Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020
This bill indefinitely extends Medicare coverage of immunosuppressive drugs for kidney transplant recipients for individuals who do not have other coverage. Under current law, Medicare coverage is limited to 36 months following a transplant.
The Government Accountability Office must report on the bill's implementation.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5534 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 5534
To amend title XVIII of the Social Security Act to provide for extended
months of Medicare coverage of immunosuppressive drugs for kidney
transplant patients, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 23, 2019
Mr. Kind (for himself, Mr. Burgess, Ms. Eshoo, Mr. Smith of Missouri,
Mr. McEachin, and Ms. Herrera Beutler) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for extended
months of Medicare coverage of immunosuppressive drugs for kidney
transplant patients, 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.
This Act may be cited as the ``Comprehensive Immunosuppressive Drug
Coverage for Kidney Transplant Patients Act of 2019''.
SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS FOR
KIDNEY TRANSPLANT PATIENTS AND OTHER RENAL DIALYSIS
PROVISIONS.
(a) Medicare Entitlement to Immunosuppressive Drugs for Kidney
Transplant Recipients.--
(1) In general.--Section 226A(b)(2) of the Social Security
Act (42 U.S.C. 426-1(b)(2)) is amended by inserting ``(except
for eligibility for enrollment under part B solely for purposes
of coverage of immunosuppressive drugs described in section
1861(s)(2)(J))'' before ``, with the thirty-sixth month''.
(2) Individuals eligible only for coverage of
immunosuppressive drugs.--
(A) In general.--Section 1836 of the Social
Security Act (42 U.S.C. 1395o) is amended--
(i) by striking ``Every'' and inserting
``(a) In General.--Every''; and
(ii) by adding at the end the following new
subsection:
``(b) Individuals Eligible for Immunosuppressive Drug Coverage.--
``(1) In general.--Except as provided under paragraph (2),
every individual whose insurance benefits under part A have
ended (whether before, on, or after January 1, 2022) by reason
of section 226A(b)(2) is eligible to enroll in the insurance
program established by this part solely for purposes of
coverage of immunosuppressive drugs in accordance with section
1837(m).
``(2) Exception if other health insurance coverage is
available.--
``(A) In general.--An individual described in
paragraph (1) shall not be eligible for enrollment in
the insurance program described in such paragraph with
respect to any period in which the individual--
``(i) is enrolled in a group health plan,
as defined in section 2791(a)(1) of the Public
Health Service Act, or individual health
insurance coverage, as defined in section
2791(b)(5) of such Act, as determined in
accordance with subparagraph (B);
``(ii) is eligible for benefits under--
``(I) a State plan under title XIX;
``(II) a State child health plan
under title XXI; or
``(III) the TRICARE program under
chapter 55 of title 10, United States
Code;
``(iii) is enrolled in a health benefits
plan under chapter 89 of title 5, United States
Code;
``(iv) is eligible for health care benefits
under the laws administered by the Secretary of
Veterans Affairs; or
``(v) is eligible to receive services from
the Indian Health Service.
``(B) Eligibility determinations.--
``(i) In general.--The Secretary, in
consultation with the Administrator of Social
Security, shall establish procedures for
determining whether an individual described in
paragraph (1) who is to be enrolled in the
insurance program described in such paragraph
meets the requirements for such enrollment
under this subsection, including the
requirement that the individual not have other
health insurance coverage as described in
subparagraph (A).
``(ii) Attestation regarding other
coverage.--The procedures established under
clause (i) shall include a requirement that--
``(I) the individual provide to the
Secretary an attestation that the
individual does not have such other
health insurance coverage; and
``(II) update such attestation--
``(aa) on an annual basis;
or
``(bb) if the health
insurance coverage situation of
the individual has changed.
``(C) Identification and reduction of improper
payments.--The Secretary, in consultation with the
Administrator of Social Security, shall--
``(i) establish procedures to ensure that
any information provided with respect to other
health insurance coverage described in
subparagraph (A) of this paragraph for an
individual described in paragraph (1) is
provided to the appropriate medicare
administrative contractor for purposes of
identifying any improper payments made with
respect to immunosuppressive drug coverage
under this part; and
``(ii) provide education to prevent or
reduce such improper payments, including
education through the improper payment outreach
and education program under section
1847A9(h).''.
(B) Conforming amendment.--Sections 1837, 1838, and
1839 of the Social Security Act (42 U.S.C. 1395p, 42
U.S.C. 1395q, 42 U.S.C. 1395r) are each amended by
striking ``1836'' and inserting ``1836(a)'' each place
it appears.
(b) Enrollment for Individuals Only Eligible for Coverage of
Immunosuppressive Drugs.--Section 1837 of the Social Security Act (42
U.S.C. 1395p) is amended by adding at the end the following new
subsection:
``(m)(1) Any individual who is eligible under section 1836(b) to
enroll in the medical insurance program established under this part for
purposes of coverage of immunosuppressive drugs may enroll only in such
manner and form as may be prescribed by regulations, and only during an
enrollment period described in this subsection.
``(2) An individual described in paragraph (1) whose entitlement
for hospital insurance benefits under part A ends by reason of section
226A(b)(2) prior to January 1, 2022, may enroll beginning on the first
day of the third month before the month in which the individual first
satisfies section 1836(b), or a date specified by the Secretary prior
to the first date on which coverage is effective under section
1838(g)(2), whichever is later. In implementing the preceding sentence,
the Secretary shall consider procedures to expedite the enrollment of
such an individual if practicable for purposes of providing continued
coverage of immunosuppressive drugs for such individual pursuant to
section 1838(g)(2).
