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 2020
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.
Additionally, the Government Accountability Office must report on the bill's implementation, including any related program integrity issues.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3353 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 3353

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 SENATE OF THE UNITED STATES

                           February 27, 2020

  Mr. Cassidy (for himself, Mr. Durbin, Ms. Ernst, Mrs. Shaheen, Mr. 
  Whitehouse, and Mr. Young) introduced the following bill; which was 
          read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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 2020''.

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 entitlement to insurance benefits under 
        part A ends (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 coverage is available.--
                    ``(A) In general.--An individual described in 
                paragraph (1) shall not be eligible for enrollment in 
                the program for purposes of coverage described in such 
                paragraph with respect to any period in which the 
                individual, as determined in accordance with 
                subparagraph (B)--
                            ``(i) is enrolled in a group health plan or 
                        group or individual health insurance coverage, 
                        as such terms are defined in section 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; or
                            ``(iii)(I) is enrolled in the patient 
                        enrollment system of the Department of Veterans 
                        Affairs established and operated under section 
                        1705 of title 38, United States Code;
                            ``(II) is not required to enroll under 
                        section 1705 of such title to receive 
                        immunosuppressive drugs described in this 
                        subsection; or
                            ``(III) is otherwise eligible under a 
                        provision of title 38, United States Code, 
                        other than section 1710 of such title to 
                        receive immunosuppressive drugs described in 
                        this subsection.
                    ``(B) Eligibility determinations.--
                            ``(i) In general.--The Secretary, in 
                        consultation with the Commissioner of Social 
                        Security, shall establish a process for 
                        determining whether an individual described in 
                        paragraph (1) who is to be enrolled or deemed 
                        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 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 in such 
                                other coverage; and
                                    ``(II) the individual notify the 
                                Secretary within 60 days of any change 
                                in the insurance coverage of the 
                                individual.''.
                    (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).
    ``(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 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, if applicable) 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 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.

SEC. 3. GAO STUDY AND REPORT.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the implementation of coverage of immunosuppressive drugs for 
kidney transplant patients under the Medicare program pursuant to the 
provisions of, and amendments made by this Act. Such study shall 
include the identification, after implementation of such coverage, of 
any leakage in the eligibility, enrollment, and coverage processes 
relating to such coverage in order to address program integrity issues.
    (b) Report.--Not later than January 1, 2024, the Comptroller 
General shall submit to Congress a report on the study conducted under 
subsection (a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines 
appropriate.
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