I 

112TH CONGRESS 

1ST SESSION H. R. 2969 

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 other renal dialysis provisions. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 20, 2011 

Mr. BURGESS (for himself, Mr. KIND, Mr. LEWIS of California, Mrs. BLACKBURN, Mr. HIMES, Mr. LATHAM, Mr. SMITH of New Jersey, Mr. ROGERS

of Michigan, Mr. HURT, Mr. YOUNG of Florida, Mr. LANCE, Mr. BACHUS, Mr. MCKINLEY, Mr. KILDEE, Ms. SCHAKOWSKY, Mr. BOREN, Mr. 

STARK, Mr. INSLEE, and Mr. LEWIS 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 

for extended months of Medicare coverage of immunosuppressive drugs for kidney transplant patients and 

other renal dialysis provisions. 

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


jbell on DSK7SPTVN1PROD with BILLS
2 

•HR 2969 IH

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 2011’’. 

5 SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNO6 SUPPRESSIVE DRUGS FOR KIDNEY TRANS7 PLANT PATIENTS AND OTHER RENAL DIALY8 SIS PROVISIONS. 

9 (a) MEDICARE ENTITLEMENT TO IMMUNO10 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI11 ENTS.— 

12 (1) KIDNEY TRANSPLANT RECIPIENTS.—Sec13 tion 226A(b)(2) of the Social Security Act (42 

14 U.S.C. 426–1(b)(2)) is amended by inserting ‘‘(ex15 cept for eligibility for enrollment under part B solely 

16 for purposes of coverage of immunosuppressive 

17 drugs described in section 1861(s)(2)(J))’’ before ‘‘, 

18 with the thirty-sixth month’’. 

19 (2) INDIVIDUALS ELIGIBLE ONLY FOR COV20 ERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 

21 (A) Section 1836 of the Social Security 

22 Act (42 U.S.C. 1395o) is amended— 

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

24 ‘‘(a) IN GENERAL.—Every’’; and 

25 (ii) by inserting at the end the fol26 lowing new subsection: 


jbell on DSK7SPTVN1PROD with BILLS
3 

•HR 2969 IH

1 ‘‘(b) INDIVIDUALS ELIGIBLE FOR IMMUNO2 SUPPRESSIVE DRUG COVERAGE.—Beginning on January 

3 1, 2012, every individual whose insurance benefits under 

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

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

6 in the insurance program established by this part solely 

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

8 (B) CONFORMING AMENDMENT.—Sections 

9 1837, 1838, and 1839 of the Social Security 

10 Act (42 U.S.C. 1395(o), 42 U.S.C. 1395(p), 42 

11 U.S.C. 1395(q)) are each amended by striking 

12 ‘‘1836’’ and inserting ‘‘1836(a)’’ each place it 

13 appears. 

14 (3) ENROLLMENT FOR INDIVIDUALS ONLY ELI15 GIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

16 DRUGS.—Section 1837 of the Social Security Act 

17 (42 U.S.C. 1395(p)) is amended by adding at the 

18 end the following new subsection: 

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

20 1836(b) to enroll in the medical insurance program estab21 lished under this part for purposes of coverage of immuno22 suppressive drugs may enroll only in such manner and 

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

24 an enrollment period described in this subsection. 


jbell on DSK7SPTVN1PROD with BILLS
4 

•HR 2969 IH

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

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

3 the month in which the individual first satisfies section 

4 1836(b). 

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

6 entitlement for hospital insurance benefits under part A 

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

8 1, 2012, shall be deemed to have enrolled in the medical 

9 insurance program established by this part for purposes 

10 of coverage of immunosuppressive drugs.’’. 

11 (4) COVERAGE PERIOD FOR INDIVIDUALS ONLY

12 ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

13 DRUGS.— 

14 (A) IN GENERAL.—Section 1838 of the So15 cial Security Act (42 U.S.C. 1395(q)) is amend16 ed by adding at the end the following new sub17 section: 

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

19 1836(b), the following rules shall apply: 

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

21 deemed to have enrolled in part B for coverage of 

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

23 such individual’s coverage period shall begin on the 

24 first day of the month in which the individual first 

25 satisfies section 1836(b). 


jbell on DSK7SPTVN1PROD with BILLS
5 

•HR 2969 IH

1 ‘‘(2) In the case of such an individual who en2 rolls in part B for coverage of immunosuppressive 

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

4 coverage period shall begin on the first day of the 

5 month in which the individual first satisfies section 

6 1836(b) or the month following the month in which 

7 the individual so enrolls, whichever is later. 

