I 

111TH CONGRESS 

1ST SESSION H. R. 1458 

To amend title XVIII of the Social Security Act to provide continued entitlement to coverage for immunosuppressive drugs furnished to beneficiaries 

under the Medicare Program that have received a kidney transplant 

and whose entitlement to coverage would otherwise expire, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 12, 2009 

Mr. CAMP (for himself and Mr. KIND) introduced the following bill; which was 

referred to the Committee on Ways and Means, and in addition to the 

Committees on Energy and Commerce and Education and Labor, 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 

continued entitlement to coverage for immunosuppressive 

drugs furnished to beneficiaries under the Medicare Program that have received a kidney transplant and whose 

entitlement to coverage would otherwise expire, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Comprehensive Im3 munosuppressive Drug Coverage for Kidney Transplant 

4 Patients Act of 2009’’. 

5 SEC. 2. PROVISION OF APPROPRIATE COVERAGE OF IM6 MUNOSUPPRESSIVE DRUGS UNDER THE 

7 MEDICARE PROGRAM FOR KIDNEY TRANS8 PLANT RECIPIENTS. 

9 (a) CONTINUED ENTITLEMENT TO IMMUNO10 SUPPRESSIVE DRUGS.— 

11 (1) KIDNEY TRANSPLANT RECIPIENTS.—Sec12 tion 226A(b)(2) of the Social Security Act (42 

13 U.S.C. 426–1(b)(2)) is amended by inserting ‘‘(ex14 cept for coverage of immunosuppressive drugs under 

15 section 1861(s)(2)(J))’’ after ‘‘shall end’’. 

16 (2) APPLICATION.—Section 1836 of the Social 

17 Security Act (42 U.S.C. 1395o) is amended— 

18 (A) by striking ‘‘Every individual who’’ 

19 and inserting ‘‘(a) IN GENERAL.—Every indi20 vidual who’’; and 

21 (B) by adding at the end the following new 

22 subsection: 

23 ‘‘(b) SPECIAL RULES APPLICABLE TO INDIVIDUALS

24 ELIGIBLE ONLY FOR COVERAGE OF IMMUNOSUPPRESSIVE

25 DRUGS.— 


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1 ‘‘(1) IN GENERAL.—In the case of an individual 

2 whose eligibility for benefits under this title has 

3 ended except for the coverage of immunosuppressive 

4 drugs by reason of section 226A(b)(2), the following 

5 rules shall apply: 

6 ‘‘(A) The individual shall be deemed to be 

7 enrolled under this part for purposes of receiv8 ing coverage of such drugs. 

9 ‘‘(B) The individual shall be responsible 

10 for the full amount of the premium under sec11 tion 1839 in order to receive such coverage. 

12 ‘‘(C) The provision of such drugs shall be 

13 subject to the application of— 

14 ‘‘(i) the deductible under section 

15 1833(b); and 

16 ‘‘(ii) the coinsurance amount applica17 ble for such drugs (as determined under 

18 this part). 

19 ‘‘(D) If the individual is an inpatient of a 

20 hospital or other entity, the individual is enti21 tled to receive coverage of such drugs under 

22 this part. 

23 ‘‘(2) ESTABLISHMENT OF PROCEDURES IN

24 ORDER TO IMPLEMENT COVERAGE.—The Secretary 

25 shall establish procedures for— 


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1 ‘‘(A) identifying beneficiaries that are enti2 tled to coverage of immunosuppressive drugs by 

3 reason of section 226A(b)(2); and 

4 ‘‘(B) distinguishing such beneficiaries from 

5 beneficiaries that are enrolled under this part 

6 for the complete package of benefits under this 

7 part.’’. 

8 (3) TECHNICAL AMENDMENT.—Subsection (c) 

9 of section 226A of the Social Security Act (42 

10 U.S.C. 426–1), as added by section 201(a)(3)(D)(ii) 

11 of the Social Security Independence and Program 

12 Improvements Act of 1994 (Public Law 103–296; 

13 108 Stat. 1497), is redesignated as subsection (d). 

14 (b) EXTENSION OF SECONDARY PAYER REQUIRE15 MENTS FOR ESRD BENEFICIARIES.—Section 

16 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 

17 1395y(b)(1)(C)) is amended by adding at the end the fol18 lowing new sentence: ‘‘With regard to immunosuppressive 

19 drugs furnished on or after the date of enactment of the 

20 Comprehensive Immunosuppressive Drug Coverage for 

21 Kidney Transplant Patients Act of 2009, this subpara22 graph shall be applied without regard to any time limita23 tion.’’. 


