I 

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. 

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 Im5 munosuppressive Drug Coverage for Kidney Transplant 

6 Patients Act of 2019’’. 


pamtmann on DSKBC07HB2PROD with BILLS
2 

•HR 5534 IH

1 SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNO2 SUPPRESSIVE DRUGS FOR KIDNEY TRANS3 PLANT PATIENTS AND OTHER RENAL DIALY4 SIS PROVISIONS. 

5 (a) MEDICARE ENTITLEMENT TO IMMUNO6 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI7 ENTS.— 

8 (1) IN GENERAL.—Section 226A(b)(2) of the 

9 Social Security Act (42 U.S.C. 426–1(b)(2)) is 

10 amended by inserting ‘‘(except for eligibility for en11 rollment under part B solely for purposes of cov12 erage of immunosuppressive drugs described in sec13 tion 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth 

14 month’’. 

15 (2) INDIVIDUALS ELIGIBLE ONLY FOR COV16 ERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 

17 (A) IN GENERAL.—Section 1836 of the So18 cial Security Act (42 U.S.C. 1395o) is amend19 ed— 

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

21 ‘‘(a) IN GENERAL.—Every’’; and 

22 (ii) by adding at the end the following 

23 new subsection: 

24 ‘‘(b) INDIVIDUALS ELIGIBLE FOR IMMUNO25 SUPPRESSIVE DRUG COVERAGE.— 


pamtmann on DSKBC07HB2PROD with BILLS
3 

•HR 5534 IH

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

2 paragraph (2), every individual whose insurance ben3 efits under part A have ended (whether before, on, 

4 or after January 1, 2022) by reason of section 

5 226A(b)(2) is eligible to enroll in the insurance pro6 gram established by this part solely for purposes of 

7 coverage of immunosuppressive drugs in accordance 

8 with section 1837(m). 

9 ‘‘(2) EXCEPTION IF OTHER HEALTH INSUR10 ANCE COVERAGE IS AVAILABLE.— 

11 ‘‘(A) IN GENERAL.—An individual de12 scribed in paragraph (1) shall not be eligible for 

13 enrollment in the insurance program described 

14 in such paragraph with respect to any period in 

15 which the individual— 

16 ‘‘(i) is enrolled in a group health plan, 

17 as defined in section 2791(a)(1) of the 

18 Public Health Service Act, or individual 

19 health insurance coverage, as defined in 

20 section 2791(b)(5) of such Act, as deter21 mined in accordance with subparagraph 

22 (B); 

23 ‘‘(ii) is eligible for benefits under— 

24 ‘‘(I) a State plan under title 

25 XIX; 


pamtmann on DSKBC07HB2PROD with BILLS
4 

•HR 5534 IH

1 ‘‘(II) a State child health plan 

2 under title XXI; or 

3 ‘‘(III) the TRICARE program 

4 under chapter 55 of title 10, United 

5 States Code; 

6 ‘‘(iii) is enrolled in a health benefits 

7 plan under chapter 89 of title 5, United 

8 States Code; 

9 ‘‘(iv) is eligible for health care bene10 fits under the laws administered by the 

11 Secretary of Veterans Affairs; or 

12 ‘‘(v) is eligible to receive services from 

13 the Indian Health Service. 

14 ‘‘(B) ELIGIBILITY DETERMINATIONS.— 

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

16 consultation with the Administrator of So17 cial Security, shall establish procedures for 

18 determining whether an individual de19 scribed in paragraph (1) who is to be en20 rolled in the insurance program described 

21 in such paragraph meets the requirements 

22 for such enrollment under this subsection, 

23 including the requirement that the indi24 vidual not have other health insurance cov25 erage as described in subparagraph (A). 


pamtmann on DSKBC07HB2PROD with BILLS
5 

•HR 5534 IH

1 ‘‘(ii) ATTESTATION REGARDING

2 OTHER COVERAGE.—The procedures estab3 lished under clause (i) shall include a re4 quirement that— 

5 ‘‘(I) the individual provide to the 

6 Secretary an attestation that the indi7 vidual does not have such other health 

8 insurance coverage; and 

9 ‘‘(II) update such attestation— 

10 ‘‘(aa) on an annual basis; or 

11 ‘‘(bb) if the health insurance 

12 coverage situation of the indi13 vidual has changed. 

