS budget accounts so long as the House and Senate Appropriations Committees are notified 10 days in advance of any transfer. Section 18112 requires the Secretary of HHS to provide a spend plan for funds appropriated to HHS to the House and Senate Appropriations Committees within 60 days of enactment of the CARES Act (i.e., May 26, 2020) and then every 60 days until September 30, 2024. Department of Homeland Security Title VI of Division B, under the heading "Department of Homeland Security," appropriates $178 million for DHS's response to the COVID-19 pandemic. The provision grants additional authority to transfer these funds between DHS accounts for the purchase of personal protective equipment and sanitization materials. Within five days after making such a transfer, DHS is required to notify the House and Senate Appropriations Committees. Department of the Interior Title VII of Division B, under the heading "Departmental Offices," provides $158 million to support for the Department of the Interior's COVID-19 pandemic response. Beginning 90 days after enactment of the CARES Act (i.e., June 25, 2020), and monthly thereafter, the Secretary of the Interior is required to provide a report detailing the use of these funds to the House and Senate Appropriations Committees. Department of Labor Title VIII of Division B, under the heading "Departmental Management," appropriates $15 million for DOL's response to the COVID-19 pandemic and provides that the Secretary of Labor may transfer these funds to other specified DOL budget accounts for this purpose. Fifteen days prior to transferring any funds, the Secretary of Labor is required to submit an operating plan to the House and Senate Appropriations Committees describing how funds will be used. Department of State Section 21007 authorizes the Secretary of State and the administrator of the U.S. Agency for International Development (USAID) to provide additional paid leave to employees for the period from January 29, 2020, to September 30, 2022, in order to address hardships created by the COVID-19 pandemic. Prior to using this authority, the Secretary of State and the administrator must consult with House and Senate Appropriations Committees, the House Committee on Foreign Affairs, and the Senate Committee on Foreign Relations. Section 21009 authorizes the Secretary of State to use passport and immigrant visa surcharges to pay costs for consular services during FY2020.The Secretary of State is required to report to the House and Senate Appropriations Committees, the House Committee on Foreign Affairs, and the Senate Committee on Foreign Relations within 90 days of the expiration of this authority (i.e., December 29, 2020) on specific expenditures made pursuant to this authority. Section 21010 authorizes the Department of State and USAID to enter into personal services contracts to support their response to the COVID-19 pandemic subject to prior consultation with and notification of the House and Senate Appropriations Committees, the House Committee on Foreign Affairs, and the Senate Committee on Foreign Relations. Within 15 days of using this authority, the Secretary of State is required to report to the same committees on the staffing needs of the Office of Medical Services. Section 21011 authorizes the Secretary of State and the administrator of USAID to administer any legally required oath of office remotely through September 30, 2021. Prior to using this authority, the Secretary of State and the administrator must each submit a report to the House and Senate Appropriations Committees, the House Committee on Foreign Affairs, and the Senate Committee on Foreign Relations describing the process they will use to administer an oath of office in this manner. Department of Transportation Section 22002 requires the Secretary of Transportation to notify the House and Senate Appropriations Committees; the House Committee on Transportation and Infrastructure; and the Senate Committee on Commerce, Science, and Transportation within seven days of enactment of the CARES Act (i.e., April 3, 2020), and every seven days thereafter, of the furlough of any National Railroad Passenger Corporation employee due to the COVID-19 pandemic. Section 22005 allows the Secretary of Transportation to waive specified requirements for highway safety grants if the COVID-19 pandemic will substantially impact the ability of the states and the Department of Transportation to meet those grant requirements. The Secretary is required to "periodically" report to the relevant committees on any waivers made under this provision. Department of the Treasury Section 2201(f)(2) establishes reporting requirements associated with the 2020 Recovery Rebates provided in Section 2201. The Secretary of the Treasury is required to submit a report to the House and Senate Appropriations Committees within 15 days of enactment of the CARES Act (i.e., April 11, 2020) providing a spending plan for the funds provided for this program. In addition, 90 days after enactment (i.e., June 25, 2020), and quarterly thereafter, the Secretary is required to provide reports to the House and Senate Appropriations Committees on actual and projected expenditures under this program. Section 4026(b)(1)(A) requires the Secretary