I 
116TH CONGRESS 
1ST SESSION H. R. 5534 
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 for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 23, 2019 
Mr. KIND (for himself, Mr. BURGESS, Ms. ESHOO, Mr. SMITH of Missouri, 
Mr. MCEACHIN, and Ms. HERRERA BEUTLER) 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 sub-
sequently 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 immuno-
suppressive drugs for kidney transplant patients, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Comprehensive Im-
munosuppressive Drug Coverage for Kidney Transplant 
Patients Act of 2019’’. 
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SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNO-
SUPPRESSIVE DRUGS FOR KIDNEY TRANS-
PLANT PATIENTS AND OTHER RENAL DIALY-
SIS PROVISIONS. 
(a) 
MEDICARE
ENTITLEMENT
TO
IMMUNO-
SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI-
ENTS.— 
(1) IN GENERAL.—Section 226A(b)(2) of the 
Social Security Act (42 U.S.C. 426–1(b)(2)) is 
amended by inserting ‘‘(except for eligibility for en-
rollment under part B solely for purposes of cov-
erage of immunosuppressive drugs described in sec-
tion 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth 
month’’. 
(2) INDIVIDUALS
ELIGIBLE
ONLY
FOR
COV-
ERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 
(A) IN GENERAL.—Section 1836 of the So-
cial Security Act (42 U.S.C. 1395o) is amend-
ed— 
(i) by striking ‘‘Every’’ and inserting 
‘‘(a) IN GENERAL.—Every’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(b) 
INDIVIDUALS
ELIGIBLE
FOR
IMMUNO-
SUPPRESSIVE DRUG COVERAGE.— 
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‘‘(1) IN GENERAL.—Except as provided under 
paragraph (2), every individual whose insurance ben-
efits under part A have ended (whether before, on, 
or after January 1, 2022) by reason of section 
226A(b)(2) is eligible to enroll in the insurance pro-
gram established by this part solely for purposes of 
coverage of immunosuppressive drugs in accordance 
with section 1837(m). 
‘‘(2) EXCEPTION
IF
OTHER
HEALTH
INSUR-
ANCE COVERAGE IS AVAILABLE.— 
‘‘(A) IN
GENERAL.—An individual de-
scribed in paragraph (1) shall not be eligible for 
enrollment in the insurance program described 
in such paragraph with respect to any period in 
which the individual— 
‘‘(i) is enrolled in a group health plan, 
as defined in section 2791(a)(1) of the 
Public Health Service Act, or individual 
health insurance coverage, as defined in 
section 2791(b)(5) of such Act, as deter-
mined in accordance with subparagraph 
(B); 
‘‘(ii) is eligible for benefits under— 
‘‘(I) a State plan under title 
XIX; 
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‘‘(II) a State child health plan 
under title XXI; or 
‘‘(III) the TRICARE program 
under chapter 55 of title 10, United 
States Code; 
‘‘(iii) is enrolled in a health benefits 
plan under chapter 89 of title 5, United 
States Code; 
‘‘(iv) is eligible for health care bene-
fits under the laws administered by the 
Secretary of Veterans Affairs; or 
‘‘(v) is eligible to receive services from 
the Indian Health Service. 
‘‘(B) ELIGIBILITY DETERMINATIONS.— 
‘‘(i) IN GENERAL.—The Secretary, in 
consultation with the Administrator of So-
cial Security, shall establish procedures for 
determining whether an individual de-
scribed in paragraph (1) who is to be en-
rolled in the insurance program described 
in such paragraph meets the requirements 
for such enrollment under this subsection, 
including the requirement that the indi-
vidual not have other health insurance cov-
erage as described in subparagraph (A). 
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‘‘(ii) 
ATTESTATION
REGARDING 
OTHER COVERAGE.—The procedures estab-
lished under clause (i) shall include a re-
quirement that— 
‘‘(I) the individual provide to the 
Secretary an attestation that the indi-
vidual does not have such other health 
insurance coverage; and 
‘‘(II) update such attestation— 
‘‘(aa) on an annual basis; or 
‘‘(bb) if the health insurance 
coverage situation of the indi-
vidual has changed. 
