I

107TH CONGRESS

1ST SESSION H. R. 1839

To amend title XVIII of the Social Security Act to provide adequate coverage

for immunosuppressive drugs furnished to beneficiaries under the medicare program that have received an organ transplant, and for other

purposes.

IN THE HOUSE OF REPRESENTATIVES

MAY 15, 2001

Mr. CAMP (for himself and Mrs. THURMAN) 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 the

Workforce, 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

adequate coverage for immunosuppressive drugs furnished to beneficiaries under the medicare program that

have received an organ transplant, 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 ‘‘Immunosuppressive

5 Drug Coverage Act of 2001’’.
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1 SEC. 2. PROVISION OF APPROPRIATE COVERAGE OF IM2 MUNOSUPPRESSIVE DRUGS UNDER THE

3 MEDICARE PROGRAM.

4 (a) CONTINUED ENTITLEMENT TO IMMUNO5 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI6 ENTS.—

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

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

9 amended by inserting ‘‘(except for coverage of im10 munosuppressive drugs under section

11 1861(s)(2)(J))’’ after ‘‘shall end’’.

12 (2) APPLICATION.—In the case of an individual

13 whose eligibility for benefits under title XVIII of the

14 Social Security Act (42 U.S.C. 1395 et seq.) has

15 ended except for the coverage of immunosuppressive

16 drugs by reason of the amendment made by para17 graph (1), the following rules shall apply:

18 (A) The individual shall be deemed to be

19 enrolled in part B of the original medicare fee20 for-service program under title XVIII of the So21 cial Security Act (42 U.S.C. 1395j et seq.) for

22 purposes of receiving coverage of such drugs.

23 (B) The individual shall be responsible for

24 the full part B premium under section 1839 of

25 such Act (42 U.S.C. 1395r) in order to receive

26 such coverage.
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1 (C) The provision of such drugs shall be

2 subject to the application of—

3 (i) the part B deductible under section

4 1833(b) of such Act (42 U.S.C. 1395l(b));

5 and

6 (ii) the coinsurance amount applicable

7 for such drugs (as determined under such

8 part B).

9 (D) If the individual is an inpatient of a

10 hospital or other entity, the individual is enti11 tled to receive coverage of such drugs under

12 such part B.

13 (3) ESTABLISHMENT OF PROCEDURES IN

14 ORDER TO IMPLEMENT COVERAGE.—The Secretary

15 of Health and Human Services shall establish proce16 dures for—

17 (A) identifying beneficiaries that are enti18 tled to coverage of immunosuppressive drugs by

19 reason of the amendment made by paragraph

20 (1); and

21 (B) distinguishing such beneficiaries from

22 beneficiaries that are enrolled under part B of

23 title XVIII of the Social Security Act for the

24 complete package of benefits under such part.
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1 (4) TECHNICAL AMENDMENT.—Subsection (c)

2 of section 226A (42 U.S.C. 426–1), as added by sec3 tion 201(a)(3)(D)(ii) of the Social Security Inde4 pendence and Program Improvements Act of 1994

5 (Public Law 103–296; 108 Stat. 1497), is redesig6 nated as subsection (d).

7 (b) EXTENSION OF SECONDARY PAYER REQUIRE8 MENTS FOR ESRD BENEFICIARIES.—Section

9 1862(b)(1)(C) of the Social Security Act (42 U.S.C.

10 1395y(b)(1)(C)) is amended by adding at the end the fol11 lowing new sentence: ‘‘With regard to immunosuppressive

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

13 Immunosuppressive Drugs Coverage Act of 2001, this

14 subparagraph shall be applied without regard to any time

15 limitation.’’.

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

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

18 date of enactment of this Act.

19 SEC. 3. PLANS REQUIRED TO MAINTAIN COVERAGE OF IM20 MUNOSUPPRESSIVE DRUGS.

21 (a) APPLICATION TO CERTAIN HEALTH INSURANCE

22 COVERAGE.—

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

24 XXVII of the Public Health Service Act (42 U.S.C.
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1 300gg–4 et seq.) is amended by adding at the end

2 the following:

3 ‘‘SEC. 2707. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

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

5 offering health insurance coverage in connection with a

6 group health plan) shall provide coverage of immuno7 suppressive drugs that is at least as comprehensive as the

8 coverage provided by such plan or issuer on the day before

9 the date of enactment of the Immunosuppressive Drug

10 Coverage Act of 2001, and such requirement shall be

11 deemed to be incorporated into this section.’’.

12 (2) CONFORMING AMENDMENT.—Section

13 2721(b)(2)(A) of the Public Health Service Act (42

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

15 ‘‘(other than section 2707)’’ after ‘‘requirements of

16 such subparts’’.

17 (b) APPLICATION TO GROUP HEALTH PLANS AND

18 GROUP HEALTH INSURANCE COVERAGE UNDER THE EM19 PLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.—

20 (1) IN GENERAL.—Subpart B of part 7 of sub21 title B of title I of the Employee Retirement Income

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

23 amended by adding at the end the following new sec24 tion:
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1 ‘‘SEC. 714. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

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

3 offering health insurance coverage in connection with a

4 group health plan) shall provide coverage of immuno5 suppressive drugs that is at least as comprehensive as the

6 coverage provided by such plan or issuer on the day before

7 the date of enactment of the Immunosuppressive Drug

8 Coverage Act of 2001, and such requirement shall be

9 deemed to be incorporated into this section.’’.

10 (2) CONFORMING AMENDMENTS.—

11 (A) Section 732(a) of the Employee Retire12 ment Income Security Act of 1974 (29 U.S.C.

13 1185(a)) is amended by striking ‘‘section 711’’

14 and inserting ‘‘sections 711 and 714’’.

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

16 the Employee Retirement Income Security Act

17 of 1974 is amended by inserting after the item

18 relating to section 713 the following new item:

‘‘Sec. 714. Coverage of Immunosuppressive drugs.’’.

19 (c) APPLICATION TO GROUP HEALTH PLANS UNDER

20 THE INTERNAL REVENUE CODE OF 1986.—Subchapter B

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

22 amended—
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1 (1) in the table of sections, by inserting after

2 the item relating to section 9812 the following new

3 item:

‘‘Sec. 9813. Coverage of immunosuppressive drugs.’’;

4 and

5 (2) by inserting after section 9812 the fol6 lowing:

7 ‘‘SEC. 9813. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

8 ‘‘A group health plan shall provide coverage of im9 munosuppressive drugs that is at least as comprehensive

10 as the coverage provided by such plan on the day before

11 the date of enactment of the Immunosuppressive Drug

12 Coverage Act of 2001, and such requirement shall be

13 deemed to be incorporated into this section.’’.

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

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

16 January 1, 2002.

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