of the Treasury, within seven days after making a loan or loan guarantee under Sections 4003(b)(1), 4003(b)(2), or 4003(b)(3), to report to the chairmen and ranking members of the House Committee on Financial Services; the House Committee on Ways and Means; the Senate Committee on Banking, Housing, and Urban Affairs; and the Senate Committee on Finance. These reports are to include an overview of the actions and financial information about those transactions. Section 4118(a) requires the Secretary of the Treasury to submit a report no later than November 1, 2020, to the House Committee on Transportation and Infrastructure; the House Committee on Financial Services; the Senate Committee on Commerce, Science, and Transportation; and the Senate Committee on Banking, Housing, and Urban Affairs on the financial assistance provided to air carriers and contractors under Subtitle B of Title IV of the CARES Act. Section 4118(b) requires that the Secretary of the Treasury provide an updated report to the same committees no later than November 1, 2021. Section 21012 amends the Bretton Woods Agreements Act to authorize additional lending by the Department of the Treasury pursuant to a decision of the executive directors of the International Monetary Fund. Prior to taking such action, the Secretary of the Treasury is required to report to Congress on the need for such loans to support the international monetary system and the availability of alternative actions. Department of Veterans Affairs Title X of Division B, under the heading "Information Technology Systems," appropriates $2.15 billion for information technology expenses related to the COVID-19 pandemic. The VA Secretary is required to submit a spending plan for these funds to the House and Senate Appropriations Committees and must also notify the same committees before any of these funds are reprogrammed among VA's budget subaccounts for information technology. Section 20001 provides additional transfer authority for the Secretary to transfer funds between identified accounts. For transfers that account for less than 2% of the amount appropriated to a particular account, the Secretary is required to notify the House and Senate Appropriations Committees. For all other transfers, the VA Secretary may transfer funds only after requesting and receiving approval from the House and Senate Appropriations Committees. Section 20002 requires the Secretary to submit monthly expenditure reports to the House and Senate Appropriations Committees for all funds appropriated by Title X of Division B. Section 20008 authorizes the Secretary to waive any limitations on pay for VA employees during the COVID-19 public health emergency for work done in support of the response to the emergency. The Secretary is required to submit a report to the House and Senate Veterans' Affairs Committees in each month that such a waiver is in place. Election Assistance Commission Title V of Division B, under the heading "Election Assistance Commission," provides a total of $400 million for election security grants to be distributed to the states by the Election Assistance Commission. This provision requires states to submit reports on how these funds were used within 20 days of each election in the 2020 federal election cycle. Within three days of receipt, the commission is required to transmit these reports to the House Committee on House Administration, the Senate Committee on Rules and Administration, and the House and Senate Appropriations Committees. Federal Emergency Management Agency Title VI of Division B, under the heading "Federal Emergency Management Agency," appropriates $45 billion to FEMA's Disaster Relief Fund. The FEMA administrator is required to report to the House and Senate Appropriations Committees every 30 days on the actual and projected use of these funds. General Services Administration Title V of Division B, under the heading "General Services Administration," appropriates $275 million to the Federal Buildings Fund of the General Services Administration (GSA) for expenses related to the COVID-19 pandemic. The provision requires the administrator of GSA to notify the House and Senate Appropriations Committees quarterly on obligations and expenditures of these funds. Section 15003 requires the GSA administrator to notify Congress in writing if the administrator determines that it is in the public interest to use non-competitive procurement procedures as authorized by the Federal Procurement Policy during a declared public health emergency. House of Representatives Title IX of Division B, under the heading "House of Representatives," appropriates a total of $25 million for expenses related to the COVID-19 pandemic. The chief administrative officer of the House of Representatives is required to submit a spending plan to the House Committee on Appropriations. Internal Revenue Service Section 15001 appropriates $250 million to the Internal Revenue Service (IRS). The provision requires that the IRS commissioner submit a spending plan to the House and Senate Appropriations Committees no later than 30 days of enactment of the CARES Act (i.e., April 26, 2020). The provision also provides that, with advance notice to the House and Senate Appropriations Committees, these