Title: Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020
Policy area: Health

Summary:
Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019
This bill indefinitely extends Medicare coverage of immunosuppressive drugs for kidney transplant recipients for individuals who do not have other coverage. Under current law, Medicare coverage is limited to 36 months following a transplant.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5534 Introduced in House (IH)]

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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 
subsequently 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 immunosuppressive drugs for kidney 
              transplant patients, and for other purposes.

    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 ``Comprehensive Immunosuppressive Drug 
Coverage for Kidney Transplant Patients Act of 2019''.

SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS FOR 
              KIDNEY TRANSPLANT PATIENTS AND OTHER RENAL DIALYSIS 
              PROVISIONS.

    (a) Medicare Entitlement to Immunosuppressive Drugs for Kidney 
Transplant Recipients.--
            (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 enrollment under part B solely for purposes 
        of coverage of immunosuppressive 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 Social 
                Security Act (42 U.S.C. 1395o) is amended--
                            (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 Immunosuppressive Drug Coverage.--
            ``(1) In general.--Except as provided under paragraph (2), 
        every individual whose insurance benefits 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 
        program established by this part solely for purposes of 
        coverage of immunosuppressive drugs in accordance with section 
        1837(m).
            ``(2) Exception if other health insurance coverage is 
        available.--
                    ``(A) In general.--An individual described 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 determined in 
                        accordance with subparagraph (B);
                            ``(ii) is eligible for benefits under--
                                    ``(I) a State plan under title XIX;
                                    ``(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 benefits 
                        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 Social 
                        Security, shall establish procedures for 
                        determining whether an individual described in 
                        paragraph (1) who is to be enrolled in the 
                        insurance program described in such paragraph 
                        meets the requirements for such enrollment 
                        under this subsection, including the 
                        requirement that the individual not have other 
                        health insurance coverage as described in 
                        subparagraph (A).
                            ``(ii) Attestation regarding other 
                        coverage.--The procedures established under 
                        clause (i) shall include a requirement that--
                                    ``(I) the individual provide to the 
                                Secretary an attestation that the 
                                individual 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 individual has changed.
                    ``(C) Identification and reduction of improper 
                payments.--The Secretary, in consultation with the 
                Administrator of Social Security, shall--
                            ``(i) establish procedures to ensure that 
                        any information provided with respect to other 
                        health insurance coverage described in 
                        subparagraph (A) of this paragraph for an 
                        individual described in paragraph (1) is 
                        provided to the appropriate medicare 
                        administrative contractor for purposes of 
                        identifying any improper payments made with 
                        respect to immunosuppressive 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.--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 under section 1836(b) to 
enroll in the medical insurance program established under this part for 
purposes of coverage of immunosuppressive 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.
    ``(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 
satisfies 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 procedures 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 terminated 
voluntarily or involuntary 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 Eligible for Coverage of 
Immunosuppressive Drugs.--
            (1) In general.--Section 1838 of the Social Security 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 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 enrolls (or 
        reenrolls) in part B for coverage of immunosuppressive 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 purposes of providing continued coverage of 
        immunosuppressive 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 individual 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 education 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 paragraph (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 pursuant to section 1836(b) 
        for coverage only of immunosuppressive drugs.''; and
            (2) by adding at the end the following new subsection:
    ``(j) Determination of Premium for Individuals Only Eligible for 
Coverage of Immunosuppressive Drugs.--The Secretary shall, during 
September 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 purpose of coverage of immunosuppressive drugs 
under section 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 succeeding calendar year. The 
monthly premium of each individual 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 
adjusted in accordance with subsections (c), (f), and (i), but shall 
not be adjusted under subsection (b).''.
    (e) Government Contribution.--Section 1844(a) of the Social 
Security Act (42 U.S.C. 1395w(a)) is amended--
            (1) in paragraph (3), by striking the period at the end and 
        inserting ``; plus'';
            (2) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) a Government contribution equal to the estimated 
        aggregate reduction in premiums payable under part B that 
        results from establishing the premium at 35 percent of the 
        actuarial rate under section 1839(j) instead of 50 percent of 
        the actuarial rate for individuals who enroll only for the 
        purpose of coverage of immunosuppressive drugs under section 
        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 paragraph (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 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 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 section 1836(b))'' before the period at 
the end.
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