II 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 immuno- suppressive drugs for kidney transplant patients, and for other purposes. 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 Im- 4 munosuppressive Drug Coverage for Kidney Transplant 5 Patients Act of 2020’’. 6 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 2 •S 3353 IS SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNO- 1 SUPPRESSIVE DRUGS FOR KIDNEY TRANS- 2 PLANT PATIENTS AND OTHER RENAL DIALY- 3 SIS PROVISIONS. 4 (a) MEDICARE ENTITLEMENT TO IMMUNO- 5 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI- 6 ENTS.— 7 (1) IN GENERAL.—Section 226A(b)(2) of the 8 Social Security Act (42 U.S.C. 426–1(b)(2)) is 9 amended by inserting ‘‘(except for eligibility for en- 10 rollment under part B solely for purposes of cov- 11 erage of immunosuppressive drugs described in sec- 12 tion 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth 13 month’’. 14 (2) INDIVIDUALS ELIGIBLE ONLY FOR COV- 15 ERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 16 (A) IN GENERAL.—Section 1836 of the So- 17 cial Security Act (42 U.S.C. 1395o) is amend- 18 ed— 19 (i) by striking ‘‘Every’’ and inserting 20 ‘‘(a) IN GENERAL.—EVERY’’; and 21 (ii) by adding at the end the following 22 new subsection: 23 ‘‘(b) INDIVIDUALS ELIGIBLE FOR IMMUNO- 24 SUPPRESSIVE DRUG COVERAGE.— 25 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 3 •S 3353 IS ‘‘(1) IN GENERAL.—Except as provided under 1 paragraph (2), every individual whose entitlement to 2 insurance benefits under part A ends (whether be- 3 fore, on, or after January 1, 2022) by reason of sec- 4 tion 226A(b)(2) is eligible to enroll in the insurance 5 program established by this part solely for purposes 6 of coverage of immunosuppressive drugs in accord- 7 ance with section 1837(m). 8 ‘‘(2) EXCEPTION IF OTHER COVERAGE IS 9 AVAILABLE.— 10 ‘‘(A) IN GENERAL.—An individual de- 11 scribed in paragraph (1) shall not be eligible for 12 enrollment in the program for purposes of cov- 13 erage described in such paragraph with respect 14 to any period in which the individual, as deter- 15 mined in accordance with subparagraph (B)— 16 ‘‘(i) is enrolled in a group health plan 17 or group or individual health insurance 18 coverage, as such terms are defined in sec- 19 tion 2791 of the Public Health Service 20 Act; 21 ‘‘(ii) is enrolled for coverage under the 22 TRICARE for Life program under section 23 1086(d) of title 10, United States Code; or 24 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 4 •S 3353 IS ‘‘(iii)(I) is enrolled in the patient en- 1 rollment system of the Department of Vet- 2 erans Affairs established and operated 3 under section 1705 of title 38, United 4 States Code; 5 ‘‘(II) is not required to enroll under 6 section 1705 of such title to receive im- 7 munosuppressive drugs described in this 8 subsection; or 9 ‘‘(III) is otherwise eligible under a 10 provision of title 38, United States Code, 11 other than section 1710 of such title to re- 12 ceive immunosuppressive drugs described 13 in this subsection. 14 ‘‘(B) ELIGIBILITY DETERMINATIONS.— 15 ‘‘(i) IN GENERAL.—The Secretary, in 16 consultation with the Commissioner of So- 17 cial Security, shall establish a process for 18 determining whether an individual de- 19 scribed in paragraph (1) who is to be en- 20 rolled or deemed to be enrolled in the in- 21 surance program described in such para- 22 graph meets the requirements for such en- 23 rollment under this subsection, including 24 the requirement that the individual not be 25 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 5 •S 3353 IS enrolled in other coverage as described in 1 subparagraph (A). 2 ‘‘(ii) ATTESTATION REGARDING 3 OTHER COVERAGE.—The process estab- 4 lished under clause (i) shall include, at a 5 minimum, a requirement that— 6 ‘‘(I) the individual provide to the 7 Commissioner an attestation that the 8 individual is not enrolled in such other 9 coverage; and 10 ‘‘(II) the individual notify the 11 Secretary within 60 days of any 12 change in the insurance coverage of 13 the individual.’’. 14 (B) CONFORMING AMENDMENT.