``(3) An individual described in paragraph (1) whose entitlement
for hospital insurance benefits under part A ends by reason of section
226A(b)(2) on or after January 1, 2022, shall be deemed to have
enrolled in the medical insurance program established by this part for
purposes of coverage of immunosuppressive drugs.
``(4) The Secretary shall establish a process under which an
individual described in paragraph (1) whose other health insurance
coverage described in section 1836(b)(2)(A), or coverage under this
part (including the medical insurance program established under this
part for purposes of coverage of immunosuppressive drugs) is terminated
voluntarily or involuntary may enroll or reenroll, if applicable, in
the medical insurance program established under this part for purposes
of coverage of immunosuppressive drugs.''.
(c) Coverage Period for Individuals Only Eligible for Coverage of
Immunosuppressive Drugs.--
(1) In general.--Section 1838 of the Social Security Act
(42 U.S.C. 1395q) is amended by adding at the end the following
new subsection:
``(g) In the case of an individual described in section 1836(b)(1),
the following rules shall apply:
``(1) In the case of such an individual who is deemed to
have enrolled in part B for coverage of immunosuppressive drugs
under section 1837(m)(3), such individual's coverage period
shall begin on the first day of the month in which the
individual first satisfies section 1836(b).
``(2) In the case of such an individual who enrolls (or
reenrolls) in part B for coverage of immunosuppressive drugs
under paragraph (2) or (4) of section 1837(m), such
individual's coverage period shall begin on January 1, 2022 (or
such earlier date as the Secretary may specify if practicable
for purposes of providing continued coverage of
immunosuppressive drugs for such an individual), or the month
following the month in which the individual so enrolls (or
reenrolls), whichever is later.
``(3) The provisions of subsections (b) and (d) shall apply
with respect to an individual described in paragraph (1) or
(2).
``(4) In addition to the reasons for termination under
subsection (b), the coverage period of an individual described
in paragraph (1) or (2) shall end when the individual becomes
entitled to benefits under this title under section 226(a) or
226A or is no longer eligible for such coverage as a result of
the application of section 1836(b)(2).
``(5) The Secretary may conduct public education activities
to raise awareness of the availability of more comprehensive,
qualified health plans for beneficiaries eligible under this
subsection.''.
(2) Conforming amendments.--Section 1838(b) of the Social
Security Act (42 U.S.C. 1395q(b)) is amended, in the matter
following paragraph (2), by inserting ``or section 1837(m)(3)''
after ``section 1837(f)'' each place it appears.
(d) Premiums for Individuals Only Eligible for Coverage of
Immunosuppressive Drugs.--Section 1839 of the Social Security Act (42
U.S.C. 1395r) is amended--
(1) in subsection (b), by adding at the end the following
new sentence: ``No increase in the premium shall be effected
for individuals who are enrolled pursuant to section 1836(b)
for coverage only of immunosuppressive drugs.''; and
(2) by adding at the end the following new subsection:
``(j) Determination of Premium for Individuals Only Eligible for
Coverage of Immunosuppressive Drugs.--The Secretary shall, during
September of each year (beginning with 2021), determine and promulgate
a monthly premium rate for the succeeding calendar year for individuals
who enroll only for the purpose of coverage of immunosuppressive drugs
under section 1836(b). Such premium shall be equal to 35 percent of the
monthly actuarial rate for enrollees age 65 and over, determined
according to paragraph (1), for that succeeding calendar year. The
monthly premium of each individual enrolled for coverage of
immunosuppressive drugs under section 1836(b) for each month shall be
the amount promulgated in this subsection. Such amount shall be
adjusted in accordance with subsections (c), (f), and (i), but shall
not be adjusted under subsection (b).''.
(e) Government Contribution.--Section 1844(a) of the Social
Security Act (42 U.S.C. 1395w(a)) is amended--
(1) in paragraph (3), by striking the period at the end and
inserting ``; plus'';
(2) by inserting after paragraph (3) the following new
paragraph:
``(4) a Government contribution equal to the estimated
aggregate reduction in premiums payable under part B that
results from establishing the premium at 35 percent of the
actuarial rate under section 1839(j) instead of 50 percent of
the actuarial rate for individuals who enroll only for the
purpose of coverage of immunosuppressive drugs under section
1836(b).''; and
(3) by adding the following sentence at the end of the
flush matter following paragraph (4), as added by paragraph (2)
of this subsection:
``The Government contribution under paragraph (4) shall be
treated as premiums payable and deposited for purposes of
subparagraphs (A) and (B) of paragraph (1).''.
(f) Ensuring Coverage Under the Medicare Savings Program.--Section
1905(p)(1)(A) of the Social Security Act (42 U.S.C. 1396d(p)(1)(A)) is
amended by inserting ``or an individual who is enrolled under part B
for the purpose of coverage of immunosuppressive drugs under section
1836(b)'' after ``section 1818''.
(g) Part D.--Section 1860D-1(a)(3)(A) of the Social Security Act
(42 U.S.C. 1395w-101(a)(3)(A)) is amended by inserting ``(but not
including an individual enrolled solely for coverage of
immunosuppressive drugs under section 1836(b))'' before the period at
the end.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Subcommittee Hearings Held.
Subcommittee Consideration and Mark-up Session Held.
Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote .
Committee Consideration and Mark-up Session Held.
Ordered to be Reported (Amended) by Voice Vote.
Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 116-687, Part I.
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Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 116-687, Part I.
Committee on Ways and Means discharged.
Committee on Ways and Means discharged.
Placed on the Union Calendar, Calendar No. 570.