ESRD Choice Act of 2016

Summary: (This measure has not been amended since it was reported to the House on September 19, 2016.  Expanding Seniors Receiving Dialysis Choice Act of 2016 or the ESRD Choice Act of 2016 (Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to allow individuals with end-stage renal disease (ESRD) to be eligible for Medicare Advantage (MA). Under current law, only individuals who develop ESRD while already enrolled in an MA plan may be considered eligible. With respect to payment, the bill: (1) shifts responsibility for the cost of kidney acquisitions from MA plans to Medicare's fee-for-service program, and (2)&nbsp;excludes&nbsp;such costs&nbsp;from the calculation of certain benchmarks that&nbsp;form the basis for payment under MA plans.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expanding Seniors Receiving Dialysis 
Choice Act of 2016'' or as the ``ESRD Choice Act of 2016''.

SEC. 2. EXPANDING MEDICARE ADVANTAGE COVERAGE FOR INDIVIDUALS WITH END-
              STAGE RENAL DISEASE (ESRD).

    (a) Expanded MA Eligibility.--
            (1) In general.--Section 1851(a)(3) of the Social Security 
        Act (42 U.S.C. 1395w-21(a)(3)) is amended--
                    (A) by striking subparagraph (B); and
                    (B) by striking ``eligible individual'' and all 
                that follows through ``In this title, subject to 
                subparagraph (B),'' and inserting ``eligible 
                individual.--In this title,''.
            (2) Conforming amendments.--
                    (A) Section 1852(b)(1) of the Social Security Act 
                (42 U.S.C. 1395w-22(b)(1)) is amended--
                            (i) by striking subparagraph (B); and
                            (ii) by striking ``Beneficiaries'' and all 
                        that follows through ``A Medicare+Choice 
                        organization'' and inserting ``Beneficiaries.--
                        A Medicare Advantage organization''.
                    (B) Section 1859(b)(6) of the Social Security Act 
                (42 U.S.C. 1395w-28(b)(6)) is amended by striking ``may 
                waive'' and all that follows through ``subparagraph 
                and''.
    (b) Excluding Costs for Kidney Acquisitions From MA Benchmark.--
Section 1853 of the Social Security Act (42 U.S.C. 1395w-23) is 
amended--
            (1) in subsection (k)--
                    (A) in paragraph (1)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``paragraphs (2) and (4)'' and 
                        inserting ``paragraphs (2), (4), and (5)''; and
                            (ii) in subparagraph (B)(i), by striking 
                        ``paragraphs (2) and (4)'' and inserting 
                        ``paragraphs (2), (4), and (5)''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(5) Exclusion of costs for kidney acquisitions from 
        capitation rates.--After determining the applicable amount for 
        an area for a year under paragraph (1) (beginning with 2019), 
        the Secretary shall adjust such applicable amount to exclude 
        from such applicable amount the Secretary's estimate of the 
        standardized costs for payments for organ acquisitions for 
        kidney transplants covered under this title (including expenses 
        covered under section 1881(d)) in the area for the year.''; and
            (2) in subsection (n)(2)--
                    (A) in subparagraph (A)(i), by inserting ``and, for 
                2019 and subsequent years, the exclusion of payments 
                for organ acquisitions for kidney transplants from the 
                capitation rate as described in subsection (k)(5)'' 
                before the semicolon at the end;
                    (B) in subparagraph (E), in the matter preceding 
                clause (i), by striking ``subparagraph (F)'' and 
                inserting ``subparagraphs (F) and (G)''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(G) Application of kidney acquisitions 
                adjustment.--The base payment amount specified in 
                subparagraph (E) for a year (beginning with 2019) shall 
                be adjusted in the same manner under paragraph (5) of 
                subsection (k) as the applicable amount is adjusted 
                under such subsection.''.
    (c) FFS Coverage of Kidney Acquisitions.--
            (1) In general.--Section 1852(a)(1)(B)(i) of the Social 
        Security Act (42 U.S.C. 1395w-22(a)(1)(B)(i)) is amended by 
        inserting ``or coverage for organ acquisitions for kidney 
        transplants, including as covered under section 1881(d)'' after 
        ``hospice care''.
            (2) Conforming amendment.--Section 1851(i) of the Social 
        Security Act (42 U.S.C. 1395w-21(i)) is amended by adding at 
        the end the following new paragraph:
            ``(3) FFS payment for expenses for kidney acquisitions.--
        Paragraphs (1) and (2) do not apply with respect to expenses 
        for organ acquisitions for kidney transplants described in 
        section 1852(a)(1)(B)(i).''.
    (d) Sense of Congress Regarding Application of Appropriate Medicare 
Advantage Risk Adjustment for Payment for Increased ESRD Enrollees.--It 
is the sense of Congress that in implementing the policies under this 
section, the Centers for Medicare & Medicaid Services should provide, 
in an accurate and transparent manner, for risk adjustment to payment 
under the Medicare Advantage program to account for the increased 
enrollment in Medicare Advantage plans of individuals with end-stage 
renal disease.
    (e) Expanded MA Education.--Section 1851(d)(2)(A)(iii) of the 
Social Security Act (42 U.S.C. 1395w-21(d)(2)(A)(iii)) is amended by 
inserting before the period at the end the following: ``, including any 
additional information that individuals determined to have end-stage 
renal disease may need to make informed decisions with respect to such 
an election''.
    (f) Report.--Not later than April 1, 2022, the Administrator of the 
Centers for Medicare & Medicaid Services shall submit to Congress a 
report on the impact of the amendments made by this section on spending 
under the traditional Medicare fee-for-service program under parts A 
and B of title XVIII of the Social Security Act as well as on spending 
under parts C and D of such title. The report shall include an 
assessment of the risk adjustment payment methodologies under such 
parts C and D and their adequacy with respect to individuals with end-
stage renal disease and such recommendations as the Administrator deems 
appropriate.
    (g) Effective Date.--The amendments made by this section shall 
apply to plans years beginning on or after January 1, 2020.

            Passed the House of Representatives September 21, 2016.

            Attest:

                                                 KAREN L. HAAS,

                                                                 Clerk.