IB 

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. LUJA ́N, 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 CaliVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H5534.RH H5534

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fornia, 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. VELA ́ZQUEZ, 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. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Comprehensive Immuno5 suppressive Drug Coverage for Kidney Transplant Patients 

6 Act of 2020’’. 

7 SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNO8 SUPPRESSIVE DRUGS FOR KIDNEY TRANS9 PLANT PATIENTS AND OTHER RENAL DIALY10 SIS PROVISIONS. 

11 (a) MEDICARE ENTITLEMENT TO IMMUNO12 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI13 ENTS.— 

14 (1) IN GENERAL.—Section 226A(b)(2) of the So15 cial Security Act (42 U.S.C. 426–1(b)(2)) is amended 

16 by inserting ‘‘(except for eligibility for enrollment 

17 under part B solely for purposes of coverage of im18 munosuppressive drugs described in section 

19 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth month’’. 

20 (2) INDIVIDUALS ELIGIBLE ONLY FOR COVERAGE

21 OF IMMUNOSUPPRESSIVE DRUGS.— 

22 (A) IN GENERAL.—Section 1836 of the So23 cial Security Act (42 U.S.C. 1395o) is amend24 ed— 


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1 (i) by striking ‘‘Every’’ and inserting 

2 ‘‘(a) IN GENERAL.—EVERY’’; and 

3 (ii) by adding at the end the following 

4 new subsection: 

5 ‘‘(b) INDIVIDUALS ELIGIBLE FOR IMMUNO6 SUPPRESSIVE DRUG COVERAGE.— 

7 ‘‘(1) IN GENERAL.—Except as provided under 

8 paragraph (2), every individual whose entitlement to 

9 insurance benefits under part A ends (whether before, 

10 on, or after January 1, 2023) by reason of section 

11 226A(b)(2) is eligible to enroll or to be deemed to have 

12 enrolled in the medical insurance program established 

13 by this part solely for purposes of coverage of im14 munosuppressive drugs in accordance with section 

15 1837(m). 

16 ‘‘(2) EXCEPTION IF OTHER COVERAGE IS AVAIL17 ABLE.— 

18 ‘‘(A) IN GENERAL.—An individual de19 scribed in paragraph (1) shall not be eligible for 

20 enrollment in the program for purposes of cov21 erage described in such paragraph with respect 

22 to any period in which the individual, as deter23 mined in accordance with subparagraph (B)— 

24 ‘‘(i) is enrolled in a group health plan 

25 or group or individual health insurance 


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1 coverage, as such terms are defined in sec2 tion 2791 of the Public Health Service Act; 

3 ‘‘(ii) is enrolled for coverage under the 

4 TRICARE for Life program under section 

5 1086(d) of title 10, United States Code; 

6 ‘‘(iii) is enrolled under a State plan 

7 (or waiver of such plan) under title XIX; 

8 ‘‘(iv) is enrolled under a State child 

9 health plan under title XXI; or 

10 ‘‘(v)(I) is enrolled in the patient enroll11 ment system of the Department of Veterans 

12 Affairs established and operated under sec13 tion 1705 of title 38, United States Code; 

14 ‘‘(II) is not required to enroll under 

15 section 1705 of such title to receive im16 munosuppressive drugs described in this 

17 subsection; or 

18 ‘‘(III) is otherwise eligible under a pro19 vision of title 38, United States Code, other 

20 than section 1710 of such title to receive im21 munosuppressive drugs described in this 

22 subsection. 

23 ‘‘(B) ELIGIBILITY DETERMINATIONS.— 

24 ‘‘(i) IN GENERAL.—The Secretary, in 

25 coordination with the Commissioner of SoVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534

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1 cial Security, shall establish a process for 

2 determining whether an individual de3 scribed in paragraph (1) who is to be en4 rolled or deemed to be enrolled in the med5 ical insurance program described in such 

6 paragraph meets the requirements for such 

7 enrollment under this subsection, including 

8 the requirement that the individual not be 

9 enrolled in other coverage as described in 

10 subparagraph (A). 

