Comprehensive Immunosuppressive Drug Coverage for Transplant Patients Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to remove time limitations on the coverage of immunosuppressive drugs for individuals who have received organ transplants. (Current law provides coverage for such drugs only for certain time periods after the transplant procedure.)
Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to: (1) continue entitlement to prescription drugs used in immunosuppressive therapy furnished to an individual who receives a kidney or other organ transplant for which payment is made under Medicare; and (2) extend Medicare secondary payer requirements for end stage renal disease beneficiaries.
Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to set forth requirements for group health plans to provide coverage of immunosuppressive drugs.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 173 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 173
To amend title XVIII of the Social Security Act to provide adequate
coverage for immunosuppressive drugs furnished to beneficiaries under
the medicare program that have received an organ transplant.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
January 26, 2005
Mr. DeWine (for himself and Mr. Durbin) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide adequate
coverage for immunosuppressive drugs furnished to beneficiaries under
the medicare program that have received an organ transplant.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Comprehensive Immunosuppressive Drug
Coverage for Transplant Patients Act of 2005''.
SEC. 2. COMPREHENSIVE COVERAGE OF IMMUNOSUPPRESSIVE DRUGS UNDER THE
MEDICARE PROGRAM.
(a) In General.--Section 1861(s)(2)(J) of the Social Security Act
(42 U.S.C. 1395x(s)(2)(J)) is amended by striking ``, to an individual
who receives'' and all that follows before the semicolon at the end and
inserting ``to an individual who has received an organ transplant''.
(b) Effective Date.--The amendments made by this section shall
apply to drugs furnished on or after the date of enactment of this Act.
SEC. 3. PROVISION OF APPROPRIATE COVERAGE OF IMMUNOSUPPRESSIVE DRUGS
UNDER THE MEDICARE PROGRAM FOR ORGAN TRANSPLANT
RECIPIENTS.
(a) Continued Entitlement to Immunosuppressive Drugs.--
(1) Kidney transplant recipients.--Section 226A(b)(2) of
the Social Security Act (42 U.S.C. 426-1(b)(2)) is amended by
inserting ``(except for coverage of immunosuppressive drugs
under section 1861(s)(2)(J))'' after ``shall end''.
(2) Other transplant recipients.--The flush matter
following paragraph (2)(C)(ii)(II) of section 226(b) of the
Social Security Act (42 U.S.C. 426(b)) is amended by striking
``of this subsection)'' and inserting ``of this subsection and
except for coverage of immunosuppressive drugs under section
1861(s)(2)(J))''.
(3) Application.--Section 1836 of the Social Security Act
(42 U.S.C. 1395o) is amended--
(A) by striking ``Every individual who'' and
inserting ``(a) In General.--Every individual who'';
and
(B) by adding at the end the following new
subsection:
``(b) Special Rules Applicable to Individuals Only Eligible for
Coverage of Immunosuppressive Drugs.--
``(1) In general.--In the case of an individual whose
eligibility for benefits under this title has ended except for
the coverage of immunosuppressive drugs by reason of section
226(b) or 226A(b)(2), the following rules shall apply:
``(A) The individual shall be deemed to be enrolled
under this part for purposes of receiving coverage of
such drugs.
``(B) The individual shall be responsible for the
full amount of the premium under section 1839 in order
to receive such coverage.
``(C) The provision of such drugs shall be subject
to the application of--
``(i) the deductible under section 1833(b);
and
``(ii) the coinsurance amount applicable
for such drugs (as determined under this part).
``(D) If the individual is an inpatient of a
hospital or other entity, the individual is entitled to
receive coverage of such drugs under this part.
``(2) Establishment of procedures in order to implement
coverage.--The Secretary shall establish procedures for--
``(A) identifying beneficiaries that are entitled
to coverage of immunosuppressive drugs by reason of
section 226(b) or 226A(b)(2); and
``(B) distinguishing such beneficiaries from
beneficiaries that are enrolled under this part for the
complete package of benefits under this part.''.
(4) Technical amendment.--Subsection (c) of section 226A of
the Social Security Act (42 U.S.C. 426-1), as added by section
201(a)(3)(D)(ii) of the Social Security Independence and
Program Improvements Act of 1994 (Public Law 103-296; 108 Stat.
1497), is redesignated as subsection (d).
(b) Extension of Secondary Payer Requirements for ESRD
Beneficiaries.--Section 1862(b)(1)(C) of the Social Security Act (42
U.S.C. 1395y(b)(1)(C)) is amended by adding at the end the following
new sentence: ``With regard to immunosuppressive drugs furnished on or
after the date of enactment of the Comprehensive Immunosuppressive Drug
Coverage for Transplant Patients Act of 2005, this subparagraph shall
be applied without regard to any time limitation.''.
(c) Effective Date.--The amendments made by this section shall
apply to drugs furnished on or after the date of enactment of this Act.
SEC. 4. PLANS REQUIRED TO MAINTAIN COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.
(a) Application to Certain Health Insurance Coverage.--
(1) In general.--Subpart 2 of part A of title XXVII of the
Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is
amended by adding at the end the following:
``SEC. 2707. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.
``A group health plan (and a health insurance issuer offering
health insurance coverage in connection with a group health plan) shall
provide coverage of immunosuppressive drugs that is at least as
comprehensive as the coverage provided by such plan or issuer on the
day before the date of enactment of the Comprehensive Immunosuppressive
Drug Coverage for Transplant Patients Act of 2005, and such requirement
shall be deemed to be incorporated into this section.''.
(2) Conforming amendment.--Section 2721(b)(2)(A) of the
Public Health Service Act (42 U.S.C. 300gg-21(b)(2)(A)) is
amended by inserting ``(other than section 2707)'' after
``requirements of such subparts''.
(b) Application to Group Health Plans and Group Health Insurance
Coverage Under the Employee Retirement Income Security Act of 1974.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following new section:
``SEC. 714. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.
``A group health plan (and a health insurance issuer offering
health insurance coverage in connection with a group health plan) shall
provide coverage of immunosuppressive drugs that is at least as
comprehensive as the coverage provided by such plan or issuer on the
day before the date of enactment of the Comprehensive Immunosuppressive
Drug Coverage for Transplant Patients Act of 2005, and such requirement
shall be deemed to be incorporated into this section.''.
(2) Conforming amendments.--
(A) Section 732(a) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1191(a)) is
amended by striking ``section 711'' and inserting
``sections 711 and 714''.
(B) The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974 is
amended by inserting after the item relating to section
713 the following new item:
``Sec. 714. Coverage of immunosuppressive drugs''.
(c) Application to Group Health Plans Under the Internal Revenue
Code of 1986.--Subchapter B of chapter 100 of the Internal Revenue Code
of 1986 is amended--
(1) in the table of sections, by inserting after the item
relating to section 9812 the following new item:
``Sec. 9813. Coverage of immunosuppressive drugs'';
and
(2) by inserting after section 9812 the following:
``SEC. 9813. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.
``A group health plan shall provide coverage of immunosuppressive
drugs that is at least as comprehensive as the coverage provided by
such plan on the day before the date of enactment of the Comprehensive
Immunosuppressive Drug Coverage for Transplant Patients Act of 2005,
and such requirement shall be deemed to be incorporated into this
section.''.
(d) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after January 1, 2006.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S580-581)
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