Restore Protections for Dialysis Patients Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1173 Introduced in Senate (IS)]

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119th CONGRESS
  1st Session
                                S. 1173

To amend title XVIII of the Social Security Act to clarify and preserve 
 the breadth of the protections under the Medicare Secondary Payer Act.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 27, 2025

  Mr. Cassidy (for himself, Mr. Booker, Mr. Cramer, and Mr. Heinrich) 
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 clarify and preserve 
 the breadth of the protections under the Medicare Secondary Payer Act.

    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 ``Restore Protections for Dialysis 
Patients Act''.

SEC. 2. PURPOSES.

    The purposes of this Act are the following:
            (1) To restore protections under Medicare Secondary Payer 
        provisions for individuals with end-stage renal disease by 
        ensuring that private health plans do not discriminate against 
        such individuals or adversely classify dialysis as compared to 
        other covered medical services.
            (2) To prohibit health insurance plans from shifting 
        primary responsibility for covering the cost of health care 
        services needed by individuals with end-stage renal disease to 
        the Medicare program.
            (3) To affirm the intent of Congress by clarifying that 
        singling out dialysis services for disfavored treatment through 
        coverage limitations as compared to other covered health 
        services constitutes inappropriate differentiations between the 
        benefits provided to individuals with end-stage renal disease 
        and other individuals, but does not change a plan's ability to 
        limit which renal dialysis providers it includes in the 
        provider network it elects to offer its enrollees.

SEC. 3. CLARIFICATION AND PRESERVATION OF PROHIBITION UNDER THE 
              MEDICARE PROGRAM.

    Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 
1395y(b)(1)(C)) is amended--
            (1) by striking clause (ii) and inserting the following:
                            ``(ii) may not on any basis (including the 
                        diagnosis of end-stage renal disease or the 
                        need for renal dialysis) or in any manner--
                                    ``(I) differentiate (or have the 
                                effect of differentiating) in the 
                                benefits it provides between 
                                individuals having end stage renal 
                                disease and other individuals covered 
                                by such plan; or
                                    ``(II) apply a limitation on 
                                benefits (including on network 
                                composition) under the plan that will 
                                disparately affect individuals having 
                                end-stage renal disease;''; and
            (2) by adding at the end of the matter following clause 
        (ii) the following: ``Nothing in this subsection shall be 
        construed as requiring a group health plan to include a 
        particular renal dialysis provider or a particular number of 
        renal dialysis providers as part of the provider network the 
        group health plan elects to offer its enrollees. The Secretary 
        shall enforce this subparagraph consistent with the 
        nonconformance determination requirements described in part 411 
        of title 42, Code of Federal Regulations (or any successor 
        regulation).''.
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