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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5534 Reported in House (RH)]

<DOC>

                                                 Union Calendar No. 570
116th CONGRESS
  2d Session
                                H. R. 5534

                      [Report No. 116-687, Part I]

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

                           December 24, 2020

   Additional sponsors: Mr. Rush, Mr. Fitzpatrick, Mr. Marchant, Mr. 
  Posey, Ms. Meng, Mr. Cole, Mrs. Axne, Mr. Cisneros, Mr. Kilmer, Ms. 
 Blunt Rochester, Mr. Visclosky, Mr. Higgins of New York, Ms. Kelly of 
     Illinois, Mrs. Luria, Mr. Latta, Mrs. Bustos, Mrs. Rodgers of 
Washington, Mr. Payne, Mr. Meeks, Mr. Case, Ms. DeGette, Mr. Grijalva, 
    Mr. Gonzalez of Texas, Mr. Deutch, Mr. Bilirakis, Mr. Ryan, Mr. 
Bucshon, Mr. Long, Ms. Norton, Mr. Lamb, Mr. Ruppersberger, Ms. Porter, 
  Ms. Brownley of California, Mr. Pocan, Mrs. Brooks of Indiana, Mr. 
 Gooden, Mr. Shimkus, Mr. Curtis, Mr. Neguse, Mrs. Murphy of Florida, 
 Mr. Kelly of Pennsylvania, Mr. Olson, Mr. Smucker, Ms. McCollum, Mr. 
  Costa, Mr. Cooper, Mr. Allred, Mr. Kildee, Mrs. Beatty, Ms. Jackson 
 Lee, Mr. Rouda, Mr. Kennedy, Ms. Wild, Mr. Rutherford, Mrs. Demings, 
    Mr. Connolly, Ms. Lofgren, Mr. Malinowski, Mr. Rodney Davis of 
  Illinois, Mr. Riggleman, Mr. McGovern, Ms. Clarke of New York, Ms. 
   Cheney, Mr. Soto, Mr. Evans, Mr. King of New York, Mr. Lujan, Mr. 
  Crawford, Mr. Welch, Mr. Blumenauer, Mr. Larson of Connecticut, Mr. 
 Rose of New York, Mr. Horsford, Mr. McKinley, Mr. Bishop of Georgia, 
 Mr. Trone, Mr. Gallego, Mr. Thompson of California, Mr. Wenstrup, Mr. 
Burchett, Mr. Price of North Carolina, Mr. Bost, Mr. Kim, Mr. Brindisi, 
Mr. Yarmuth, Mr. Nadler, Ms. Kaptur, Mr. Levin of Michigan, Ms. Kendra 
   S. Horn of Oklahoma, Mr. Simpson, Mr. Aguilar, Ms. Velazquez, Mr. 
Lawson of Florida, Ms. Roybal-Allard, Ms. Moore, Ms. Craig, Ms. Sewell 
of Alabama, Mr. Carson of Indiana, Mr. Richmond, Mr. Baird, Ms. Johnson 
  of Texas, Ms. Underwood, Mr. Hastings, Mr. Green of Texas, Mr. Van 
           Drew, Mrs. Miller, Ms. DelBene, and Ms. Finkenauer

                           December 24, 2020

  Reported from the Committee on Energy and Commerce with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

                           December 24, 2020

 Committee on Ways and Means discharged; committed to the Committee of 
  the Whole House on the State of the Union and ordered to be printed
    [For text of introduced bill, see copy of bill as introduced on 
                           December 23, 2019]

_______________________________________________________________________

                                 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 2020''.

