Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020

IB Union Calendar No. 570 116TH CONGRESS 2D SESSION H. R. 5534 [Report No. 116–687, Part I] 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 sub- sequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned DECEMBER 24, 2020 Additional sponsors: Mr. RUSH, Mr. FITZPATRICK, Mr. MARCHANT, Mr. POSEY, Ms. MENG, Mr. COLE, Mrs. AXNE, Mr. CISNEROS, Mr. KILMER, Ms. BLUNT ROCHESTER, Mr. VISCLOSKY, Mr. HIGGINS of New York, Ms. KELLY of Illinois, Mrs. LURIA, Mr. LATTA, Mrs. BUSTOS, Mrs. ROD- GERS of Washington, Mr. PAYNE, Mr. MEEKS, Mr. CASE, Ms. DEGETTE, Mr. GRIJALVA, Mr. GONZALEZ of Texas, Mr. DEUTCH, Mr. BILIRAKIS, Mr. RYAN, Mr. BUCSHON, Mr. LONG, Ms. NORTON, Mr. LAMB, Mr. RUP- PERSBERGER, Ms. PORTER, Ms. BROWNLEY of California, Mr. POCAN, Mrs. BROOKS of Indiana, Mr. GOODEN, Mr. SHIMKUS, Mr. CURTIS, Mr. NEGUSE, Mrs. MURPHY of Florida, Mr. KELLY of Pennsylvania, Mr. OLSON, Mr. SMUCKER, Ms. MCCOLLUM, Mr. COSTA, Mr. COOPER, Mr. ALLRED, Mr. KILDEE, Mrs. BEATTY, Ms. JACKSON LEE, Mr. ROUDA, Mr. KENNEDY, Ms. WILD, Mr. RUTHERFORD, Mrs. DEMINGS, Mr. CON- NOLLY, Ms. LOFGREN, Mr. MALINOWSKI, Mr. RODNEY DAVIS of Illinois, Mr. RIGGLEMAN, Mr. MCGOVERN, Ms. CLARKE of New York, Ms. CHE- NEY, Mr. SOTO, Mr. EVANS, Mr. KING of New York, Mr. LUJA´N, Mr. CRAWFORD, Mr. WELCH, Mr. BLUMENAUER, Mr. LARSON of Con- necticut, Mr. ROSE of New York, Mr. HORSFORD, Mr. MCKINLEY, Mr. BISHOP of Georgia, Mr. TRONE, Mr. GALLEGO, Mr. THOMPSON of Cali- VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 5534 RH fornia, Mr. WENSTRUP, Mr. BURCHETT, Mr. PRICE of North Carolina, Mr. BOST, Mr. KIM, Mr. BRINDISI, Mr. YARMUTH, Mr. NADLER, Ms. KAPTUR, Mr. LEVIN of Michigan, Ms. KENDRA S. HORN of Oklahoma, Mr. SIMPSON, Mr. AGUILAR, Ms. VELA´ZQUEZ, Mr. LAWSON of Florida, Ms. ROYBAL-ALLARD, Ms. MOORE, Ms. CRAIG, Ms. SEWELL of Alabama, Mr. CARSON of Indiana, Mr. RICHMOND, Mr. BAIRD, Ms. JOHNSON of Texas, Ms. UNDERWOOD, Mr. HASTINGS, Mr. GREEN of Texas, Mr. VAN DREW, Mrs. MILLER, Ms. DELBENE, and Ms. FINKENAUER DECEMBER 24, 2020 Reported from the Committee on Energy and Commerce with an amendment [Strike out all after the enacting clause and insert the part printed in italic] DECEMBER 24, 2020 Committee on Ways and Means discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed [For text of introduced bill, see copy of bill as introduced on December 23, 2019] A BILL To amend title XVIII of the Social Security Act to provide for extended months of Medicare coverage of immuno- suppressive drugs for kidney transplant patients, and for other purposes. VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 5534 RH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Comprehensive Immuno- 4 suppressive Drug Coverage for Kidney Transplant Patients 5 Act of 2020’’. 6 SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNO- 7 SUPPRESSIVE DRUGS FOR KIDNEY TRANS- 8 PLANT PATIENTS AND OTHER RENAL DIALY- 9 SIS PROVISIONS. 10 (a) MEDICARE ENTITLEMENT TO IMMUNO- 11 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI- 12 ENTS.— 13 (1) IN GENERAL.—Section 226A(b)(2) of the So- 14 cial Security Act (42 U.S.C. 426–1(b)(2)) is amended 15 by inserting ‘‘(except for eligibility for enrollment 16 under part B solely for purposes of coverage of im- 17 munosuppressive drugs described in section 18 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth month’’. 19 (2) INDIVIDUALS ELIGIBLE ONLY FOR COVERAGE 20 OF IMMUNOSUPPRESSIVE DRUGS.— 21 (A) IN GENERAL.—Section 1836 of the So- 22 cial Security Act (42 U.S.C. 1395o) is amend- 23 ed— 24 VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 5534 RH (i) by striking ‘‘Every’’ and inserting 1 ‘‘(a) IN GENERAL.—EVERY’’; and 2 (ii) by adding at the end the following 3 new subsection: 4 ‘‘(b) INDIVIDUALS ELIGIBLE FOR IMMUNO- 5 SUPPRESSIVE DRUG COVERAGE.— 6 ‘‘(1) IN GENERAL.—Except as provided under 7 paragraph (2), every individual whose entitlement to 8 insurance benefits under part A ends (whether before, 9 on, or after January 1, 2023) by reason of section 10 226A(b)(2) is eligible to enroll or to be deemed to have 11 enrolled in the medical insurance program established 12 by this part solely for purposes of coverage of im- 13 munosuppressive drugs in accordance with section 14 1837(m). 15 ‘‘(2) EXCEPTION IF OTHER COVERAGE IS AVAIL- 16 ABLE.— 17 ‘‘(A) IN GENERAL.