IB 
Union Calendar No. 570 
116TH CONGRESS 
2D SESSION 
H. R. 5534 
[Report No. 116–687, Part I] 
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 
DECEMBER 24, 2020 
Additional sponsors: Mr. RUSH, Mr. FITZPATRICK, Mr. MARCHANT, Mr. 
POSEY, Ms. MENG, Mr. COLE, Mrs. AXNE, Mr. CISNEROS, Mr. KILMER, 
Ms. BLUNT ROCHESTER, Mr. VISCLOSKY, Mr. HIGGINS of New York, 
Ms. KELLY of Illinois, Mrs. LURIA, Mr. LATTA, Mrs. BUSTOS, Mrs. ROD-
GERS of Washington, Mr. PAYNE, Mr. MEEKS, Mr. CASE, Ms. DEGETTE, 
Mr. GRIJALVA, Mr. GONZALEZ of Texas, Mr. DEUTCH, Mr. BILIRAKIS, 
Mr. RYAN, Mr. BUCSHON, Mr. LONG, Ms. NORTON, Mr. LAMB, Mr. RUP-
PERSBERGER, Ms. PORTER, Ms. BROWNLEY of California, Mr. POCAN, 
Mrs. BROOKS of Indiana, Mr. GOODEN, Mr. SHIMKUS, Mr. CURTIS, Mr. 
NEGUSE, Mrs. MURPHY of Florida, Mr. KELLY of Pennsylvania, Mr. 
OLSON, Mr. SMUCKER, Ms. MCCOLLUM, Mr. COSTA, Mr. COOPER, Mr. 
ALLRED, Mr. KILDEE, Mrs. BEATTY, Ms. JACKSON LEE, Mr. ROUDA, 
Mr. KENNEDY, Ms. WILD, Mr. RUTHERFORD, Mrs. DEMINGS, Mr. CON-
NOLLY, Ms. LOFGREN, Mr. MALINOWSKI, Mr. RODNEY DAVIS of Illinois, 
Mr. RIGGLEMAN, Mr. MCGOVERN, Ms. CLARKE of New York, Ms. CHE-
NEY, Mr. SOTO, Mr. EVANS, Mr. KING of New York, Mr. LUJA´N, Mr. 
CRAWFORD, Mr. WELCH, Mr. BLUMENAUER, Mr. LARSON of Con-
necticut, Mr. ROSE of New York, Mr. HORSFORD, Mr. MCKINLEY, Mr. 
BISHOP of Georgia, Mr. TRONE, Mr. GALLEGO, Mr. THOMPSON of Cali-
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fornia, Mr. WENSTRUP, Mr. BURCHETT, Mr. PRICE of North Carolina, 
Mr. BOST, Mr. KIM, Mr. BRINDISI, Mr. YARMUTH, Mr. NADLER, Ms. 
KAPTUR, Mr. LEVIN of Michigan, Ms. KENDRA S. HORN of Oklahoma, 
Mr. SIMPSON, Mr. AGUILAR, Ms. VELA´ZQUEZ, Mr. LAWSON of Florida, 
Ms. ROYBAL-ALLARD, Ms. MOORE, Ms. CRAIG, Ms. SEWELL of Alabama, 
Mr. CARSON of Indiana, Mr. RICHMOND, Mr. BAIRD, Ms. JOHNSON of 
Texas, Ms. UNDERWOOD, Mr. HASTINGS, Mr. GREEN of Texas, Mr. VAN 
DREW, Mrs. MILLER, Ms. DELBENE, and Ms. FINKENAUER 
DECEMBER 24, 2020 
Reported from the Committee on Energy and Commerce with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
DECEMBER 24, 2020 
Committee on Ways and Means discharged; committed to the Committee of 
the Whole House on the State of the Union and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on December 23, 2019] 
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. 
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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 Immuno-
suppressive Drug Coverage for Kidney Transplant Patients 
Act of 2020’’. 
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 So-
cial Security Act (42 U.S.C. 426–1(b)(2)) is amended 
by inserting ‘‘(except for eligibility for enrollment 
under part B solely for purposes of coverage of im-
munosuppressive 
drugs 
described 
in 
section 
1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth month’’. 