14 ‘‘(C) IDENTIFICATION AND REDUCTION OF

15 IMPROPER PAYMENTS.—The Secretary, in con16 sultation with the Administrator of Social Secu17 rity, shall— 

18 ‘‘(i) establish procedures to ensure 

19 that any information provided with respect 

20 to other health insurance coverage de21 scribed in subparagraph (A) of this para22 graph for an individual described in para23 graph (1) is provided to the appropriate 

24 medicare administrative contractor for pur25 poses of identifying any improper payVerDate Sep 11 2014 18:11 Dec 29, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5534.IH H5534

pamtmann on DSKBC07HB2PROD with BILLS
6 

•HR 5534 IH

1 ments made with respect to immuno2 suppressive drug coverage under this part; 

3 and 

4 ‘‘(ii) provide education to prevent or 

5 reduce such improper payments, including 

6 education through the improper payment 

7 outreach and education program under 

8 section 1847A9(h).’’. 

9 (B) CONFORMING AMENDMENT.—Sections 

10 1837, 1838, and 1839 of the Social Security 

11 Act (42 U.S.C. 1395p, 42 U.S.C. 1395q, 42 

12 U.S.C. 1395r) are each amended by striking 

13 ‘‘1836’’ and inserting ‘‘1836(a)’’ each place it 

14 appears. 

15 (b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE

16 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec17 tion 1837 of the Social Security Act (42 U.S.C. 1395p) 

18 is amended by adding at the end the following new sub19 section: 

20 ‘‘(m)(1) Any individual who is eligible under section 

21 1836(b) to enroll in the medical insurance program estab22 lished under this part for purposes of coverage of immuno23 suppressive drugs may enroll only in such manner and 

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

25 an enrollment period described in this subsection. 


pamtmann on DSKBC07HB2PROD with BILLS
7 

•HR 5534 IH

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

2 entitlement for hospital insurance benefits under part A 

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

4 2022, may enroll beginning on the first day of the third 

5 month before the month in which the individual first satis6 fies section 1836(b), or a date specified by the Secretary 

7 prior to the first date on which coverage is effective under 

8 section 1838(g)(2), whichever is later. In implementing 

9 the preceding sentence, the Secretary shall consider proce10 dures to expedite the enrollment of such an individual if 

11 practicable for purposes of providing continued coverage 

12 of immunosuppressive drugs for such individual pursuant 

13 to section 1838(g)(2). 

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

15 entitlement for hospital insurance benefits under part A 

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

17 1, 2022, shall be deemed to have enrolled in the medical 

18 insurance program established by this part for purposes 

19 of coverage of immunosuppressive drugs. 

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

21 which an individual described in paragraph (1) whose 

22 other health insurance coverage described in section 

23 1836(b)(2)(A), or coverage under this part (including the 

24 medical insurance program established under this part for 

25 purposes of coverage of immunosuppressive drugs) is terVerDate Sep 11 2014 18:11 Dec 29, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5534.IH H5534

pamtmann on DSKBC07HB2PROD with BILLS
8 

•HR 5534 IH

1 minated voluntarily or involuntary may enroll or reenroll, 

2 if applicable, in the medical insurance program established 

3 under this part for purposes of coverage of immuno4 suppressive drugs.’’. 

5 (c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELI6 GIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

7 DRUGS.— 

8 (1) IN GENERAL.—Section 1838 of the Social 

9 Security Act (42 U.S.C. 1395q) is amended by add10 ing at the end the following new subsection: 

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

12 1836(b)(1), the following rules shall apply: 

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

14 deemed to have enrolled in part B for coverage of 

15 immunosuppressive drugs under section 1837(m)(3), 

16 such individual’s coverage period shall begin on the 

17 first day of the month in which the individual first 

18 satisfies section 1836(b). 

19 ‘‘(2) In the case of such an individual who en20 rolls (or reenrolls) in part B for coverage of im21 munosuppressive drugs under paragraph (2) or (4) 

22 of section 1837(m), such individual’s coverage period 

23 shall begin on January 1, 2022 (or such earlier date 

24 as the Secretary may specify if practicable for pur25 poses of providing continued coverage of immunoVerDate Sep 11 2014 18:11 Dec 29, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5534.IH H5534

pamtmann on DSKBC07HB2PROD with BILLS
9 

•HR 5534 IH

1 suppressive drugs for such an individual), or the 

2 month following the month in which the individual 

3 so enrolls (or reenrolls), whichever is later. 