—An individual de- 18 scribed in paragraph (1) shall not be eligible for 19 enrollment in the program for purposes of cov- 20 erage described in such paragraph with respect 21 to any period in which the individual, as deter- 22 mined in accordance with subparagraph (B)— 23 ‘‘(i) is enrolled in a group health plan 24 or group or individual health insurance 25 VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 5534 RH coverage, as such terms are defined in sec- 1 tion 2791 of the Public Health Service Act; 2 ‘‘(ii) is enrolled for coverage under the 3 TRICARE for Life program under section 4 1086(d) of title 10, United States Code; 5 ‘‘(iii) is enrolled under a State plan 6 (or waiver of such plan) under title XIX; 7 ‘‘(iv) is enrolled under a State child 8 health plan under title XXI; or 9 ‘‘(v)(I) is enrolled in the patient enroll- 10 ment system of the Department of Veterans 11 Affairs established and operated under sec- 12 tion 1705 of title 38, United States Code; 13 ‘‘(II) is not required to enroll under 14 section 1705 of such title to receive im- 15 munosuppressive drugs described in this 16 subsection; or 17 ‘‘(III) is otherwise eligible under a pro- 18 vision of title 38, United States Code, other 19 than section 1710 of such title to receive im- 20 munosuppressive drugs described in this 21 subsection. 22 ‘‘(B) ELIGIBILITY DETERMINATIONS.— 23 ‘‘(i) IN GENERAL.—The Secretary, in 24 coordination with the Commissioner of So- 25 VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 5534 RH cial Security, shall establish a process for 1 determining whether an individual de- 2 scribed in paragraph (1) who is to be en- 3 rolled or deemed to be enrolled in the med- 4 ical insurance program described in such 5 paragraph meets the requirements for such 6 enrollment under this subsection, including 7 the requirement that the individual not be 8 enrolled in other coverage as described in 9 subparagraph (A). 10 ‘‘(ii) ATTESTATION REGARDING OTHER 11 COVERAGE.—The process established under 12 clause (i) shall include, at a minimum, a 13 requirement that— 14 ‘‘(I) the individual provide to the 15 Commissioner an attestation that the 16 individual is not enrolled and does not 17 expect to enroll in such other coverage; 18 and 19 ‘‘(II) the individual agree to no- 20 tify the Commissioner within 60 days 21 of enrollment in such other coverage.’’. 22 (B) CONFORMING AMENDMENT.— 23 (i) IN GENERAL.—Sections 1837, 1838, 24 and 1839 of the Social Security Act (42 25 VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 5534 RH U.S.C. 1395p, 42 U.S.C. 1395q, 42 U.S.C. 1 1395r) are each amended by striking 2 ‘‘1836’’ and inserting ‘‘1836(a)’’ each place 3 it appears. 4 (ii) ADDITIONAL AMENDMENT.—Sec- 5 tion 1837(j)(1) of such Act (42 U.S.C. 6 1395p(j)(1)) is amended by striking 7 ‘‘1836(1)’’ and inserting ‘‘1836(a)(1)’’. 8 (b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE 9 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Section 10 1837 of the Social Security Act (42 U.S.C. 1395p) is 11 amended by adding at the end the following new subsection: 12 ‘‘(m)(1) Any individual who is eligible for coverage of 13 immunosuppressive drugs under section 1836(b) may enroll 14 or be deemed to have enrolled only in such manner and 15 form as may be prescribed by regulations, and only during 16 an enrollment period described in this subsection. 17 ‘‘(2) An individual described in paragraph (1) whose 18 entitlement for hospital insurance benefits under part A 19 ends by reason of section 226A(b)(2) prior to January 1, 20 2023, may enroll beginning on October 1, 2022, or the day 21 on which the individual first satisfies section 1836(b), 22 whichever is later. 23 ‘‘(3) An individual described in paragraph (1) whose 24 entitlement for hospital insurance benefits under part A 25 VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 5534 RH ends by reason of section 226A(b)(2) on or after January 1 1, 2023, shall be deemed to have enrolled in the medical 2 insurance program established by this part for purposes of 3 coverage of immunosuppressive drugs. 4 ‘‘(4) The Secretary shall establish a process under 5 which an individual described in paragraph (1) whose other 6 coverage described in section 1836(b)(2)(A), or coverage 7 under this part (including the medical insurance program 8 established under this part for purposes of coverage of im- 9 munosuppressive drugs) is terminated voluntarily or invol- 10 untary may enroll or reenroll, if applicable, in the medical 11 insurance program established under this part for purposes 12 of coverage of immunosuppressive drugs.’’