funds may be transferred between IRS budget accounts as necessary to respond to the COVID-19 pandemic. Kennedy Center Title VII of Division B, under the heading "John F. Kennedy Center for the Performing Arts," provides $25 million to support the Kennedy Center's response to the COVID-19 pandemic. The provision requires the Board of Trustees of the Kennedy Center to report to the House and Senate Appropriations Committees by October 21, 2020, with a detailed explanation of the use of the funds. Register of Copyrights Section 19011 amends Chapter 7 of Title 17 of the U.S. Code to provide that, through December 31, 2021, if an emergency declared by the President under the National Emergencies Act disrupts the ordinary functioning of the copyright system, the Register of Copyrights may waive or modify specified timing requirements. If the Register of Copyrights takes such action he or she must notify Congress within 20 days. Small Business Administration Section 1103(d) requires SBA to report to the House Committee on Small Business and the Senate Committee on Small Business and Entrepreneurship on its activities related to education, training and advising grants under Section 1103(b) of the CARES Act. The initial report under this section is due six months after enactment of the CARES Act (i.e., September 27, 2020), with additional reports annually thereafter. Section 1107(c) requires SBA to provide a spending plan for funds appropriated in Section 1107(a) to the House and Senate Appropriations Committees within 180 days of enactment of the CARES Act (i.e., September 23, 2020). U.S. Patent and Trademark Office Section 12004(a) provides the director of the U.S. Patent and Trademark Office with authority to toll, waive, adjust, or modify specified deadlines in Title 35 of the U.S. Code during the COVID-19 emergency if certain conditions are met. To use this authority, the director is required, under Section 12004(c), to submit a statement to Congress within 20 days explaining his or her action and the rationale underlying it. General Provisions for Title VII of Division B In addition to the requirements listed above for specific federal entities and sub-entities, Section 18109 authorizes that funds provided under Title VII of Division B may be used for personal services contracts with prior notification to the House and Senate Appropriations Committees. Title VII of Division B makes appropriations to the Department of the Interior, the Environmental Protection Agency, the Forest Service (Department of Agriculture), the Indian Health Service (HHS), the Agency for Toxic Substances and Disease Registry (HHS), the Institute of American Indian and Alaska Native Culture and Arts Development, the Smithsonian Institution, the Kennedy Center, and the National Foundation on the Arts and Humanities. Requirements for Testimony Chairman of the Board of Governors of the Federal Reserve System Section 4026 requires the chairman of Federal Reserve to testify, on a quarterly basis, before the House Committee on Financial Services and the Senate Committee on Banking, Housing, and Urban Affairs regarding the Federal Reserve's activities under the CARES Act. Secretary of the Treasury Section 4003(c)(3)(A)(iii) allows the Secretary of the Treasury to waive compensation limits established by Section 4004 as well as restrictions on "stock buybacks," the payment of dividends, and other capital distributions established by Section 4003(c)(3)(A)(ii) for businesses receiving a loan, loan guarantee, or other investment under the CARES Act. In order to waive those requirements, the Secretary must determine that such action is necessary to "protect the interests of the Federal Government" and must also "make himself available to testify before the Committee on Banking, Housing, and Urban Affairs of the Senate and the Committee on Financial Services of the House of Representatives regarding the reasons for the waiver." Section 4026 requires the Secretary of the Treasury to testify, on a quarterly basis, before the House Committee on Financial Services and the Senate Committee on Banking, Housing, and Urban Affairs regarding the Treasury's activities under the CARES Act.


Introduction The Coronavirus Disease 2019 (COVID-19) pandemic is affecting communities around the world and throughout the United States, with case counts growing daily. As private health insurance is the predominant source of health coverage in the United States, there is considerable congressional interest in understanding private health insurance coverage of health benefits related to COVID-19 diagnosis, treatment, and prevention. This report addresses frequently asked questions about covered benefits and consumer cost sharing related to COVID-19 testing, treatment, and a potential vaccine. It discusses recent legislation, references relevant existing federal requirements and recent administrative interpretations of them in relation to COVID-19, and notes state and private-sector actions. It begins with background information on types and regulation of private health insurance plans. The Families First Coronavirus Response Act (FFCRA; P.L. 116-127 ) requires specified types of private health insurance plans to cover COVID-19 testing, administration of the test, and related items and services, without consumer cost sharing. