Kidney Disease Equitable Access, Prevention, and Research Act of 2012 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS), in specified circumstances, to accept the results of a state licensure survey for purposes of determining federal certification of the compliance of a renal dialysis facility (RDF) with the conditions of Medicare participation.
Allows the Secretary to assess and collect reasonable fees for the initial Medicare survey from an RDF.
Revises Medicare requirements for group health plans to extend from 12 to 42 months after an individual becomes eligible for Medicare part A (Hospital Insurance Benefits for the Aged and Disabled) benefits the period during which a group health plan is a primary payer (and Medicare the secondary payer) for ESRD patients.
Requires such a plan to: (1) provide adequate, advanced, written notice to patients regarding changes to dialysis service benefits, new restrictions on out-of-network access, or reductions in rates paid for out-of-network benefits; (2) allow patients to continue using their existing provider or facility for dialysis services for at least 24 months after a plan or issuer notice of any change; (3) hold patients harmless from a provider network change if the change requires unreasonable drive time or disrupts the physician-patient relationship; (4) ensure that out-of-pocket payments for such services apply to the Medicare part C (Medicare+Choice Program) out-of-pocket maximums and are treated as non-routine for copayment purposes; and (5) meet minimum network adequacy standards.
Prohibits such a plan from: (1) restricting the duration or number of dialysis sessions for patients to less than the number for which payment may be made; (2) requiring assignment of benefits for such services; or (3) denying or limiting coverage for patients for such services if premiums, copayments, or other payments are made by third parties on their behalf.
Directs the Secretary to study: (1) the social, behavioral, and biological factors leading to kidney disease; and (2) efforts to slow the progression of kidney disease in minority populations that are disproportionately affected by it.
Directs the Secretary to report to Congress on the research gaps with respect to the development of quality metrics and care management metrics for ESRD patients.
Directs the Comptroller General to evaluate the transportation barriers facing dialysis patients that result in less than 100% compliance with their plan of care under the Medicare program.
Includes as a person qualified to furnish kidney disease education services an RDF with a physician or a physician assistant, nurse practitioner, or clinical nurse specialist.
Declares that the mandatory single payment to an RDF or other provider of renal dialysis services shall not take into account the amount of payment for kidney disease education services.
Revises the definition of “kidney disease education services” to specify education services furnished to individuals: (1) with stage V (as well as those with stage IV) chronic kidney disease, and (2) who are not receiving dialysis services.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 2163 Introduced in Senate (IS)]
112th CONGRESS
2d Session
S. 2163
To amend title XVIII of the Social Security Act to improve Medicare
benefits for individuals with kidney disease, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 6, 2012
Mr. Conrad 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 improve Medicare
benefits for individuals with kidney disease, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Kidney Disease
Equitable Access, Prevention, and Research Act of 2012''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--PROVIDING EQUITABLE ACCESS TO CARE FOR INDIVIDUALS WITH KIDNEY
DISEASE
Sec. 101. Improving access to care through improvements in the initial
survey process for renal dialysis
facilities.
Sec. 102. Providing choice in primary insurer.
Sec. 103. Protecting individuals with kidney failure from unfair
practices.
TITLE II--SUPPORTING RESEARCH TO IMPROVE ACCESS TO HIGH QUALITY KIDNEY
CARE
Sec. 201. Understanding the progression of kidney disease in minority
populations.
Sec. 202. Recommendations on dialysis quality and care management
research gaps.
Sec. 203. GAO study on transportation barriers to access kidney care.
TITLE III--IMPROVING ACCESS TO PREVENTIVE CARE FOR INDIVIDUALS WITH
KIDNEY DISEASE
Sec. 301. Improving access to medicare kidney disease education.
TITLE I--PROVIDING EQUITABLE ACCESS TO CARE FOR INDIVIDUALS WITH KIDNEY
DISEASE
SEC. 101. IMPROVING ACCESS TO CARE THROUGH IMPROVEMENTS IN THE INITIAL
SURVEY PROCESS FOR RENAL DIALYSIS FACILITIES.
Section 1864 of the Social Security Act (42 U.S.C. 1395aa) is
amended--
(1) by redesignating subsection (e) as subsection (f);
(2) by inserting after subsection (d) the following new
subsection:
``(e)(1) If the Secretary has entered into an agreement with any
State under this section under which the appropriate State or local
agency that performs any survey related to determining the compliance
of a renal dialysis facility subject to the requirements of section
1881(b) and the State licensure survey requirements are consistent with
or exceed such Federal requirements, the Secretary must accept the
results of the State licensure survey for purposes of determining
Federal certification of compliance. In the case of such an initial
survey of a renal dialysis facility, the Secretary may allow any State
to waive the reimbursement for conducting the survey under this section
if it requests such a waiver.