. 13 (c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELIGI- 14 BLE FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 15 (1) IN GENERAL.—Section 1838 of the Social Se- 16 curity Act (42 U.S.C. 1395q) is amended by adding 17 at the end the following new subsection: 18 ‘‘(g) In the case of an individual described in section 19 1836(b)(1), the following rules shall apply: 20 ‘‘(1) In the case of such an individual who is 21 deemed to have enrolled in part B for coverage of im- 22 munosuppressive drugs under section 1837(m)(3), 23 such individual’s coverage period shall begin on the 24 VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 5534 RH first day of the month in which the individual first 1 satisfies section 1836(b). 2 ‘‘(2) In the case of such an individual who en- 3 rolls (or reenrolls, if applicable) in part B for cov- 4 erage of immunosuppressive drugs under paragraph 5 (2) or (4) of section 1837(m), such individual’s cov- 6 erage period shall begin on January 1, 2023, or the 7 month following the month in which the individual so 8 enrolls (or reenrolls), whichever is later. 9 ‘‘(3) The provisions of subsections (b) and (d) 10 shall apply with respect to an individual described in 11 paragraph (1) or (2). 12 ‘‘(4) In addition to the reasons for termination 13 under subsection (b), the coverage period of an indi- 14 vidual described in paragraph (1) or (2) shall end 15 when the individual becomes entitled to benefits under 16 this title under section 226(a) or 226A or is no longer 17 eligible for such coverage as a result of the application 18 of section 1836(b)(2). 19 ‘‘(5) The Secretary may conduct public edu- 20 cation activities to raise awareness of the availability 21 of more comprehensive, qualified health plans for in- 22 dividuals eligible under section 1836(b) to enroll or to 23 be deemed enrolled in the medical insurance program 24 VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 5534 RH established under this part for purposes of coverage of 1 immunosuppressive drugs.’’. 2 (2) CONFORMING AMENDMENTS.—Section 3 1838(b) of the Social Security Act (42 U.S.C. 4 1395q(b)) is amended, in the matter following para- 5 graph (2), by inserting ‘‘or section 1837(m)(3)’’ after 6 ‘‘section 1837(f)’’ each place it appears. 7 (d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE FOR 8 COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Section 9 1839 of the Social Security Act (42 U.S.C. 1395r) is 10 amended— 11 (1) in subsection (b), by adding at the end the 12 following new sentence: ‘‘No increase in the premium 13 shall be effected for individuals who are enrolled pur- 14 suant to section 1836(b) for coverage only of immuno- 15 suppressive drugs.’’; and 16 (2) by adding at the end the following new sub- 17 section: 18 ‘‘(j) DETERMINATION OF PREMIUM FOR INDIVIDUALS 19 ONLY ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE 20 DRUGS.—The Secretary shall, during September of each 21 year (beginning with 2022), determine and promulgate a 22 monthly premium rate for the succeeding calendar year for 23 individuals enrolled only for the purpose of coverage of im- 24 munosuppressive drugs under section 1836(b). Such pre- 25 VerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H5534.RH H5534 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 5534 RH mium shall be equal to 35 percent of the monthly actuarial 1 rate for enrollees age 65 and over (as would be determined 2 in accordance with subsection (a)(1) if the reference to ‘one- 3 half’ in such subsection were a reference to ‘100 percent’) 4 for that succeeding calendar year. The monthly premium 5 of each individual enrolled for coverage of immuno- 6 suppressive drugs under section 1836(b) for each month 7 shall be the amount promulgated in this subsection. Such 8 amount shall be adjusted in accordance with subsections (c), 9 (f), and (i), but shall not be adjusted under subsection (b).’’. 10 (e) ENSURING COVERAGE UNDER THE MEDICARE SAV- 11 INGS PROGRAM.—Section 1905(p)(1)(A) of the Social Secu- 12 rity Act (42 U.S.C. 1396d(p)(1)(A)) is amended by insert- 13 ing ‘‘or who is enrolled under part B for the purpose of 14 coverage of immunosuppressive drugs under section 15 1836(b)’’ after ‘‘under section 1818A)’’. 16 (f) PART D.— [Text truncated for display. Full text available on Congress.gov.]