‘‘(C) IDENTIFICATION AND REDUCTION OF 
IMPROPER PAYMENTS.—The Secretary, in con-
sultation with the Administrator of Social Secu-
rity, shall— 
‘‘(i) establish procedures to ensure 
that any information provided with respect 
to other health insurance coverage de-
scribed in subparagraph (A) of this para-
graph for an individual described in para-
graph (1) is provided to the appropriate 
medicare administrative contractor for pur-
poses of identifying any improper pay-
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ments made with respect to immuno-
suppressive drug coverage under this part; 
and 
‘‘(ii) provide education to prevent or 
reduce such improper payments, including 
education through the improper payment 
outreach and education program under 
section 1847A9(h).’’. 
(B) CONFORMING AMENDMENT.—Sections 
1837, 1838, and 1839 of the Social Security 
Act (42 U.S.C. 1395p, 42 U.S.C. 1395q, 42 
U.S.C. 1395r) are each amended by striking 
‘‘1836’’ and inserting ‘‘1836(a)’’ each place it 
appears. 
(b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE 
FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec-
tion 1837 of the Social Security Act (42 U.S.C. 1395p) 
is amended by adding at the end the following new sub-
section: 
‘‘(m)(1) Any individual who is eligible under section 
1836(b) to enroll in the medical insurance program estab-
lished under this part for purposes of coverage of immuno-
suppressive drugs may enroll only in such manner and 
form as may be prescribed by regulations, and only during 
an enrollment period described in this subsection. 
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‘‘(2) An individual described in paragraph (1) whose 
entitlement for hospital insurance benefits under part A 
ends by reason of section 226A(b)(2) prior to January 1, 
2022, may enroll beginning on the first day of the third 
month before the month in which the individual first satis-
fies section 1836(b), or a date specified by the Secretary 
prior to the first date on which coverage is effective under 
section 1838(g)(2), whichever is later. In implementing 
the preceding sentence, the Secretary shall consider proce-
dures to expedite the enrollment of such an individual if 
practicable for purposes of providing continued coverage 
of immunosuppressive drugs for such individual pursuant 
to section 1838(g)(2). 
‘‘(3) An individual described in paragraph (1) whose 
entitlement for hospital insurance benefits under part A 
ends by reason of section 226A(b)(2) on or after January 
1, 2022, shall be deemed to have enrolled in the medical 
insurance program established by this part for purposes 
of coverage of immunosuppressive drugs. 
‘‘(4) The Secretary shall establish a process under 
which an individual described in paragraph (1) whose 
other health insurance coverage described in section 
1836(b)(2)(A), or coverage under this part (including the 
medical insurance program established under this part for 
purposes of coverage of immunosuppressive drugs) is ter-
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minated voluntarily or involuntary may enroll or reenroll, 
if applicable, in the medical insurance program established 
under this part for purposes of coverage of immuno-
suppressive drugs.’’. 
(c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELI-
GIBLE
FOR
COVERAGE
OF
IMMUNOSUPPRESSIVE 
DRUGS.— 
(1) IN GENERAL.—Section 1838 of the Social 
Security Act (42 U.S.C. 1395q) is amended by add-
ing at the end the following new subsection: 
‘‘(g) In the case of an individual described in section 
1836(b)(1), the following rules shall apply: 
‘‘(1) In the case of such an individual who is 
deemed to have enrolled in part B for coverage of 
immunosuppressive drugs under section 1837(m)(3), 
such individual’s coverage period shall begin on the 
first day of the month in which the individual first 
satisfies section 1836(b). 
‘‘(2) In the case of such an individual who en-
rolls (or reenrolls) in part B for coverage of im-
munosuppressive drugs under paragraph (2) or (4) 
of section 1837(m), such individual’s coverage period 
shall begin on January 1, 2022 (or such earlier date 
as the Secretary may specify if practicable for pur-
poses of providing continued coverage of immuno-
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suppressive drugs for such an individual), or the 
month following the month in which the individual 
so enrolls (or reenrolls), whichever is later. 