—Sections 15 1837, 1838, and 1839 of the Social Security 16 Act (42 U.S.C. 1395p, 42 U.S.C. 1395q, 42 17 U.S.C. 1395r) are each amended by striking 18 ‘‘1836’’ and inserting ‘‘1836(a)’’ each place it 19 appears. 20 (b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE 21 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec- 22 tion 1837 of the Social Security Act (42 U.S.C. 1395p) 23 is amended by adding at the end the following new sub- 24 section: 25 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 6 •S 3353 IS ‘‘(m)(1) Any individual who is eligible under section 1 1836(b) to enroll in the medical insurance program estab- 2 lished under this part for purposes of coverage of immuno- 3 suppressive drugs may enroll only in such manner and 4 form as may be prescribed by regulations, and only during 5 an enrollment period described in this subsection. 6 ‘‘(2) An individual described in paragraph (1) whose 7 entitlement for hospital insurance benefits under part A 8 ends by reason of section 226A(b)(2) prior to January 1, 9 2022, may enroll beginning on the first day of the third 10 month before the month in which the individual first satis- 11 fies section 1836(b). 12 ‘‘(3) An individual described in paragraph (1) whose 13 entitlement for hospital insurance benefits under part A 14 ends by reason of section 226A(b)(2) on or after January 15 1, 2022, shall be deemed to have enrolled in the medical 16 insurance program established by this part for purposes 17 of coverage of immunosuppressive drugs. 18 ‘‘(4) The Secretary shall establish a process under 19 which an individual described in paragraph (1) whose 20 other coverage described in section 1836(b)(2)(A), or cov- 21 erage under this part (including the medical insurance 22 program established under this part for purposes of cov- 23 erage of immunosuppressive drugs) is terminated volun- 24 tarily or involuntary may enroll or reenroll, if applicable, 25 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 7 •S 3353 IS in the medical insurance program established under this 1 part for purposes of coverage of immunosuppressive 2 drugs.’’. 3 (c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELI- 4 GIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE 5 DRUGS.— 6 (1) IN GENERAL.—Section 1838 of the Social 7 Security Act (42 U.S.C. 1395q) is amended by add- 8 ing at the end the following new subsection: 9 ‘‘(g) In the case of an individual described in section 10 1836(b)(1), the following rules shall apply: 11 ‘‘(1) In the case of such an individual who is 12 deemed to have enrolled in part B for coverage of 13 immunosuppressive drugs under section 1837(m)(3), 14 such individual’s coverage period shall begin on the 15 first day of the month in which the individual first 16 satisfies section 1836(b). 17 ‘‘(2) In the case of such an individual who en- 18 rolls (or reenrolls, if applicable) in part B for cov- 19 erage of immunosuppressive drugs under paragraph 20 (2) or (4) of section 1837(m), such individual’s cov- 21 erage period shall begin on January 1, 2022, or the 22 month following the month in which the individual 23 so enrolls (or reenrolls), whichever is later. 24 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 8 •S 3353 IS ‘‘(3) The provisions of subsections (b) and (d) 1 shall apply with respect to an individual described in 2 paragraph (1) or (2). 3 ‘‘(4) In addition to the reasons for termination 4 under subsection (b), the coverage period of an indi- 5 vidual described in paragraph (1) or (2) shall end 6 when the individual becomes entitled to benefits 7 under this title under section 226(a) or 226A or is 8 no longer eligible for such coverage as a result of the 9 application of section 1836(b)(2). 10 ‘‘(5) The Secretary may conduct public edu- 11 cation activities to raise awareness of the availability 12 of more comprehensive, qualified health plans for 13 beneficiaries eligible under this subsection.’’. 14 (2) CONFORMING AMENDMENTS.—Section 15 1838(b) of the Social Security Act (42 U.S.C. 16 1395q(b)) is amended, in the matter following para- 17 graph (2), by inserting ‘‘or section 1837(m)(3)’’ 18 after ‘‘section 1837(f)’’ each place it appears. 