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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to drugs furnished on or after the 

3 date of enactment of this Act. 

4 SEC. 3. PLANS REQUIRED TO MAINTAIN COVERAGE OF IM5 MUNOSUPPRESSIVE DRUGS FOR KIDNEY 

6 TRANSPLANT RECIPIENTS. 

7 (a) APPLICATION TO CERTAIN HEALTH INSURANCE

8 COVERAGE.— 

9 (1) IN GENERAL.—Subpart 2 of part A of title 

10 XXVII of the Public Health Service Act (42 U.S.C. 

11 300gg–4 et seq.) is amended by adding at the end 

12 the following: 

13 ‘‘SEC. 2708. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS 

14 FOR KIDNEY TRANSPLANT RECIPIENTS. 

15 ‘‘A group health plan (and a health insurance issuer 

16 offering health insurance coverage in connection with a 

17 group health plan) shall provide coverage of immuno18 suppressive drugs in connection with a kidney transplant 

19 that is at least as comprehensive as the coverage provided 

20 by such plan or issuer on the day before the date of enact21 ment of the Comprehensive Immunosuppressive Drug 

22 Coverage for Kidney Transplant Patients Act of 2009, 

23 and such requirement shall be deemed to be incorporated 

24 into this section.’’. 


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1 (2) CONFORMING AMENDMENT.—Section 

2 2721(b)(2)(A) of the Public Health Service Act (42 

3 U.S.C. 300gg–21(b)(2)(A)) is amended by inserting 

4 ‘‘(other than section 2708)’’ after ‘‘requirements of 

5 such subparts’’. 

6 (b) APPLICATION TO GROUP HEALTH PLANS AND

7 GROUP HEALTH INSURANCE COVERAGE UNDER THE EM8 PLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.— 

9 (1) IN GENERAL.—Subpart B of part 7 of sub10 title B of title I of the Employee Retirement Income 

11 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

12 amended by adding at the end the following new sec13 tion: 

14 ‘‘SEC. 715. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS 

15 FOR KIDNEY TRANSPLANT RECIPIENTS. 

16 ‘‘A group health plan (and a health insurance issuer 

17 offering health insurance coverage in connection with a 

18 group health plan) shall provide coverage of immuno19 suppressive drugs in connection with a kidney transplant 

20 that is at least as comprehensive as the coverage provided 

21 by such plan or issuer on the day before the date of enact22 ment of the Comprehensive Immunosuppressive Drug 

23 Coverage for Kidney Transplant Patients Act of 2009, 

24 and such requirement shall be deemed to be incorporated 

25 into this section.’’. 


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1 (2) CONFORMING AMENDMENTS.— 

2 (A) Section 732(a) of the Employee Retire3 ment Income Security Act of 1974 (29 U.S.C. 

4 1191a(a)) is amended by striking ‘‘section 711’’ 

5 and inserting ‘‘sections 711 and 715’’. 

6 (B) The table of contents in section 1 of 

7 the Employee Retirement Income Security Act 

8 of 1974 is amended by inserting after the item 

9 relating to section 714 the following new item: 

‘‘Sec. 715. Coverage of immunosuppressive drugs.’’. 

10 (c) APPLICATION TO GROUP HEALTH PLANS UNDER

11 THE INTERNAL REVENUE CODE OF 1986.—Subchapter B 

12 of chapter 100 of the Internal Revenue Code of 1986 is 

13 amended— 

14 (1) in the table of sections, by inserting after 

15 the item relating to section 9813 the following new 

16 item: 

‘‘Sec. 9814. Coverage of immunosuppressive drugs for kidney transplant recipients.’’; 

17 and 

18 (2) by inserting after section 9813 the fol19 lowing: 

20 ‘‘SEC. 9814. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS 

21 FOR KIDNEY TRANSPLANT RECIPIENTS. 

22 ‘‘A group health plan shall provide coverage of im23 munosuppressive drugs in connection with a kidney transVerDate Nov 24 2008 22:07 Mar 13, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1458.IH H1458

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1 plant that is at least as comprehensive as the coverage 

2 provided by such plan on the day before the date of enact3 ment of the Comprehensive Immunosuppressive Drug 

4 Coverage for Kidney Transplant Patients Act of 2009, 

5 and such requirement shall be deemed to be incorporated 

6 into this section.’’. 

7 (d) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply to plan years beginning on or after 

9 January 1, 2010. 

Æ 


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