ESRD Choice Act of 2016

To amend title XVIII of the Social Security Act with respect to expanding Medicare Advantage coverage for individuals with end-stage renal disease (ESRD). 1. Short title This Act may be cited as the Expanding Seniors Receiving Dialysis Choice Act of 2016 ESRD Choice Act of 2016 2. Expanding Medicare Advantage coverage for individuals with end-stage renal disease (ESRD) (a) Expanded MA eligibility (1) In general Section 1851(a)(3) of the Social Security Act ( 42 U.S.C. 1395w–21(a)(3) (A) by striking subparagraph (B); and (B) by striking eligible individual In this title, subject to subparagraph (B), eligible individual (2) Conforming amendments (A) Section 1852(b)(1) of the Social Security Act ( 42 U.S.C. 1395w–22(b)(1) (i) by striking subparagraph (B); and (ii) by striking Beneficiaries A Medicare+Choice organization Beneficiaries (B) Section 1859(b)(6) of the Social Security Act ( 42 U.S.C. 1395w–28(b)(6) may waive subparagraph and (b) Excluding costs for kidney acquisitions from MA benchmark Section 1853 of the Social Security Act ( 42 U.S.C. 1395w–23 (1) in subsection (k)— (A) in paragraph (1)— (i) in the matter preceding subparagraph (A), by striking paragraphs (2) and (4) paragraphs (2), (4), and (5) (ii) in subparagraph (B)(i), by striking paragraphs (2) and (4) paragraphs (2), (4), and (5) (B) by adding at the end the following new paragraph: (5) Exclusion of costs for kidney acquisitions from capitation rates After determining the applicable amount for an area for a year under paragraph (1) (beginning with 2019), the Secretary shall adjust such applicable amount to exclude from such applicable amount the Secretary’s estimate of the standardized costs for payments for organ acquisitions for kidney transplants covered under this title (including expenses covered under section 1881(d)) in the area for the year. ; and (2) in subsection (n)(2)— (A) in subparagraph (A)(i), by inserting and, for 2019 and subsequent years, the exclusion of payments for organ acquisitions for kidney transplants from the capitation rate as described in subsection (k)(5) (B) in subparagraph (E), in the matter preceding clause (i), by striking subparagraph (F) subparagraphs (F) and (G) (C) by adding at the end the following new subparagraph: (G) Application of kidney acquisitions adjustment The base payment amount specified in subparagraph (E) for a year (beginning with 2019) shall be adjusted in the same manner under paragraph (5) of subsection (k) as the applicable amount is adjusted under such subsection. . (c) FFS coverage of kidney acquisitions (1) In general Section 1852(a)(1)(B)(i) of the Social Security Act ( 42 U.S.C. 1395w–22(a)(1)(B)(i) or coverage for organ acquisitions for kidney transplants, including as covered under section 1881(d) hospice care (2) Conforming amendment Section 1851(i) of the Social Security Act ( 42 U.S.C. 1395w–21(i) (3) FFS payment for expenses for kidney acquisitions Paragraphs (1) and (2) do not apply with respect to expenses for organ acquisitions for kidney transplants described in section 1852(a)(1)(B)(i). . (d) Sense of Congress regarding application of appropriate Medicare Advantage risk adjustment for payment for increased ESRD enrollees It is the sense of Congress that in implementing the policies under this section, the Centers for Medicare & Medicaid Services should provide, in an accurate and transparent manner, for risk adjustment to payment under the Medicare Advantage program to account for the increased enrollment in Medicare Advantage plans of individuals with end-stage renal disease. (e) Expanded MA education Section 1851(d)(2)(A)(iii) of the Social Security Act ( 42 U.S.C. 1395w–21(d)(2)(A)(iii) , including any additional information that individuals determined to have end-stage renal disease may need to make informed decisions with respect to such an election (f) Report Not later than April 1, 2022, the Administrator of the Centers for Medicare & Medicaid Services shall submit to Congress a report on the impact of the amendments made by this section on spending under the traditional Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act as well as on spending under parts C and D of such title. The report shall include an assessment of the risk adjustment payment methodologies under such parts C and D and their adequacy with respect to individuals with end-stage renal disease and such recommendations as the Administrator deems appropriate. (g) Effective date The amendments made by this section shall apply to plans years beginning on or after January 1, 2020. September 19, 2016 Reported from the Committee on Ways and Means September 19, 2016 The Committee on Energy and Commerce

Summary: Expanding Seniors Receiving Dialysis Choice Act of 2016 or the ESRD Choice Act of 2016 (Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to allow individuals with end-stage renal disease (ESRD) to be eligible for Medicare Advantage (MA). Under current law, only individuals who develop ESRD while already enrolled in an MA plan may be considered eligible. With respect to payment, the bill: (1) shifts responsibility for the cost of kidney acquisitions from MA plans to Medicare's fee-for-service program, and (2) excludes such costs from the calculation of certain benchmarks that form the basis for payment under MA plans.