(2) INDIVIDUALS ELIGIBLE ONLY FOR COVERAGE 
OF IMMUNOSUPPRESSIVE DRUGS.— 
(A) IN GENERAL.—Section 1836 of the So-
cial Security Act (42 U.S.C. 1395o) is amend-
ed— 
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(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.— 
‘‘(1) IN GENERAL.—Except as provided under 
paragraph (2), every individual whose entitlement to 
insurance benefits under part A ends (whether before, 
on, or after January 1, 2023) by reason of section 
226A(b)(2) is eligible to enroll or to be deemed to have 
enrolled in the medical insurance program established 
by this part solely for purposes of coverage of im-
munosuppressive drugs in accordance with section 
1837(m). 
‘‘(2) EXCEPTION IF OTHER COVERAGE IS AVAIL-
ABLE.— 
‘‘(A) IN
GENERAL.—An individual de-
scribed in paragraph (1) shall not be eligible for 
enrollment in the program for purposes of cov-
erage described in such paragraph with respect 
to any period in which the individual, as deter-
mined in accordance with subparagraph (B)— 
‘‘(i) is enrolled in a group health plan 
or group or individual health insurance 
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coverage, as such terms are defined in sec-
tion 2791 of the Public Health Service Act; 
‘‘(ii) is enrolled for coverage under the 
TRICARE for Life program under section 
1086(d) of title 10, United States Code; 
‘‘(iii) is enrolled under a State plan 
(or waiver of such plan) under title XIX; 
‘‘(iv) is enrolled under a State child 
health plan under title XXI; or 
‘‘(v)(I) is enrolled in the patient enroll-
ment system of the Department of Veterans 
Affairs established and operated under sec-
tion 1705 of title 38, United States Code; 
‘‘(II) is not required to enroll under 
section 1705 of such title to receive im-
munosuppressive drugs described in this 
subsection; or 
‘‘(III) is otherwise eligible under a pro-
vision of title 38, United States Code, other 
than section 1710 of such title to receive im-
munosuppressive drugs described in this 
subsection. 
‘‘(B) ELIGIBILITY DETERMINATIONS.— 
‘‘(i) IN GENERAL.—The Secretary, in 
coordination with the Commissioner of So-
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cial Security, shall establish a process for 
determining whether an individual de-
scribed in paragraph (1) who is to be en-
rolled or deemed to be enrolled in the med-
ical insurance program described in such 
paragraph meets the requirements for such 
enrollment under this subsection, including 
the requirement that the individual not be 
enrolled in other coverage as described in 
subparagraph (A). 
‘‘(ii) ATTESTATION REGARDING OTHER 
COVERAGE.—The process established under 
clause (i) shall include, at a minimum, a 
requirement that— 
‘‘(I) the individual provide to the 
Commissioner an attestation that the 
individual is not enrolled and does not 
expect to enroll in such other coverage; 
and 
‘‘(II) the individual agree to no-
tify the Commissioner within 60 days 
of enrollment in such other coverage.’’. 
(B) CONFORMING AMENDMENT.— 
(i) IN GENERAL.—Sections 1837, 1838, 
and 1839 of the Social Security Act (42 
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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. 
(ii) ADDITIONAL
AMENDMENT.—Sec-
tion 1837(j)(1) of such Act (42 U.S.C. 
1395p(j)(1)) 
is 
amended 
by 
striking 
‘‘1836(1)’’ and inserting ‘‘1836(a)(1)’’. 
(b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE 
FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Section 
1837 of the Social Security Act (42 U.S.C. 1395p) is 
amended by adding at the end the following new subsection: 
‘‘(m)(1) Any individual who is eligible for coverage of 
immunosuppressive drugs under section 1836(b) may enroll 
or be deemed to have enrolled only in such manner and 
form as may be prescribed by regulations, and only during 
an enrollment period described in this subsection. 
