I 

113TH CONGRESS 

1ST SESSION H. R. 1428 

To amend title XVIII of the Social Security Act to provide Medicare 

entitlement to immunosuppressive drugs for kidney transplant recipients. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 9, 2013 

Mr. BURGESS (for himself, Mr. KIND, Mrs. BLACKBURN, Mr. MARINO, Mr. 

CASSIDY, Mr. YOUNG of Florida, Mr. CRENSHAW, Mr. MCDERMOTT, Mr. 

BACHUS, Mr. GRIMM, Mr. WOLF, Mr. TIBERI, Mr. LOEBSACK, Mr. COOPER, Mr. HIMES, Mrs. CAPPS, Mr. TAKANO, Mr. CUMMINGS, Mr. HASTINGS of Florida, Mr. HOLT, Mrs. DAVIS of California, Ms. ESHOO, and 

Mr. DAVID SCOTT of Georgia) 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 

Medicare entitlement to immunosuppressive drugs for 

kidney transplant recipients. 

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 2013’’. 


sroberts on DSK5SPTVN1PROD with BILLS
2 

•HR 1428 IH

1 SEC. 2. MEDICARE ENTITLEMENT TO IMMUNO2 SUPPRESSIVE DRUGS FOR KIDNEY TRANS3 PLANT RECIPIENTS. 

4 (a) KIDNEY TRANSPLANT RECIPIENTS.—Section 

5 226A(b)(2) of the Social Security Act (42 U.S.C. 426– 

6 1(b)(2)) is amended by inserting ‘‘(except for eligibility for 

7 enrollment under part B solely for purposes of coverage 

8 of immunosuppressive drugs described in section 

9 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth month’’. 

10 (b) INDIVIDUALS ELIGIBLE ONLY FOR COVERAGE OF

11 IMMUNOSUPPRESSIVE DRUGS.— 

12 (1) IN GENERAL.—Section 1836 of the Social 

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

14 (A) by striking ‘‘Every’’ and inserting ‘‘(a) 

15 IN GENERAL.—Every’’; and 

16 (B) by inserting at the end the following 

17 new subsection: 

18 ‘‘(b) INDIVIDUALS ELIGIBLE FOR IMMUNO19 SUPPRESSIVE DRUG COVERAGE.—Beginning on January 

20 1, 2014, every individual whose insurance benefits under 

21 part A have ended (whether before, on, or after such date) 

22 by reason of section 226A(b)(2) is eligible for enrollment 

23 in the insurance program established by this part solely 

24 for purposes of coverage of immunosuppressive drugs.’’. 

25 (2) CONFORMING AMENDMENT.—Sections 

26 1837, 1838, and 1839 of the Social Security Act (42 


sroberts on DSK5SPTVN1PROD with BILLS
3 

•HR 1428 IH

1 U.S.C. 1395(o), 42 U.S.C. 1395(p), 42 U.S.C. 

2 1395(q)) are each amended by striking ‘‘1836’’ and 

3 inserting ‘‘1836(a)’’ each place it appears. 

4 (c) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE

5 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec6 tion 1837 of the Social Security Act (42 U.S.C. 1395(p)) 

7 is amended by adding at the end the following new sub8 section: 

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

10 1836(b) to enroll in the medical insurance program estab11 lished under this part for purposes of coverage of immuno12 suppressive drugs may enroll only in such manner and 

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

14 an enrollment period described in this subsection. 

15 ‘‘(2) An individual described in paragraph (1) may 

16 enroll beginning on the first day of the third month before 

17 the month in which the individual first satisfies section 

18 1836(b). 

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

20 entitlement for hospital insurance benefits under part A 

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

22 1, 2014, shall be deemed to have enrolled in the medical 

23 insurance program established by this part for purposes 

24 of coverage of immunosuppressive drugs.’’. 


sroberts on DSK5SPTVN1PROD with BILLS
4 

•HR 1428 IH

1 (d) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELI2 GIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

3 DRUGS.— 

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

5 Security Act (42 U.S.C. 1395(q)) is amended by 

6 adding at the end the following new subsection: 

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

8 1836(b), the following rules shall apply: 

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

10 deemed to have enrolled in part B for coverage of 

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

12 such individual’s coverage period shall begin on the 

13 first day of the month in which the individual first 

14 satisfies section 1836(b). 

15 ‘‘(2) In the case of such an individual who en16 rolls in part B for coverage of immunosuppressive 

17 drugs under section 1837(m)(2), such individual’s 

18 coverage period shall begin on the first day of the 

19 month in which the individual first satisfies section 

20 1836(b) or the month following the month in which 

21 the individual so enrolls, whichever is later. 