``(2) In the case of a renal dialysis facility that has waited for
more than 6 months to receive the results of an initial survey under
this section, the Secretary shall establish a specific timetable for
completing and reporting the results of the survey.''; and
(3) in subsection (f), as so redesignated--
(A) by striking ``Notwithstanding any other
provision of law,'' and inserting ``(1) Notwithstanding
any other provision of law and except as provided in
paragraph (2)''; and
(B) by adding at the end the following:
``(2) The Secretary may assess and collect fees for the initial
Medicare survey from a renal dialysis facility subject to the
requirements of section 1881(b) in an amount not to exceed a reasonable
fee necessary to cover the costs of initial surveys conducted for
purposes of determining the compliance of a renal dialysis facility
with the requirements of section 1881(b). Fees may be assessed and
collected under this paragraph only in such manner as would result in
an aggregate amount of fees collected during any fiscal year being
equal to the aggregate amount of costs for such fiscal year for initial
surveys of such facilities under this section. A renal dialysis
facility's liability for such fees shall be reasonably based on the
proportion of the survey costs which relate to such facility. Any funds
collected under this paragraph shall be used only to conduct the
initial survey of the facilities providing the fees.
``(3) Fees authorized under paragraph (2) shall be collected by the
Secretary and available only to the extent and in the amount provided
in advance in appropriations Acts and upon request of the Secretary,
subject to the amount and usage limitations of such paragraph. Such
fees so collected are authorized to remain available until expended.''.
SEC. 102. PROVIDING CHOICE IN PRIMARY INSURER.
(a) Providing for Patient Choice.--
(1) In general.--Section 1862(b)(1)(C) of the Social
Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended--
(A) in the last sentence, by inserting ``and before
January 1, 2013,'' after ``prior to such date)''; and
(B) by adding at the end the following new
sentence: ``Effective for items and services furnished
on or after January 1, 2013 (with respect to periods
beginning on or after the date that is 42 months prior
to such date), clauses (i) and (ii) shall be applied by
substituting `42-month' for `12-month' each place it
appears in the first sentence.''.
(2) Effective date.--The amendments made by this subsection
shall take effect on the date of enactment of this Act. For
purposes of determining an individual's status under section
1862(b)(1)(C) of the Social Security Act (42 U.S.C.
1395y(b)(1)(C)), as amended by paragraph (1), an individual who
is within the coordinating period as of the date of enactment
of this Act shall have that period extended to the full 42
months described in the last sentence of such section, as added
by the amendment made by paragraph (1)(B).
(b) Providing Equitable Access to Insurance for Individuals With
Kidney Failure.--The Secretary of Health and Human Services shall
clarify upon enactment of this Act that the Medicare Secondary Payer
rules set forth in section 1862(b)(1)(C) of the Social Security Act (42
U.S.C. 1395y(b)(1)(C)), as amended by this Act, apply to qualified
health plans established under section 1311(b)(1)(B) of Public Law 111-
148 (42 U.S.C. 13031(b)(1)(B)).
SEC. 103. PROTECTING INDIVIDUALS WITH KIDNEY FAILURE FROM UNFAIR
PRACTICES.
(a) In General.--Section 1862(b)(1)(C)(ii) of the Social Security
Act (42 U.S.C. 1395y(b)(1)(C)(ii)) is amended to read as follows:
``(ii) may not differentiate in the
benefits it provides between individuals having
end stage renal disease and other individuals
covered by such plan or issuer on the basis of
the existence of end stage renal disease, the
need for renal dialysis, or in any other
manner, and such plan--
``(I) shall provide adequate,
advanced, written notification to
patients regarding changes to dialysis
service benefits, new restrictions on
out-of-network access, or reductions in
rates paid for out-of-network benefits
for such services;
``(II) shall allow patients to
continue using their existing provider
or facility of such services for at
least 24 months following the date of
notice of any change by the plan or
issuer in the dialysis services network
of the plan or issuer;
``(III) shall hold patients
harmless from provider network changes
with respect to such services if such
changes require unreasonable drive time
or disrupt the physician-patient
relationship;
``(IV) may not restrict the
duration or number of dialysis sessions
for patients, such as based on a fixed
number of treatments per week, to less
than the number for which payment may
be made pursuant to section 1881(b)(1);
``(V) may not require assignment of
benefits for such services;
``(VI) shall ensure that out-of-
pocket payments for such services apply
to the medicare part C out-of-pocket
maximums and not treated as routine for
purposes of calculating beneficiary
copayments;
``(VII) may not deny or limit
coverage for patients for such services
if premiums, copayments, or other
payments are made by third parties on
their behalf; and
``(VIII) shall meet minimum network
adequacy standards specified by the
Secretary with respect to such
services;''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to group health plans as of January 1, 2014.
