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)]
<DOC>
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.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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