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136 ) further addresses private health insurance coverage of COVID-19 testing, and requires coverage of a potential vaccine and other preventive services without cost sharing, if they are recommended by specified federal entities. There are no federal requirements that specifically require coverage of COVID-19 treatment services. However, one or more existing federal requirements are potentially relevant, as discussed in this report. Some states have also announced requirements related to covered benefits and consumer costs, and some insurers have reported that they will voluntarily cover certain relevant benefits. This report discusses most U.S. private health insurance plans' coverage of health care items and services related to COVID-19, but it generally does not discuss the delivery of those services, insurers' payments to health care providers, or private health insurance coverage of other benefits. The Appendix lists Congressional Research Service (CRS) analysts who can discuss with congressional clients other topics of interest related to private health insurance and COVID-19, including types of plans and coverage of benefits not addressed in this report. Also beyond the scope of this report are public health coverage programs (e.g., Medicare); the domestic and international public health responses to COVID-19; and economic, human services, and other nonhealth issues. For further information on these topics, congressional clients can access the CRS Coronavirus Disease 2019 resources page at https://www.crs.gov/resources/coronavirus-disease-2019 . The information in this report is current as of its publication date and may be superseded by subsequent congressional or administrative action. Congressional clients may contact the report author and/or the experts listed in the Appendix for questions about further developments. In addition, Centers for Medicare & Medicaid Services (CMS) guidance related to private health insurance and COVID-19 is compiled on its website. Background on Private Health Insurance The private health insurance market includes both the group market (largely made up of employer-sponsored insurance) and the individual market (which includes plans directly purchased from an insurer). The group market is divided into small- and large-group market segments; a small group is typically defined as a group of up to 50 individuals (e.g., employees), and a large group is typically defined as one with 51 or more individuals. Employers and other group health plan sponsors may purchase coverage from an insurer in the small- and large-group markets (i.e., they may fully insure ). Sponsors may instead finance coverage themselves (i.e., they may self-insure ). The individual and small-group markets include plans sold on and off the individual and small-group health insurance exchanges, respectively. Covered benefits, consumer costs, and other plan features may vary by plan, subject to applicable federal and state requirements. The federal government may regulate all the coverage types noted above (i.e., individual coverage, fully insured small- and large-group coverage, and self-insured group plans), and states may regulate all but self-insured group plans. Federal and state requirements may vary by coverage type. This report focuses on private-sector plans explained above. There are some variations of these coverage types, and there are other types of private health coverage arrangements, which may or may not be subject to the requirements discussed in this report, or for which there may be other policy questions related to COVID-19. These other coverage types are out of the scope of this report, but a number of them are identified in the Appendix , along with resources for further information. One coverage variation, grandfathered plans , is included in this report because it is explicitly referenced in legislation relevant to COVID-19 and private health insurance coverage. Grandfathered plans are individual or group plans in which at least one individual was enrolled as of enactment of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 , as amended), and which continue to meet certain criteria. Plans that maintain their grandfathered status are exempt from some, but not all, federal requirements. Another type of coverage, short-term, limited duration insurance (STLDI or STLD plans), is also included in this report, because it is explicitly excluded from a coverage definition cited by relevant legislation. STLDI is coverage, generally sold in the individual market, which meets certain definitional criteria. The statutory definition of "individual health insurance coverage" excludes STLDI; thus, STLDI is exempt from complying with all federal health insurance requirements applicable to individual health insurance plans. FAQ: COVID-19 Covered Benefits and Cost Sharing The remainder of this report addresses private health insurance coverage of COVID-19 testing, treatment, and vaccination, when a vaccine becomes available. Where there are federal requirements related to such coverage, it is useful to understand the following: Is the service or item required to be covered? If