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

23 shall apply with respect to an individual described in 

24 paragraph (1) or (2). 


sroberts on DSK5SPTVN1PROD with BILLS
5 

•HR 1428 IH

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

2 under subsection (b), the coverage period of an indi3 vidual described in paragraph (1) or (2) shall end 

4 when the individual becomes entitled to benefits 

5 under this title under section 226(a), 226(b), or 

6 226A.’’. 

7 (2) CONFORMING AMENDMENTS.—Section 

8 1838(b) is amended in the matter following para9 graph (2) by adding ‘‘or section 1837(m)(3)’’ after 

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

11 (e) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE

12 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec13 tion 1839 of the Social Security Act (42 U.S.C. 1395r) 

14 is amended— 

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

16 following new sentence: ‘‘No increase in the pre17 mium shall be effected for individuals who are en18 rolled pursuant to section 1836(b) for coverage only 

19 of immunosuppressive drugs.’’; and 

20 (2) by adding at the end the following new sub21 section: 

22 ‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID23 UALS ONLY ELIGIBLE FOR COVERAGE OF IMMUNO24 SUPPRESSIVE DRUGS.—The Secretary shall, during Sep25 tember of each year, determine and promulgate a monthly 


sroberts on DSK5SPTVN1PROD with BILLS
6 

•HR 1428 IH

1 premium rate for the succeeding calendar year for individ2 uals who enroll only for the purpose of coverage of im3 munosuppressive drugs under section 1836(b). Such pre4 mium shall be equal to 35 percent of the monthly actuarial 

5 rate for enrollees age 65 and over, determined according 

6 to paragraph (1), for that succeeding calendar year. The 

7 monthly premium of each individual enrolled for coverage 

8 of immunosuppressive drugs under section 1836(b) for 

9 each month shall be the amount promulgated in this sub10 section. Such amount shall be adjusted in accordance with 

11 subsections (c) and (f).’’. 

12 (f) GOVERNMENT CONTRIBUTION.—Section 1844(a) 

13 of the Social Security Act (42 U.S.C. 1395(w)) is amend14 ed— 

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

16 the end and inserting ‘‘; plus’’; 

17 (2) by adding at the end the following new 

18 paragraph: 

19 ‘‘(4) a Government contribution equal to the es20 timated aggregate reduction in premiums payable 

21 under part B that results from establishing the pre22 mium at 35 percent of the actuarial rate under sec23 tion 1839(j) instead of 50 percent of the actuarial 

24 rate for individuals who enroll only for the purpose 


sroberts on DSK5SPTVN1PROD with BILLS
7 

•HR 1428 IH

1 of coverage of immunosuppressive drugs under sec2 tion 1836(b).’’; and 

3 (3) by adding at the end the following flush 

4 matter: 

5 ‘‘The Government contribution under paragraph (4) 

6 shall be treated as premiums payable and deposited 

7 for purposes of subparagraphs (A) and (B) of para8 graph (1).’’. 

9 (g) EXTENSION OF SECONDARY PAYER REQUIRE10 MENTS FOR ESRD BENEFICIARIES ELIGIBLE FOR COV11 ERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Section 

12 1862(b)(1)(C) (42 U.S.C. 1395(y)(b)(1)) is amended by 

13 adding at the end the following new sentence: ‘‘With re14 gard to immunosuppressive drugs furnished to an indi15 vidual who enrolls for the purpose of coverage of immuno16 suppressive drugs under section 1836(b) on or after Janu17 ary 1, 2014, this subparagraph shall apply without regard 

18 to any time limitation, except that when such individual 

19 becomes entitled to benefits under this title under sections 

20 226(a) or 226(b), or entitled to or eligible for benefits 

21 under this title under section 226A, the provisions of sub22 paragraphs (A) and (B), and the time limitations under 

23 this subparagraph, respectively, shall apply.’’. 

24 (h) ENSURING COVERAGE UNDER THE MEDICARE

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


sroberts on DSK5SPTVN1PROD with BILLS
8 

•HR 1428 IH

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

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

3 for the purpose of coverage of immunosuppressive drugs 

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

5 (i) PART D.—Section 1860D–1(a)(3)(A) of the So6 cial Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is 

7 amended by inserting ‘‘(but not including an individual en8 rolled solely for coverage of immunosuppressive drugs 

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

Æ 


sroberts on DSK5SPTVN1PROD with BILLS