Sec. 3. Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions

1,772 words·~8 min read·/bill/116/hr/2477/eh/section-3

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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 . Section 1836 of the Social Security Act ( 42 U.S.C. 1395o ) is amended— by striking Every and inserting

(a); and In general. —Every by adding at the end the following new subsection: Except as provided under paragraph (2), every individual whose entitlement to insurance benefits under part A ends (whether before, on, or after January 1, 2023) by reason of section 226A(b)(2) is eligible to enroll or to be deemed to have enrolled in the medical insurance program established by this part solely for purposes of coverage of immunosuppressive drugs in accordance with section 1837(n). 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)— 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; is enrolled for coverage under the TRICARE for Life program under section 1086(d) of title 10, United States Code; is enrolled under a State plan (or waiver of such plan) under title XIX and is eligible to receive benefits for immunosuppressive drugs described in this subsection under such plan (or such waiver); is enrolled under a State child health plan (or waiver of such plan) under title XXI and is eligible to receive benefits for such drugs under such plan (or such waiver); or 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; is not required to enroll under section 1705 of such title to receive immunosuppressive drugs described in this subsection; or 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. The Secretary, in coordination 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 medical 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). The process established under clause

(i)shall include, at a minimum, a requirement that— the individual provide to the Commissioner an attestation that the individual is not enrolled and does not expect to enroll in such other coverage; and the individual notify the Commissioner within 60 days of enrollment in such other coverage. . 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. Section 1837(j)(1) of such Act ( 42 U.S.C. 1395p(j)(1) ) is amended by striking 1836(1) and inserting 1836(a)(1) . Section 1837 of the Social Security Act ( 42 U.S.C. 1395p ), as amended by section 2(b)(2)(A), is further amended by adding at the end the following new subsection: Any individual who is eligible for coverage of immunosuppressive drugs under section 1836(b) may enroll or be deemed to have enrolled only in such manner and form as may be prescribed by regulations, and only during an enrollment period described in this subsection. 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, 2023, may enroll beginning on October 1, 2022, or the day on which the individual first satisfies section 1836(b), whichever is later. 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, 2023, shall be deemed to have enrolled in the medical insurance program established by this part for purposes of coverage of immunosuppressive drugs. 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. . Section 1838 of the Social Security Act ( 42 U.S.C. 1395q ), as amended by section 2(b)(2)(B), is further amended by adding at the end the following new subsection: In the case of an individual described in section 1836(b)(1), the following rules shall apply: In the case of such an individual who is deemed to have enrolled in part B for coverage of immunosuppressive drugs under section 1837(n)(3), such individual’s coverage period shall begin on the first day of the month in which the individual first satisfies section 1836(b). 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(n), such individual’s coverage period shall begin on January 1, 2023, or the month following the month in which the individual so enrolls (or reenrolls), whichever is later. The provisions of subsections

(b)and

(d)shall apply with respect to an individual described in paragraph

(1)or (2). 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 subsection

(a)or

(b)of section 226, or under section 226A, or is no longer eligible for such coverage as a result of the application of section 1836(b)(2). The Secretary may conduct public education activities to raise awareness of the availability of more comprehensive, individual health insurance coverage (as defined in section 2791 of the Public Health Service Act) for individuals eligible under section 1836(b) to enroll or to be deemed enrolled in the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs. . 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(n)(3) after section 1837(f) each place it appears. Section 1839 of the Social Security Act ( 42 U.S.C. 1395r ) is amended— 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 by adding at the end the following new subsection: The Secretary shall, during September of each year (beginning with 2022), determine and promulgate a monthly premium rate for the succeeding calendar year for individuals enrolled only for the purpose of coverage of immunosuppressive drugs under section 1836(b). Such premium shall be equal to 15 percent of the monthly actuarial rate for enrollees age 65 and over (as would be determined in accordance with subsection (a)(1) if the reference to one-half in such subsection were a reference to 100 percent ) 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. In the case of such individual not otherwise enrolled under this part, such premium shall be in lieu of any other monthly premium applicable under this section. Such amount shall be adjusted in accordance with subsections (c), (f), and (i), but shall not be adjusted under subsection (b). . Section 1839(f) of the Social Security Act ( 42 U.S.C. 1395r(f) ) is amended by adding at the end the following new sentence: Any increase in the premium for an individual who was enrolled under section 1836(b) attributable to such individual otherwise enrolling under this part shall not be taken into account in applying this subsection. . Section 1839(i)(3)(A)(ii)(II) of the Social Security Act ( 42 U.S.C. 1395r(i)(3)(A)(ii)(II) ) is amended by inserting except in the case of an individual enrolled under section 1836(b) and not otherwise enrolled under this part, before 4 times . Section 1844(a) of the Social Security Act ( 42 U.S.C. 1395w(a) ) is amended— in paragraph (3), by striking the period at the end and inserting ; plus ; by inserting after paragraph

(3)the following new paragraph: a Government contribution equal to the estimated aggregate reduction in premiums payable under part B that results from establishing the premium at 15 percent of the actuarial rate (as would be determined in accordance with section 1839(a)(1) if the reference to one-half in such section were a reference to 100 percent ) under section 1839(j) instead of 25 percent of such rate (as so determined) for individuals enrolled only for the purpose of coverage of immunosuppressive drugs under section 1836(b). ; and 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). . Section 1905(p)(1)(A) of the Social Security Act ( 42 U.S.C. 1396d(p)(1)(A) ) is amended by inserting or who is enrolled under part B for the purpose of coverage of immunosuppressive drugs under section 1836(b) after under section 1818A) . Section 1902(a)(10)(E) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(E) ) is amended in each of clauses

(iii)and

(iv)by inserting (including such individuals enrolled under section 1836(b)) after section 1905(p)(1) . 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. The Comptroller General of the United States (in this subsection 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 section. Not later than January 1, 2025, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1), together with recommendations as the Comptroller General determines appropriate.

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