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 entitlement to insurance benefits under 
        part A ends (whether before, on, or after January 1, 2023) by 
        reason of section 226A(b)(2) is eligible to enroll or to be 
        deemed to have enrolled in the medical insurance program 
        established by this part solely for purposes of coverage of 
        immunosuppressive drugs in accordance with section 1837(m).
            ``(2) Exception if other coverage is available.--
                    ``(A) In general.--An individual described in 
                paragraph (1) shall not be eligible for enrollment in 
                the program for purposes of coverage described in such 
                paragraph with respect to any period in which the 
                individual, as determined in accordance with 
                subparagraph (B)--
                            ``(i) is enrolled in a group health plan or 
                        group or individual health insurance coverage, 
                        as such terms are defined in section 2791 of 
                        the Public Health Service Act;
                            ``(ii) is enrolled for coverage under the 
                        TRICARE for Life program under section 1086(d) 
                        of title 10, United States Code;
                            ``(iii) is enrolled under a State plan (or 
                        waiver of such plan) under title XIX;
                            ``(iv) is enrolled under a State child 
                        health plan under title XXI; or
                            ``(v)(I) is enrolled in the patient 
                        enrollment system of the Department of Veterans 
                        Affairs established and operated under section 
                        1705 of title 38, United States Code;
                            ``(II) is not required to enroll under 
                        section 1705 of such title to receive 
                        immunosuppressive drugs described in this 
                        subsection; or
                            ``(III) is otherwise eligible under a 
                        provision of title 38, United States Code, 
                        other than section 1710 of such title to 
                        receive immunosuppressive drugs described in 
                        this subsection.
                    ``(B) Eligibility determinations.--
                            ``(i) In general.--The Secretary, in 
                        coordination with the Commissioner of Social 
                        Security, shall establish a process for 
                        determining whether an individual described in 
                        paragraph (1) who is to be enrolled or deemed 
                        to be enrolled in the medical insurance program 
                        described in such paragraph meets the 
                        requirements for such enrollment under this 
                        subsection, including the requirement that the 
                        individual not be enrolled in other coverage as 
                        described in subparagraph (A).
                            ``(ii) Attestation regarding other 
                        coverage.--The process established under clause 
                        (i) shall include, at a minimum, a requirement 
                        that--
                                    ``(I) the individual provide to the 
                                Commissioner an attestation that the 
                                individual is not enrolled and does not 
                                expect to enroll in such other 
                                coverage; and
                                    ``(II) the individual agree to 
                                notify the Commissioner within 60 days 
                                of enrollment in such other 
                                coverage.''.
                    (B) Conforming amendment.--
                            (i) In general.--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.
                            (ii) Additional amendment.--Section 
                        1837(j)(1) of such Act (42 U.S.C. 1395p(j)(1)) 
                        is amended by striking ``1836(1)'' and 
                        inserting ``1836(a)(1)''.
    (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 for coverage of 
immunosuppressive drugs under section 1836(b) may enroll or be deemed 
to have enrolled 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, 2023, may enroll beginning on October 1, 
2022, or the day on which the individual first satisfies section 
1836(b), whichever is later.
    ``(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, 2023, 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 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, if applicable) 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, 2023, 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 individuals eligible under section 
        1836(b) to enroll or to be deemed enrolled in the medical 
        insurance program established under this part for purposes of 
        coverage of immunosuppressive drugs.''.
            (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 2022), determine and promulgate 
a monthly premium rate for the succeeding calendar year for individuals 
enrolled 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 (as would be 
determined in accordance with subsection (a)(1) if the reference to 
`one-half' in such subsection were a reference to `100 percent') 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) 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 who is enrolled under part B for the purpose 
of coverage of immunosuppressive drugs under section 1836(b)'' after 
``under section 1818A)''.
    (f) 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.

SEC. 3. GAO STUDY AND REPORT.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the implementation of coverage of immunosuppressive drugs for 
kidney transplant patients under the Medicare program pursuant to the 
provisions of, and amendments made by, this Act.
    (b) Report.--Not later than January 1, 2025, the Comptroller 
General shall submit to Congress a report on the study conducted under 
subsection (a), together with recommendations as the Comptroller 
General determines appropriate.
                                                 Union Calendar No. 570

116th CONGRESS

  2d Session

                               H. R. 5534

                      [Report No. 116-687, Part I]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                           December 24, 2020

  Reported from the Committee on Energy and Commerce with an amendment

                           December 24, 2020

 Committee on Ways and Means discharged; committed to the Committee of 
  the Whole House on the State of the Union and ordered to be printed
```