before clause (i), by inserting after ‘‘subparagraph 
(A)(v))’’ the following: ‘‘, a qualified health plan estab-
lished pursuant to or governed by subtitle D of title I of 
the Patient Protection and Affordable Care Act, or any 
individual health insurance coverage (as defined in section 
2791(b)(5) of the Public Health Service Act, excluding ex-
cepted coverage under subsection (c) of such section)’’. 
SEC. 302. ACCESS TO MEDIGAP POLICIES. 
(a) IN GENERAL.—Section 1882(s) of the Social Se-
curity Act (42 U.S.C. 1395ss(s)) is amended— 
(1) in paragraph (2)(A), by inserting ‘‘, or is el-
igible for hospital insurance benefits under part A 
on the basis of sections 226(b) or 226A’’ after ‘‘65 
years of age or older’’; 
(2) in paragraph (2)(D), by striking ‘‘the 6- 
month period described in subparagraph (A) to an 
individual who is 65 years of age or older as of the 
date of issuance and’’ and inserting ‘‘a 6-month pe-
riod described in subparagraph (A) to an indi-
vidual’’; and 
(3) in paragraph (3)(B)(vi), by striking ‘‘at age 
65’’. 
(b) EFFECTIVE DATE.— 
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(1) IN GENERAL.—The amendments made by 
subsection (a) shall take effect as of the date of the 
enactment of this Act. 
(2) TRANSITION.— 
(A) No medicare supplemental policy of an 
issuer shall be deemed to meet the standards in 
subsection (c) of section 1882 of the Social Se-
curity Act (42 U.S.C. 1395ss) unless the issuer 
permits each individual described in subpara-
graph (B), during the 6-month period beginning 
on the first day of the first month beginning 
after the date of the enactment of this Act, to 
be enrolled under a medicare supplemental pol-
icy in accordance with subsection (s) of such 
section, as amended by subsection (a), applied 
as if the individual were first enrolled under 
part B of title XVIII of the Social Security Act 
as of the first day of such first month. 
(B) For purposes of subparagraph (A), an 
individual described in this subparagraph is an 
individual who, as of the first day of the first 
month beginning after the date of the enact-
ment of this Act— 
(i) is under 65 years of age; 
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(ii) is enrolled under part B of title 
XVIII of the Social Security Act; and 
(iii) is not enrolled in a medicare sup-
plemental policy. 
SEC. 303. PROTECTING INDIVIDUALS WITH KIDNEY FAIL-
URE 
FROM 
UNFAIR 
PRACTICES 
UNDER 
HEALTH CARE REFORM. 
(a) IN GENERAL.—Section 2719A of the Public 
Health Service Act (42 U.S.C. 300gg–19a), as added by 
section 10101(h) of the Patient Protection and Affordable 
Care Act (Public Law 111–148), is amended by adding 
at the end the following new subsection: 
‘‘(e) ACCESS FOR PATIENTS WITH KIDNEY FAIL-
URE.— 
‘‘(1) IN GENERAL.—In the case of an individual 
who is a participant, beneficiary, or enrollee under 
a group health plan, or health insurance coverage of-
fered by a health insurance issuer in the group or 
individual market and who has kidney failure, the 
plan or issuer may only impose restrictions with re-
spect to treatment for kidney failure if the restric-
tions are reasonable and assure adequate access to 
out-of-network providers consistent with this sub-
section. 
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‘‘(2) SPECIFIC
REQUIREMENTS.—In carrying 
out paragraph (1), a plan or issuer— 
‘‘(A) may not set out-of-network rates 
through unilateral rate setting or other mecha-
nisms that restrict or limit negotiations with 
providers and facilities that furnish services to 
treat kidney failure; 
‘‘(B) shall provide adequate, advanced, 
written 
notification 
to 
patients 
regarding 
changes to dialysis service benefits, new restric-
tions on out-of-network access, or reductions to 
rates paid for out-of-network benefits for such 
services; 
‘‘(C) shall allow patients to continue using 
their existing provider or facility of such serv-
ices for at least 24 months following the date 
of notice of any change by the plan or issuer in 
their dialysis services network; 
‘‘(D) shall hold patients harmless from 
provider network changes with respect to such 
services if such changes require unreasonable 
drive time or disrupt the physician-patient rela-
tionship; 
‘‘(E) may not restrict the duration or num-
ber of dialysis sessions for patients, such as 
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based on a fixed number of treatments per 
week, to less than the number permitted under 
the Medicare program under title XVIII of the 
Social Security Act; 
‘‘(F) may not penalize physicians for refer-
ring patients to out-of-network providers or fa-
cilities for such services; 
‘‘(G) may not require assignment of bene-
fits for such services; 
‘‘(H) shall ensure equity with respect to 
out-of-pocket payments for such services; 
‘‘(I) may not deny or limit coverage for pa-
tients for such services if premiums, co-pay-
ments, or other payments are made by third 
parties on their behalf; and 
‘‘(J) shall meet minimum network ade-
quacy standards specified by the Secretary with 
respect to such services.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to plans and issuers as of Janu-
ary 1, 2014. 
Æ 
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