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

9 shall apply with respect to an individual described in 

10 paragraph (1) or (2). 

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

12 under subsection (b), the coverage period of an indi13 vidual described in paragraph (1) or (2) shall end 

14 when the individual becomes entitled to benefits 

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

16 226A.’’. 

17 (B) CONFORMING AMENDMENTS.—Section 

18 1838(b) is amended in the matter following 

19 paragraph (2) by adding ‘‘or section 

20 1837(m)(3)’’ after ‘‘section 1837(f)’’ each place 

21 it appears. 

22 (5) PREMIUMS FOR INDIVIDUALS ONLY ELIGI23 BLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

24 DRUGS.—Section 1839 of the Social Security Act 

25 (42 U.S.C. 1395r) is amended— 


jbell on DSK7SPTVN1PROD with BILLS
6 

•HR 2969 IH

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

2 the following new sentence: ‘‘No increase in the 

3 premium shall be effected for individuals who 

4 are enrolled pursuant to section 1836(b) for 

5 coverage only of immunosuppressive drugs.’’; 

6 and 

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

8 subsection: 

9 ‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID10 UALS ONLY ELIGIBLE FOR COVERAGE OF IMMUNO11 SUPPRESSIVE DRUGS.—The Secretary shall, during Sep12 tember of each year, determine and promulgate a monthly 

13 premium rate for the succeeding calendar year for individ14 uals who enroll only for the purpose of coverage of im15 munosuppressive drugs under section 1836(b). Such pre16 mium shall be equal to 35 percent of the monthly actuarial 

17 rate for enrollees age 65 and over, determined according 

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

19 monthly premium of each individual enrolled for coverage 

20 of immunosuppressive drugs under section 1836(b) for 

21 each month shall be the amount promulgated in this sub22 section. Such amount shall be adjusted in accordance with 

23 subsections (c) and (f).’’. 


jbell on DSK7SPTVN1PROD with BILLS
7 

•HR 2969 IH

1 (6) GOVERNMENT CONTRIBUTION.—Section 

2 1844(a) of the Social Security Act (42 U.S.C. 

3 1395(w)) is amended— 

4 (A) in paragraph (3), by striking the pe5 riod at the end and inserting ‘‘; plus’’; 

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

7 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 (C) by adding at the end the following 

17 flush matter: 

18 ‘‘The Government contribution under paragraph (4) 

19 shall be treated as premiums payable and deposited 

20 for purposes of subparagraphs (A) and (B) of para21 graph (1).’’. 

22 (7) EXTENSION OF SECONDARY PAYER RE23 QUIREMENTS FOR ESRD BENEFICIARIES ELIGIBLE

24 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 

25 Section 1862(b)(1)(C) (42 U.S.C. 1395(y)(b)(1)) is 


jbell on DSK7SPTVN1PROD with BILLS
8 

•HR 2969 IH

1 amended by adding at the end the following new 

2 sentence: ‘‘With regard to immunosuppressive drugs 

3 furnished to an individual who enrolls for the pur4 pose of coverage of immunosuppressive drugs under 

5 section 1836(b) on or after January 1, 2012, this 

6 subparagraph shall apply without regard to any time 

7 limitation, except that when such individual becomes 

8 entitled to benefits under this title under sections 

9 226(a) or 226(b), or entitled to or eligible for bene10 fits under this title under section 226A, the provi11 sions of subparagraphs (A) and (B), and the time 

12 limitations under this subparagraph, respectively, 

13 shall apply.’’. 

14 (8) ENSURING COVERAGE UNDER THE MEDI15 CARE SAVINGS PROGRAM.—Section 1905(p)(1)(A) of 

16 the Social Security Act (42 U.S.C. 1396d(p)(1)(A)) 

17 is amended by inserting ‘‘or an individual who is en18 rolled under part B for the purpose of coverage of 

19 immunosuppressive drugs under section 1836(b)’’ 

20 after ‘‘section 1818’’. 

21 (9) PART D.—Section 1860D–1(a)(3)(A) of the 

22 Social Security Act (42 U.S.C. 1395w–101(a)(3)(A)) 

23 is amended by inserting ‘‘(but not including an indi24 vidual enrolled solely for coverage of immunoVerDate Mar 15 2010 00:22 Sep 22, 2011 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2969.IH H2969

jbell on DSK7SPTVN1PROD with BILLS
9 

•HR 2969 IH

1 suppressive drugs under section 1836(b))’’ before 

2 the period at the end. 

Æ 


jbell on DSK7SPTVN1PROD with BILLS