19 (d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE 20 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec- 21 tion 1839 of the Social Security Act (42 U.S.C. 1395r) 22 is amended— 23 (1) in subsection (b), by adding at the end the 24 following new sentence: ‘‘No increase in the pre- 25 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 9 •S 3353 IS mium shall be effected for individuals who are en- 1 rolled pursuant to section 1836(b) for coverage only 2 of immunosuppressive drugs.’’; and 3 (2) by adding at the end the following new sub- 4 section: 5 ‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID- 6 UALS ONLY ELIGIBLE FOR COVERAGE OF IMMUNO- 7 SUPPRESSIVE DRUGS.—The Secretary shall, during Sep- 8 tember of each year (beginning with 2021), determine and 9 promulgate a monthly premium rate for the succeeding 10 calendar year for individuals who enroll only for the pur- 11 pose of coverage of immunosuppressive drugs under sec- 12 tion 1836(b). Such premium shall be equal to 35 percent 13 of the monthly actuarial rate for enrollees age 65 and over, 14 determined according to paragraph (1), for that suc- 15 ceeding calendar year. The monthly premium of each indi- 16 vidual enrolled for coverage of immunosuppressive drugs 17 under section 1836(b) for each month shall be the amount 18 promulgated in this subsection. Such amount shall be ad- 19 justed in accordance with subsections (c), (f), and (i), but 20 shall not be adjusted under subsection (b).’’. 21 (e) GOVERNMENT CONTRIBUTION.—Section 1844(a) 22 of the Social Security Act (42 U.S.C. 1395w(a)) is amend- 23 ed— 24 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 10 •S 3353 IS (1) in paragraph (3), by striking the period at 1 the end and inserting ‘‘; plus’’; 2 (2) by inserting after paragraph (3) the fol- 3 lowing new paragraph: 4 ‘‘(4) a Government contribution equal to the es- 5 timated aggregate reduction in premiums payable 6 under part B that results from establishing the pre- 7 mium at 35 percent of the actuarial rate under sec- 8 tion 1839(j) instead of 50 percent of the actuarial 9 rate for individuals who enroll only for the purpose 10 of coverage of immunosuppressive drugs under sec- 11 tion 1836(b).’’; and 12 (3) by adding the following sentence at the end 13 of the flush matter following paragraph (4), as 14 added by paragraph (2) of this subsection: 15 ‘‘The Government contribution under paragraph (4) 16 shall be treated as premiums payable and deposited 17 for purposes of subparagraphs (A) and (B) of para- 18 graph (1).’’. 19 (f) ENSURING COVERAGE UNDER THE MEDICARE 20 SAVINGS PROGRAM.—Section 1905(p)(1)(A) of the Social 21 Security Act (42 U.S.C. 1396d(p)(1)(A)) is amended by 22 inserting ‘‘or an individual who is enrolled under part B 23 for the purpose of coverage of immunosuppressive drugs 24 under section 1836(b)’’ after ‘‘section 1818’’. 25 VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS 11 •S 3353 IS (g) PART D.—Section 1860D–1(a)(3)(A) of the So- 1 cial Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is 2 amended by inserting ‘‘(but not including an individual en- 3 rolled solely for coverage of immunosuppressive drugs 4 under section 1836(b))’’ before the period at the end. 5 SEC. 3. GAO STUDY AND REPORT. 6 (a) STUDY.—The Comptroller General of the United 7 States (in this section referred to as the ‘‘Comptroller 8 General’’) shall conduct a study on the implementation of 9 coverage of immunosuppressive drugs for kidney trans- 10 plant patients under the Medicare program pursuant to 11 the provisions of, and amendments made by this Act. Such 12 study shall include the identification, after implementation 13 of such coverage, of any leakage in the eligibility, enroll- 14 ment, and coverage processes relating to such coverage in 15 order to address program integrity issues. 16 (b) REPORT.—Not later than January 1, 2024, the 17 Comptroller General shall submit to Congress a report on 18 the study conducted under subsection (a), together with 19 recommendations for such legislation and administrative 20 action as the Comptroller General determines appropriate. 21 Æ VerDate Sep 11 2014 03:16 Feb 28, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S3353.IS S3353 kjohnson on DSK79L0C42PROD with BILLS