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

5 shall apply with respect to an individual described in 

6 paragraph (1) or (2). 

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

8 under subsection (b), the coverage period of an indi9 vidual described in paragraph (1) or (2) shall end 

10 when the individual becomes entitled to benefits 

11 under this title under section 226(a) or 226A or is 

12 no longer eligible for such coverage as a result of the 

13 application of section 1836(b)(2). 

14 ‘‘(5) The Secretary may conduct public edu15 cation activities to raise awareness of the availability 

16 of more comprehensive, qualified health plans for 

17 beneficiaries eligible under this subsection.’’. 

18 (2) CONFORMING AMENDMENTS.—Section 

19 1838(b) of the Social Security Act (42 U.S.C. 

20 1395q(b)) is amended, in the matter following para21 graph (2), by inserting ‘‘or section 1837(m)(3)’’ 

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

23 (d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE

24 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—SecVerDate Sep 11 2014 18:11 Dec 29, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5534.IH H5534

pamtmann on DSKBC07HB2PROD with BILLS
10 

•HR 5534 IH

1 tion 1839 of the Social Security Act (42 U.S.C. 1395r) 

2 is amended— 

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

4 following new sentence: ‘‘No increase in the pre5 mium shall be effected for individuals who are en6 rolled pursuant to section 1836(b) for coverage only 

7 of immunosuppressive drugs.’’; and 

8 (2) by adding at the end the following new sub9 section: 

10 ‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID11 UALS ONLY ELIGIBLE FOR COVERAGE OF IMMUNO12 SUPPRESSIVE DRUGS.—The Secretary shall, during Sep13 tember of each year (beginning with 2021), determine and 

14 promulgate a monthly premium rate for the succeeding 

15 calendar year for individuals who enroll only for the pur16 pose of coverage of immunosuppressive drugs under sec17 tion 1836(b). Such premium shall be equal to 35 percent 

18 of the monthly actuarial rate for enrollees age 65 and over, 

19 determined according to paragraph (1), for that suc20 ceeding calendar year. The monthly premium of each indi21 vidual enrolled for coverage of immunosuppressive drugs 

22 under section 1836(b) for each month shall be the amount 

23 promulgated in this subsection. Such amount shall be ad24 justed in accordance with subsections (c), (f), and (i), but 

25 shall not be adjusted under subsection (b).’’. 


pamtmann on DSKBC07HB2PROD with BILLS
11 

•HR 5534 IH

1 (e) GOVERNMENT CONTRIBUTION.—Section 1844(a) 

2 of the Social Security Act (42 U.S.C. 1395w(a)) is amend3 ed— 

4 (1) in paragraph (3), by striking the period at 

5 the end and inserting ‘‘; plus’’; 

6 (2) by inserting after paragraph (3) the fol7 lowing new paragraph: 

8 ‘‘(4) a Government contribution equal to the es9 timated aggregate reduction in premiums payable 

10 under part B that results from establishing the pre11 mium at 35 percent of the actuarial rate under sec12 tion 1839(j) instead of 50 percent of the actuarial 

13 rate for individuals who enroll only for the purpose 

14 of coverage of immunosuppressive drugs under sec15 tion 1836(b).’’; and 

16 (3) by adding the following sentence at the end 

17 of the flush matter following paragraph (4), as 

18 added by paragraph (2) of this subsection: 

19 ‘‘The Government contribution under paragraph (4) 

20 shall be treated as premiums payable and deposited 

21 for purposes of subparagraphs (A) and (B) of para22 graph (1).’’. 

23 (f) ENSURING COVERAGE UNDER THE MEDICARE

24 SAVINGS PROGRAM.—Section 1905(p)(1)(A) of the Social 

25 Security Act (42 U.S.C. 1396d(p)(1)(A)) is amended by 


pamtmann on DSKBC07HB2PROD with BILLS
12 

•HR 5534 IH

1 inserting ‘‘or an individual who is enrolled under part B 

2 for the purpose of coverage of immunosuppressive drugs 

3 under section 1836(b)’’ after ‘‘section 1818’’. 

4 (g) PART D.—Section 1860D–1(a)(3)(A) of the So5 cial Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is 

6 amended by inserting ‘‘(but not including an individual en7 rolled solely for coverage of immunosuppressive drugs 

8 under section 1836(b))’’ before the period at the end. 

Æ 


pamtmann on DSKBC07HB2PROD with BILLS