Patient Access to ESRD New Innovative Devices Act
Bill: H.R.5331 | Sponsor: Rep. Davis, Danny K. (D-IL)
Policy area: Health

Summary:
Patient Access to ESRD New Innovative Devices Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to provide a certain payment adjustment under the Medicare end-stage renal disease (ESRD) prospective payment system. Specifically, the CMS must provide for a three-year temporary add-on payment adjustment for new medical devices used to diagnose, treat, or manage ESRD. (CMS regulations currently provide a two-year temporary add-on payment adjustment.)

To amend title XVIII of the Social Security Act to improve access to 
innovative new medical devices furnished to individuals with end stage 
 renal disease under part B of the Medicare program by establishing a 
         new device add-on payment adjustment under such part.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patient Access to ESRD New 
Innovative Devices Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) There are approximately 400,000 Medicare beneficiaries 
        with end-stage renal disease, making up 1 percent of the 
        Medicare population but accounting for approximately 7 percent 
        of all Medicare spending.
            (2) Expected remaining lifetime for dialysis patients under 
        80 years old is one-third as long as their counterparts without 
        ESRD, and for dialysis patients over 80 years old, it is one-
        half as long as that of their counterparts without ESRD.
            (3) On average, hemodialysis patients are hospitalized 
        nearly twice per year and about 30 percent have an unplanned 
        rehospitalization within the 30 days following discharge, 
        contributing to high costs for treating ESRD Medicare 
        beneficiaries.
            (4) There is a lack of innovative new devices for ESRD 
        Medicare beneficiaries, in part because of the lack of 
        reimbursement incentives for novel devices.

SEC. 3. TEMPORARY ADD-ON PAYMENT FOR NEW MEDICAL DEVICES TO DIAGNOSE, 
              TREAT, OR MANAGE END STAGE RENAL DISEASE.

    The Secretary of Health and Human Services shall provide--
            (1) a three-year temporary add-on payment adjustment (as 
        described in section 413.236(d) of title 42, Code of Federal 
        Regulations) for a new medical device approved by the Food and 
        Drug Administration under section 513(f)(2) of the Federal 
        Food, Drug, and Cosmetic Act (21 U.S.C. 360c) on or after 
        January 1, 2020, and furnished to an individual entitled to 
        benefits under part B of title XVIII of the Social Security Act 
        for the diagnosis, treatment, or management of end stage renal 
        disease; and
            (2) for the adjustment under paragraph (1) to be 
        implemented in a nonbudget neutral manner under subparagraph 
        (D)(iv) of section 1881(b)(14) of the Social Security Act (42 
        U.S.C. 1395rr(b)(14)(D)(iv)).
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