‘‘(3) The provisions of subsections (b) and (d) 
shall apply with respect to an individual described in 
paragraph (1) or (2). 
‘‘(4) In addition to the reasons for termination 
under subsection (b), the coverage period of an indi-
vidual described in paragraph (1) or (2) shall end 
when the individual becomes entitled to benefits 
under this title under section 226(a) or 226A or is 
no longer eligible for such coverage as a result of the 
application of section 1836(b)(2). 
‘‘(5) The Secretary may conduct public edu-
cation activities to raise awareness of the availability 
of more comprehensive, qualified health plans for 
beneficiaries eligible under this subsection.’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1838(b) of the Social Security Act (42 U.S.C. 
1395q(b)) is amended, in the matter following para-
graph (2), by inserting ‘‘or section 1837(m)(3)’’ 
after ‘‘section 1837(f)’’ each place it appears. 
(d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE 
FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec-
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tion 1839 of the Social Security Act (42 U.S.C. 1395r) 
is amended— 
(1) in subsection (b), by adding at the end the 
following new sentence: ‘‘No increase in the pre-
mium shall be effected for individuals who are en-
rolled pursuant to section 1836(b) for coverage only 
of immunosuppressive drugs.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID-
UALS ONLY ELIGIBLE
FOR COVERAGE
OF IMMUNO-
SUPPRESSIVE DRUGS.—The Secretary shall, during Sep-
tember of each year (beginning with 2021), determine and 
promulgate a monthly premium rate for the succeeding 
calendar year for individuals who enroll only for the pur-
pose of coverage of immunosuppressive drugs under sec-
tion 1836(b). Such premium shall be equal to 35 percent 
of the monthly actuarial rate for enrollees age 65 and over, 
determined according to paragraph (1), for that suc-
ceeding calendar year. The monthly premium of each indi-
vidual enrolled for coverage of immunosuppressive drugs 
under section 1836(b) for each month shall be the amount 
promulgated in this subsection. Such amount shall be ad-
justed in accordance with subsections (c), (f), and (i), but 
shall not be adjusted under subsection (b).’’. 
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(e) GOVERNMENT CONTRIBUTION.—Section 1844(a) 
of the Social Security Act (42 U.S.C. 1395w(a)) is amend-
ed— 
(1) in paragraph (3), by striking the period at 
the end and inserting ‘‘; plus’’; 
(2) by inserting after paragraph (3) the fol-
lowing new paragraph: 
‘‘(4) a Government contribution equal to the es-
timated aggregate reduction in premiums payable 
under part B that results from establishing the pre-
mium at 35 percent of the actuarial rate under sec-
tion 1839(j) instead of 50 percent of the actuarial 
rate for individuals who enroll only for the purpose 
of coverage of immunosuppressive drugs under sec-
tion 1836(b).’’; and 
(3) by adding the following sentence at the end 
of the flush matter following paragraph (4), as 
added by paragraph (2) of this subsection: 
‘‘The Government contribution under paragraph (4) 
shall be treated as premiums payable and deposited 
for purposes of subparagraphs (A) and (B) of para-
graph (1).’’. 
(f) ENSURING COVERAGE UNDER THE MEDICARE 
SAVINGS PROGRAM.—Section 1905(p)(1)(A) of the Social 
Security Act (42 U.S.C. 1396d(p)(1)(A)) is amended by 
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inserting ‘‘or an individual who is enrolled under part B 
for the purpose of coverage of immunosuppressive drugs 
under section 1836(b)’’ after ‘‘section 1818’’. 
(g) PART D.—Section 1860D–1(a)(3)(A) of the So-
cial Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is 
amended by inserting ‘‘(but not including an individual en-
rolled solely for coverage of immunosuppressive drugs 
under section 1836(b))’’ before the period at the end. 
Æ 
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