‘‘(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, 
2023, may enroll beginning on October 1, 2022, or the day 
on which the individual first satisfies section 1836(b), 
whichever is later. 
‘‘(3) An individual described in paragraph (1) whose 
entitlement for hospital insurance benefits under part A 
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ends by reason of section 226A(b)(2) on or after January 
1, 2023, 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 
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 im-
munosuppressive drugs) is terminated voluntarily or invol-
untary may enroll or reenroll, if applicable, in the medical 
insurance program established under this part for purposes 
of coverage of immunosuppressive drugs.’’. 
(c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELIGI-
BLE FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 
(1) IN GENERAL.—Section 1838 of the Social Se-
curity Act (42 U.S.C. 1395q) is amended by adding 
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 im-
munosuppressive drugs under section 1837(m)(3), 
such individual’s coverage period shall begin on the 
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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, if applicable) in part B for cov-
erage of immunosuppressive drugs under paragraph 
(2) or (4) of section 1837(m), such individual’s cov-
erage period shall begin on January 1, 2023, 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 in-
dividuals eligible under section 1836(b) to enroll or to 
be deemed enrolled in the medical insurance program 
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established under this part for purposes of coverage of 
immunosuppressive drugs.’’. 
(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.—Section 
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 premium 
shall be effected for individuals who are enrolled pur-
suant to section 1836(b) for coverage only of immuno-
suppressive drugs.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(j) DETERMINATION OF PREMIUM FOR INDIVIDUALS 
ONLY ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE 
DRUGS.—The Secretary shall, during September of each 
year (beginning with 2022), determine and promulgate a 
monthly premium rate for the succeeding calendar year for 
individuals enrolled only for the purpose of coverage of im-
munosuppressive drugs under section 1836(b). Such pre-
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mium shall be equal to 35 percent of the monthly actuarial 
rate for enrollees age 65 and over (as would be determined 
in accordance with subsection (a)(1) if the reference to ‘one- 
half’ in such subsection were a reference to ‘100 percent’) 
for that succeeding calendar year. The monthly premium 
of each individual enrolled for coverage of immuno-
suppressive drugs under section 1836(b) for each month 
shall be the amount promulgated in this subsection. Such 
amount shall be adjusted in accordance with subsections (c), 
(f), and (i), but shall not be adjusted under subsection (b).’’. 
(e) ENSURING COVERAGE UNDER THE MEDICARE SAV-
INGS PROGRAM.—Section 1905(p)(1)(A) of the Social Secu-
rity Act (42 U.S.C. 1396d(p)(1)(A)) is amended by insert-
ing ‘‘or who is enrolled under part B for the purpose of 
coverage of immunosuppressive drugs under section 
1836(b)’’ after ‘‘under section 1818A)’’. 
(f) PART D.—Section 1860D–1(a)(3)(A) of the Social 
Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is amended 
by inserting ‘‘(but not including an individual enrolled 
solely for coverage of immunosuppressive drugs under sec-
tion 1836(b))’’ before the period at the end. 
SEC. 3. GAO STUDY AND REPORT. 
(a) STUDY.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller Gen-
eral’’) shall conduct a study on the implementation of cov-
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erage of immunosuppressive drugs for kidney transplant 
patients under the Medicare program pursuant to the provi-
sions of, and amendments made by, this Act. 
(b) REPORT.—Not later than January 1, 2025, the 
Comptroller General shall submit to Congress a report on 
the study conducted under subsection (a), together with rec-
ommendations as the Comptroller General determines ap-
propriate. 
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Union Calendar No. 570 
116TH CONGRESS 
2D SESSION 
H. R. 5534 
[Report No. 116–687, Part I] 
A BILL 
To amend title XVIII of the Social Security Act to 
provide for extended months of Medicare cov-
erage of immunosuppressive drugs for kidney 
transplant patients, and for other purposes. 
DECEMBER 24, 2020 
Reported from the Committee on Energy and Commerce 
with an amendment 
DECEMBER 24, 2020 
Committee on Ways and Means discharged; committed to 
the Committee of the Whole House on the State of the 
Union and ordered to be printed 
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