I 118th CONGRESS 2d Session H. R. 10282 IN THE HOUSE OF REPRESENTATIVES December 4, 2024 Ms. DelBene (for herself, Mr. Bucshon , Ms. Schrier , Mrs. Miller of West Virginia , Mr. Nadler , and Ms. Kelly of Illinois ) 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 the Public Health Service Act with respect to the Living Organ Donation Reimbursement Program.

1. Short title This Act may be cited as the Expanding Support for Living Donors Act of 2024 . 2. No consideration of income of organ recipient Section 377 of the Public Health Service Act ( 42 U.S.C. 274f ) is amended— (1) by redesignating subsections (c), (d), (e), and (f) as subsections (d), (e), (i), and (j), respectively; (2) by inserting after subsection (b) the following: (c) No consideration of income of organ recipient The recipient of a grant under this section, in providing reimbursement to a donating individual through such grant, shall not give any consideration to the income of the organ recipient. ; and (3) in subsection (i), as so redesignated— (A) in paragraph (1), by striking subsection (c)(1) and inserting subsection (d)(1) ; and (B) in paragraph (2), by striking subsection (c)(2) and inserting subsection (d)(2) . 3. Removal of expectation of payments by organ recipients Section 377(e) of the Public Health Service Act ( 42 U.S.C. 274f(e) ), as redesignated by section 2, is amended— (1) in paragraph (1), by adding or at the end; (2) in paragraph (2), by striking ; or and inserting a period; and (3) by striking paragraph (3). 4. Ensuring eligibility of donating individuals whose household income is at or below 700 percent of the poverty line Section 377 of the Public Health Service Act ( 42 U.S.C. 274f ), as amended by section 2, is further amended by inserting after subsection (e) the following: (f) Eligibility of donating individuals based on household income (1) In general In providing reimbursement to donating individuals using funds from grant awards under this section, the recipient of the grant award shall not limit the eligibility of a donating individual for such reimbursement based on the individual’s income if the individual’s household income is at or below 700 percent of the poverty line. (2) Definition In this section, the term poverty line means the applicable poverty line as set forth in the most recent poverty guidelines of the Department of Health and Human Services published under the authority of section 673(2) of the Community Services Block Grant Act. . 5. Maximum amount of reimbursement Section 377 of the Public Health Service Act ( 42 U.S.C. 274f ), as amended by section 4, is further amended by inserting after subsection (f) the following: (g) Reimbursement amount (1) In general The amount of reimbursement of qualifying expenses provided by a recipient of a grant award under this section to each such donating individual shall be the lesser of— (A) the total amount of the donating individual’s qualifying expenses; and (B) the maximum permissible amount described in paragraph (2). (2) Maximum permissible amount (A) Rule Subject to subparagraph (B), the maximum permissible amount described in this section is— (i) for fiscal year 2026, $10,000; and (ii) for subsequent fiscal years, the maximum permissible amount allowed under this subsection for the preceding fiscal year adjusted by the total percentage change (rounded to the nearest hundredth) that occurred in the Consumer Price Index for all urban consumers (all items; United States city average) for the preceding fiscal year. (B) Exception for recipients based on insufficient funds The Secretary may, with respect to reimbursement provided by a recipient of a grant award under this section to donating individuals, lower the maximum permissible amount under subparagraph (A) for a fiscal year if the Secretary— (i) determines that such recipient has insufficient funds to provide the full amount that would otherwise apply under paragraph (1) to all donating individuals; and (ii) at least 30 days before making such determination effective, provides to the Congress written notice of such determination, including a justification. (C) Special rules If the Secretary, with respect to reimbursement provided by a recipient of a grant award under this section to donating individuals, makes a determination under subparagraph (B) to lower the maximum permissible amount under subparagraph (A) for a fiscal year— (i) such determination shall not affect the amount of reimbursement for any approved donating individual prior to the effective date of such determination; and (ii) the maximum permissible amount under subparagraph (A)(ii) for any subsequent year shall be calculated without regard to such lowered amount. . 6. Annual report Section 377 of the Public Health Service Act ( 42 U.S.C. 274f ), as amended by section 5, is amended by inserting after subsection (g) the following: (h) Annual report Not later than the end of fiscal year 2025 and annually thereafter, the Secretary— (1) shall submit to the Congress, and make publicly available, a report on the impacts, ongoing activities, challenges, and future needs of the program under this section; (2) shall include in each such report, for the year covered by the report— (A) an overview of the program under this section; (B) current and trended historical information about the program under this section, including— (i) the total number of donating individuals applying for reimbursement; (ii) the average and median reimbursement amount provided to donating individuals; (iii) demographic information regarding— (I) donating individuals applying for reimbursement; and (II) donating individuals approved for reimbursement; (iv) the types of expenses for which reimbursement was requested (including requests for reimbursement of non-qualifying expenses); (v) the amount of funding provided to donating individuals with respect to each such type of expenses; (vi) the amount of funding provided to donating individuals with respect to each organ category; (vii) the total amount expended to carry out this section, disaggregated by— (I) the amount expended by the Secretary and the recipients of grants under this section on administrative expenses; and (II) the amount provided to donating individuals as reimbursement; (C) the impacts of the program under this section, including— (i) the number of completed donations for which reimbursement was provided; (ii) the proportion of living donor transplants in the United States in which the donor received reimbursement through the program under this section; (iii) an estimate of the savings to the Medicare program under title XVIII of the Social Security Act resulting from the program under this section, both— (I) for the year covered by the report; and (II) cumulatively since the program’s creation; (D) the types of donations made by donating individuals receiving reimbursement, disaggregated according to— (i) the type of organ donated; and (ii) whether the donations were directed, non-directed, or a paired exchange; (E) a description of any efforts to expand or improve the program under this section; (F) a description of the efforts of the Secretary and recipients of grants under this section to increase awareness of the program under this section; (G) a description of challenges experienced by the program under this section, including— (i) the number and percentage of donating individuals applying for reimbursement whose qualifying expenses approached or exceeded the maximum amount allowed under subsection (g); and (ii) an estimate of the total funding needed to fully reimburse, without regard to the maximum amount allowed under subsection (g) or donor income eligibility caps, all donating individuals in the United States for all qualifying expenses; and (H) areas of concern regarding, and identified barriers to, the elimination of financial disincentives to living organ donation; and (3) in addition to the matters listed in paragraph (2), may include other such other matters as may be specified by the Secretary. . 7. Authorization of appropriations Subsection (j) of section 377 of the Public Health Service Act ( 42 U.S.C. 274f ), as redesignated by section 2, is amended by striking is authorized to be appropriated $5,000,000 for each of the fiscal years 2005 through 2009 and inserting are authorized to be appropriated such sums as may be necessary for fiscal years 2026 through 2035 . 8. GAO study Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall— (1) conduct a study on how the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) could, under existing statutory authorities, pay costs that would otherwise be paid through the Living Organ Donation Reimbursement Program under section 377 of the Public Health Service Act ( 42 U.S.C. 274f ); and (2) submit to the Congress a report on the results of such study, including recommendations for any changes needed to achieve such purpose.