so, is cost sharing allowed? In general, private health insurance cost sharing includes deductibles, coinsurance, and copayments. Are plans allowed to impose prior authorization or other medical management requirements? For example, some insurers require that they (the insurer) provide prior authorization for routine hospital inpatient care, and/or require that primary care physicians provide approval or referrals for specialty care, as a condition for covering the care. Does the coverage requirement depend on how or where the service or item is furnished (e.g., by an in-network versus out-of-network provider)? Under private insurance, benefit coverage and consumer cost sharing is often contingent upon whether the service or item is furnished by a provider that the insurer has contracted with (i.e., whether that provider is in network for a given plan). In instances where a contract between an insurer and provider does not exist, the provider is considered out of network . When does the coverage requirement go into effect? What types of plans are subject to the coverage requirement? To the extent that information is available, these issues are addressed with regard to private health insurance coverage of COVID-19 testing, treatment, and vaccination. Table 1 summarizes key information. Are Plans Required to Cover COVID-19 Testing? FFCRA and CARES Act Prior to the enactment of the FFCRA ( P.L. 116-127 ), there were no federal requirements specifically mandating private health insurance coverage of items or services related to COVID-19 testing. Section 6001 of the FFCRA requires most private health insurance plans to cover COVID-19 testing, administration of the test, and related items and services, as defined in the act. Per FFCRA, the coverage must be provided without consumer cost sharing, including deductibles, copayments, or coinsurance. Prior authorization or other medical management requirements are prohibited. The definition of testing that must be covered was expanded by Section 3201 of the CARES Act ( P.L. 116-136 ). In addition, the Department of Labor (DOL), Department of Health and Human Services (HHS), and the Treasury issued an FAQ document on April 11, 2020 (hereinafter, "Tri-Agency April 11 FAQ"), on the private health insurance coverage requirements in FFCRA and the CARES Act. Together, the acts and guidance require coverage of certain tests and services, as summarized below. Specified COVID-19 diagnostic tests, including both molecular (e.g., polymerase chain reaction, or PCR, tests) and serological tests (i.e., antibody tests), and the administration of such tests are covered. "Items and services furnished to an individual during [visits, as specified below] that result in an order for or administration of [an applicable COVID-19 test], but only to the extent such items and services relate to the furnishing or administration of such product or to the evaluation of such individual for purposes of determining the need of such individual for such product." This definition could encompass additional diagnostic testing associated with the visit. However, it would not encompass treatment for COVID-19-associated illnesses. The coverage requirements apply to the specified items and services when furnished at visits including to health care provider offices, urgent care centers, emergency rooms, and "nontraditional" settings, including drive-through testing sites. The requirements apply to both in-person and telehealth visits. FFCRA does not specify whether its coverage requirements apply when the test is furnished by an out-of-network provider. However Section 3202 of the CARES Act addresses insurer payments to in-network and out-of-network providers. In addition, the Tri-Agency April 11 FAQ clarifies that the FFCRA coverage requirements apply both in network and out of network. The coverage requirements in FFCRA apply only to the specified items and services that are furnished during the COVID-19 public health emergency period described in that act, as of the date the FFCRA was enacted (March 18, 2020). These requirements apply to individual health insurance coverage and to small- and large-group plans, whether fully insured or self-insured. This includes grandfathered individual or group plans, which are exempt from certain other federal private health insurance requirements. Per the definition of individual health insurance coverage cited in the act, the requirements do not apply to STLDI. State and Private-Sector Actions In recent weeks, some states have announced coverage requirements, and some insurers have clarified or expanded their policies, regarding coverage of COVID-19 testing, among other services. However, states cannot regulate self-insured plans, and insurer announcements do not necessarily apply to those plans either. FFCRA does apply to self-insured group plans in addition to the other plan types discussed above. To the extent that state requirements about or plans' voluntary coverage of COVID-19 testing did not extend as far as FFCRA and CARES Act requirements, the federal laws supersede them. However, state requirements and plans' voluntary coverage may exceed applicable federal requirements, as long as they do not prevent the implementation of any federal