11 ‘‘(ii) ATTESTATION REGARDING OTHER

12 COVERAGE.—The process established under 

13 clause (i) shall include, at a minimum, a 

14 requirement that— 

15 ‘‘(I) the individual provide to the 

16 Commissioner an attestation that the 

17 individual is not enrolled and does not 

18 expect to enroll in such other coverage; 

19 and 

20 ‘‘(II) the individual agree to no21 tify the Commissioner within 60 days 

22 of enrollment in such other coverage.’’. 

23 (B) CONFORMING AMENDMENT.— 

24 (i) IN GENERAL.—Sections 1837, 1838, 

25 and 1839 of the Social Security Act (42 


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1 U.S.C. 1395p, 42 U.S.C. 1395q, 42 U.S.C. 

2 1395r) are each amended by striking 

3 ‘‘1836’’ and inserting ‘‘1836(a)’’ each place 

4 it appears. 

5 (ii) ADDITIONAL AMENDMENT.—Sec6 tion 1837(j)(1) of such Act (42 U.S.C. 

7 1395p(j)(1)) is amended by striking 

8 ‘‘1836(1)’’ and inserting ‘‘1836(a)(1)’’. 

9 (b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE

10 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Section 

11 1837 of the Social Security Act (42 U.S.C. 1395p) is 

12 amended by adding at the end the following new subsection: 

13 ‘‘(m)(1) Any individual who is eligible for coverage of 

14 immunosuppressive drugs under section 1836(b) may enroll 

15 or be deemed to have enrolled only in such manner and 

16 form as may be prescribed by regulations, and only during 

17 an enrollment period described in this subsection. 

18 ‘‘(2) An individual described in paragraph (1) whose 

19 entitlement for hospital insurance benefits under part A 

20 ends by reason of section 226A(b)(2) prior to January 1, 

21 2023, may enroll beginning on October 1, 2022, or the day 

22 on which the individual first satisfies section 1836(b), 

23 whichever is later. 

24 ‘‘(3) An individual described in paragraph (1) whose 

25 entitlement for hospital insurance benefits under part A 


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1 ends by reason of section 226A(b)(2) on or after January 

2 1, 2023, shall be deemed to have enrolled in the medical 

3 insurance program established by this part for purposes of 

4 coverage of immunosuppressive drugs. 

5 ‘‘(4) The Secretary shall establish a process under 

6 which an individual described in paragraph (1) whose other 

7 coverage described in section 1836(b)(2)(A), or coverage 

8 under this part (including the medical insurance program 

9 established under this part for purposes of coverage of im10 munosuppressive drugs) is terminated voluntarily or invol11 untary may enroll or reenroll, if applicable, in the medical 

12 insurance program established under this part for purposes 

13 of coverage of immunosuppressive drugs.’’. 

14 (c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELIGI15 BLE FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 

16 (1) IN GENERAL.—Section 1838 of the Social Se17 curity Act (42 U.S.C. 1395q) is amended by adding 

18 at the end the following new subsection: 

19 ‘‘(g) In the case of an individual described in section 

20 1836(b)(1), the following rules shall apply: 

21 ‘‘(1) In the case of such an individual who is 

22 deemed to have enrolled in part B for coverage of im23 munosuppressive drugs under section 1837(m)(3), 

24 such individual’s coverage period shall begin on the 


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1 first day of the month in which the individual first 

2 satisfies section 1836(b). 

3 ‘‘(2) In the case of such an individual who en4 rolls (or reenrolls, if applicable) in part B for cov5 erage of immunosuppressive drugs under paragraph 

6 (2) or (4) of section 1837(m), such individual’s cov7 erage period shall begin on January 1, 2023, or the 

8 month following the month in which the individual so 

9 enrolls (or reenrolls), whichever is later. 

10 ‘‘(3) The provisions of subsections (b) and (d) 

11 shall apply with respect to an individual described in 

12 paragraph (1) or (2). 