TITLE II--SUPPORTING RESEARCH TO IMPROVE ACCESS TO HIGH QUALITY KIDNEY
CARE
SEC. 201. UNDERSTANDING THE PROGRESSION OF KIDNEY DISEASE IN MINORITY
POPULATIONS.
Not later than one year after the date of the enactment of this
Act, the Secretary of Health and Human Services shall complete a study
(and submit a report to Congress) on--
(1) the social, behavioral, and biological factors leading
to kidney disease; and
(2) efforts to slow the progression of kidney disease in
minority populations that are disproportionately affected by
such disease.
SEC. 202. RECOMMENDATIONS ON DIALYSIS QUALITY AND CARE MANAGEMENT
RESEARCH GAPS.
Not later than 2 years after the date of the enactment of this Act,
the Secretary of Health and Human Services shall submit to Congress a
report regarding the research gaps with respect to the development of
quality metrics and care management metrics for patients with end-stage
renal disease, including pediatric and home dialysis patients. Such
report shall include recommendations about undertaking research to fill
such gaps and prioritizing such research.
SEC. 203. GAO STUDY ON TRANSPORTATION BARRIERS TO ACCESS KIDNEY CARE.
(a) In General.--The Comptroller General of the United States shall
conduct an evaluation of the transportation barriers facing dialysis
patients that result in less than 100 percent compliance with their
plan of care under the Medicare program.
(b) Specific Matters Evaluated.--In conducting the evaluation under
subsection (a), the Comptroller General shall examine--
(1) the costs associated with providing dialysis services;
(2) the number and characteristics of patients who miss at
least 2 dialysis treatments during a month or have shortened
treatments because of barriers to transportation; and
(3) the potential sources of providing dialysis patients
with such transportation services.
(c) Report.--Not later than the date that is 6 months after the
date of the enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under subsection (a)
together with recommendations for such legislation and administrative
action as the Comptroller General determines appropriate.
TITLE III--IMPROVING ACCESS TO PREVENTIVE CARE FOR INDIVIDUALS WITH
KIDNEY DISEASE
SEC. 301. IMPROVING ACCESS TO MEDICARE KIDNEY DISEASE EDUCATION.
(a) In General.--Section 1861(ggg)(2) of the Social Security Act
(42 U.S.C. 1395x(ggg)(2)) is amended--
(1) by striking subparagraph (B); and
(2) in subparagraph (A)--
(A) by striking ``(A)'' after ``(2)'';
(B) by striking ``and'' at the end of clause (i);
(C) by striking the period at the end of clause
(ii) and inserting ``; and'';
(D) by redesignating clauses (i) and (ii) as
subparagraphs (A) and (B), respectively; and
(E) by adding at the end the following:
``(C) a renal dialysis facility subject to the
requirements of section 1881(b)(1) with personnel--
``(i) who provide the services described in
paragraph (1); and
``(ii) that include a physician (as defined
in subsection (r)(1)) or a physician assistant,
nurse practitioner, or clinical nurse
specialist (as defined in subsection
(aa)(5)).''.
(b) Payment to Renal Dialysis Facilities.--Section 1881(b) of such
Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following
new paragraph:
``(15) For purposes of paragraph (14), the single payment for renal
dialysis services under such paragraph shall not take into account the
amount of payment for kidney disease education services (as defined in
section 1861(ggg)). Instead, payment for such services shall be made to
the renal dialysis facility on an assignment-related basis under
section 1848.''.
(c) Providing Education Services to Individuals With Kidney
Failure.--Section 1861(ggg)(1)(A) of the Social Security Act (42 U.S.C.
1395x(ggg)(1)(A)) is amended--
(1) by inserting ``or stage V'' after ``stage IV''; and
(2) by inserting ``and who is not receiving dialysis
services'' after ``chronic kidney disease''.
(d) Effective Date.--The amendments made by this section apply to
kidney disease education services furnished on or after January 1,
2013.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S1425)
Read twice and referred to the Committee on Finance.
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