requirements. Even though federal law now requires most plans to cover specified COVID-19 testing services without cost sharing, it may be useful for consumers to contact their insurers or plan sponsors to understand their coverage. Subject to applicable federal and state requirements, coverage of the COVID-19 test and related services and items may vary by plan. Are Plans Required to Cover COVID-19 Treatment? Essential Health Benefits Guidance on COVID-19 Coverage Although FFCRA requires certain plans to cover specified COVID-19 testing services without cost sharing, neither FFCRA nor the CARES Act mandates coverage of COVID-19 treatment services. There is no federal requirement specifically mandating private health insurance coverage of items or services related to COVID-19 treatment. However, one or more existing federal requirements are potentially relevant, subject to state implementation and plan variation. There is a federal statutory requirement that certain plans cover a core set of 10 categories of essential health benefits (EHB). However, states, rather than the federal government, generally specify the benefit coverage requirements within those categories. Current regulation allows each state to select an EHB-benchmark plan. The benchmark plan serves as a reference plan on which plans subject to EHB requirements must substantially base their benefits packages. Because states select their own EHB-benchmark plans, there is considerable variation in EHB coverage from state to state. On March 5, 2020, and March 12, 2020, CMS issued guidance addressing the potential relevance of EHB requirements to coverage of COVID-19 treatment, among other benefits, subject to variation in states' EHB-benchmark plan designations. According to the March 12 document, "all 51 EHB-benchmark plans currently provide coverage for the diagnosis and treatment of COVID-19" (emphasis added), but coverage of specific benefits within the 10 categories of EHB (e.g., hospitalization, laboratory services) may vary by state and by plan. The March 12 document suggests that coverage of medically necessary hospitalizations would include coverage of medically necessary isolation and quarantine during the hospital admission, subject to state and plan variation. Quarantine in other settings, such as at home, is not a medical benefit. The document notes, "however, other medical benefits that occur in the home that are required by and under the supervision of a medical provider, such as home health care or telemedicine, may be covered as EHB," subject to state and plan variation. The March 12 document confirms that "exact coverage details and cost-sharing amounts for individual services may vary by plan, and some plans may require prior authorization before these services are covered." In other words, even where certain treatment items and services are required to be covered as EHB in a state, cost-sharing and medical management requirements could apply, subject to applicable federal and state requirements. In addition, cost sharing and other coverage details may vary for services furnished by out-of-network providers. Individual and fully insured small-group plans are subject to EHB requirements. Large-group plans, self-insured plans, grandfathered plans, and STLDI are not. Whether or not certain treatment services are defined as EHB in a state, other state benefit coverage requirements may be relevant to COVID-19 treatment. Plans may also voluntarily cover benefits. See " State and Private-Sector Actions " below. Certain Federal Requirements Related to Cost Sharing Other existing federal requirements are also relevant to consumer cost sharing on COVID-19 treatment services, to the extent that such treatments are covered by the consumer's plan, and largely to the extent that they are defined by a state as EHB. For example, plans must comply with annual l imits on consumers' out-of-pocket spending (i.e., cost sharing, including deductibles, coinsurance, and copayments) on in-network coverage of the EHB. If certain treatment services are defined as EHB in a state, and are furnished by an in-network provider, consumers' out-of-pocket costs for the plan year would be limited as discussed below. If certain treatment services are not defined as EHB in a state, and/or are furnished by out-of-network providers, this out-of-pocket maximum would not necessarily apply. In 2020, the out-of-pocket limits cannot exceed $8,150 for self-only coverage and $16,300 for coverage other than self-only. This means that once a consumer has spent up to that amount in cost sharing on applicable in-network benefits, the plan would cover 100% of remaining applicable costs for the plan year. The out-of-pocket maximum applies to individual health insurance coverage and to small- and large-group plans, whether fully insured or self-insured. The requirement does not apply to grandfathered plans or STLDI. State and Private-Sector Actions As stated above, in recent weeks, some states have announced coverage requirements related to COVID-19 testing services and items, and some insurers have clarified or expanded their policies to include relevant coverage. Some of these state and insurer statements also address coverage of treatment services. However, as discussed