13 ‘‘(4) In addition to the reasons for termination 

14 under subsection (b), the coverage period of an indi15 vidual described in paragraph (1) or (2) shall end 

16 when the individual becomes entitled to benefits under 

17 this title under section 226(a) or 226A or is no longer 

18 eligible for such coverage as a result of the application 

19 of section 1836(b)(2). 

20 ‘‘(5) The Secretary may conduct public edu21 cation activities to raise awareness of the availability 

22 of more comprehensive, qualified health plans for in23 dividuals eligible under section 1836(b) to enroll or to 

24 be deemed enrolled in the medical insurance program 


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1 established under this part for purposes of coverage of 

2 immunosuppressive drugs.’’. 

3 (2) CONFORMING AMENDMENTS.—Section 

4 1838(b) of the Social Security Act (42 U.S.C. 

5 1395q(b)) is amended, in the matter following para6 graph (2), by inserting ‘‘or section 1837(m)(3)’’ after 

7 ‘‘section 1837(f)’’ each place it appears. 

8 (d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE FOR

9 COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Section 

10 1839 of the Social Security Act (42 U.S.C. 1395r) is 

11 amended— 

12 (1) in subsection (b), by adding at the end the 

13 following new sentence: ‘‘No increase in the premium 

14 shall be effected for individuals who are enrolled pur15 suant to section 1836(b) for coverage only of immuno16 suppressive drugs.’’; and 

17 (2) by adding at the end the following new sub18 section: 

19 ‘‘(j) DETERMINATION OF PREMIUM FOR INDIVIDUALS

20 ONLY ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

21 DRUGS.—The Secretary shall, during September of each 

22 year (beginning with 2022), determine and promulgate a 

23 monthly premium rate for the succeeding calendar year for 

24 individuals enrolled only for the purpose of coverage of im25 munosuppressive drugs under section 1836(b). Such preVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534

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1 mium shall be equal to 35 percent of the monthly actuarial 

2 rate for enrollees age 65 and over (as would be determined 

3 in accordance with subsection (a)(1) if the reference to ‘one4 half’ in such subsection were a reference to ‘100 percent’) 

5 for that succeeding calendar year. The monthly premium 

6 of each individual enrolled for coverage of immuno7 suppressive drugs under section 1836(b) for each month 

8 shall be the amount promulgated in this subsection. Such 

9 amount shall be adjusted in accordance with subsections (c), 

10 (f), and (i), but shall not be adjusted under subsection (b).’’. 

11 (e) ENSURING COVERAGE UNDER THE MEDICARE SAV12 INGS PROGRAM.—Section 1905(p)(1)(A) of the Social Secu13 rity Act (42 U.S.C. 1396d(p)(1)(A)) is amended by insert14 ing ‘‘or who is enrolled under part B for the purpose of 

15 coverage of immunosuppressive drugs under section 

16 1836(b)’’ after ‘‘under section 1818A)’’. 

17 (f) PART D.—Section 1860D–1(a)(3)(A) of the Social 

18 Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is amended 

19 by inserting ‘‘(but not including an individual enrolled 

20 solely for coverage of immunosuppressive drugs under sec21 tion 1836(b))’’ before the period at the end. 

22 SEC. 3. GAO STUDY AND REPORT. 

23 (a) STUDY.—The Comptroller General of the United 

24 States (in this section referred to as the ‘‘Comptroller Gen25 eral’’) shall conduct a study on the implementation of covVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534

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1 erage of immunosuppressive drugs for kidney transplant 

2 patients under the Medicare program pursuant to the provi3 sions of, and amendments made by, this Act. 

4 (b) REPORT.—Not later than January 1, 2025, the 

5 Comptroller General shall submit to Congress a report on 

6 the study conducted under subsection (a), together with rec7 ommendations as the Comptroller General determines ap8 propriate. 


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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 

transplant patients, and for other purposes. erage of immunosuppressive drugs for kidney provide for extended months of Medicare covDECEMBER 24, 2020 

Reported from the Committee on Energy and Commerce 

D

with an amendment 

ECEMBER 24, 2020 

Committee on Ways and Means discharged; committed to 

Union and ordered to be printed the Committee of the Whole House on the State of the 


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