above, states cannot regulate self-insured plans, and insurer announcements do not necessarily apply to those plans either. Coverage, cost sharing, and the application of medical management techniques (e.g., prior authorization) can vary by plan, subject to applicable federal and state requirements. It may be useful for consumers to contact their insurers or plan sponsors to understand their coverage of services and items related to COVID-19 treatment. Will Plans Be Required to Cover a COVID-19 Vaccine? CARES Act and Existing Preventive Services Coverage Requirements As of the date of this report, there is no vaccine against COVID-19 approved by the Food and Drug Administration (FDA) for use in the United States, although several candidates are in development. Prior to the enactment of the CARES Act, there were no federal requirements specifically mandating private health insurance coverage of items or services related to a COVID-19 vaccine. However, per an existing federal requirement (Â§2713 of the Public Health Service Act [PHSA]) and its accompanying regulations, most plans must cover specified preventive health services without cost sharing. This includes any preventive service recommended with an A or B rating by the United States Preventive Services Task Force (USPSTF); or any immunization with a recommendation by the Advisory Committee on Immunization Practices (ACIP), adopted by the Centers for Disease Control and Prevention (CDC), for routine use for a given individual. These coverage requirements apply no sooner than one year after a new or revised recommendation is published. Requirements of PHSA Section 2713 apply to individual health insurance coverage and to small- and large-group plans, whether fully insured or self-insured. The requirements do not apply to grandfathered plans or to STLDI. By regulation, plans are generally not required to cover preventive services furnished out of network. They are allowed to use "reasonable medical management" techniques, within provided guidelines. Cost sharing for office visits associated with a furnished preventive service may or may not be allowed, as specified in regulation. Section 3203 of the CARES Act requires specified plansâthe same types as those subject to PHSA Section 2713âto cover a COVID-19 vaccine, when available, and potentially other COVID-19 preventive services, if they are recommended by ACIP or USPSTF, respectively. This coverage must be provided without cost sharing. Section 3203 also applies an expedited effective date for the required coverage: 15 business days after an applicable ACIP or USPSTF recommendation is published. Otherwise, requirements of Section 3203 mirror the existing requirements under PHSA Section 2713. The requirement to cover COVID-19 vaccination and other preventive services is not time limited, whereas the FFCRA requirement to cover COVID-19 testing is limited to the duration of a declared COVID-19 public health emergency. See " Are Plans Required to Cover COVID-19 Testing? " State and Private-Sector Actions Some of the state and insurer announcements about coverage of COVID-19 benefits, discussed earlier in this report, reference coverage of a potential vaccine. However, pending development and approval of the vaccine, and pending the implementation of the CARES Act requirements related to COVID-19 vaccine coverage, it is premature to discuss potential variations in coverage of the vaccine at the state or plan level. It may still be useful for consumers to contact their insurers or plan sponsors to understand their coverage of services and items related to a potential COVID-19 vaccine. Appendix. Resources for Questions about Private Health Insurance and COVID-19 This report has focused on coverage of COVID-19 testing, treatment, and vaccination by most types of private health insurance plans. CRS analysts are also available to congressional clients to discuss other topics of interest related to private health insurance and COVID-19, including coverage of COVID-19 benefits by types of private plans not specifically addressed in this report; other issues related to private coverage of COVID-19 benefits; private coverage of certain other benefits of concern during this pandemic, or of services furnished via telehealth; and issues related to private health insurance enrollment and premium payments. The following table lists examples of such topics of interest, any relevant legislative or administrative resources, any relevant CRS resources, and names of appropriate CRS experts for the benefit of congressional clients. Besides the CRS reports listed below that provide background on relevant topics, also see CRS reports on health provisions in recent COVID-19 legislation: CRS Report R46316, Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116-127 , and CRS Report R46334, Selected Health Provisions in Title III of the CARES Act (P.L. 116-136) . The information in this report is current as of its publication date and may be superseded by subsequent congressional or administrative action. Congressional clients may contact the report author and/or experts listed below for questions about further developments. In addition, CMS guidance related to private health insurance and COVID-19 is compiled on its website.