H.R. 6011 (112th): Kidney Disease Equitable Access, Prevention, and Research Act of 2012

112th Congress, 2011–2013. Text as of Jun 21, 2012 (Introduced).

Status & Summary | PDF | Source: GPO

I

112th CONGRESS

2d Session

H. R. 6011

IN THE HOUSE OF REPRESENTATIVES

June 21, 2012

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 title XVIII of the Social Security Act to improve Medicare benefits for individuals with kidney disease, and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Kidney Disease Equitable Access, Prevention, and Research Act of 2012.

(b)

Table of contents

The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

Title I—Providing equitable access to care for individuals with kidney disease

Sec. 101. Improving access to care through improvements in the initial survey process for renal dialysis facilities.

Sec. 102. Providing choice in primary insurer.

Sec. 103. Protecting individuals with kidney failure from unfair practices.

Title II—Supporting research to improve access to high-quality kidney care

Sec. 201. Understanding the progression of kidney disease in minority populations.

Sec. 202. Recommendations on dialysis quality and care management research gaps.

Sec. 203. GAO study on transportation barriers to access kidney care.

Title III—Improving access to preventive care for individuals with kidney disease

Sec. 301. Improving access to medicare kidney disease education.

I

Providing equitable access to care for individuals with kidney disease

101.

Improving access to care through improvements in the initial survey process for renal dialysis facilities

Section 1864 of the Social Security Act (42 U.S.C. 1395aa) is amended—

(1)

by redesignating subsection (e) as subsection (f);

(2)

by inserting after subsection (d) the following new subsection:

(e)
(1)

If the Secretary has entered into an agreement with any State under this section under which the appropriate State or local agency that performs any survey related to determining the compliance of a renal dialysis facility subject to the requirements of section 1881(b) and the State licensure survey requirements are consistent with or exceed such Federal requirements, the Secretary must accept the results of the State licensure survey for purposes of determining Federal certification of compliance. In the case of such an initial survey of a renal dialysis facility, the Secretary may allow any State to waive the reimbursement for conducting the survey under this section if it requests such a waiver.

(2)

In the case of a renal dialysis facility that has waited for more than 6 months to receive the results of an initial survey under this section, the Secretary shall establish a specific timetable for completing and reporting the results of the survey.

; and

(3)

in subsection (f), as so redesignated—

(A)

by striking Notwithstanding any other provision of law, and inserting (1) Notwithstanding any other provision of law and except as provided in paragraph (2); and

(B)

by adding at the end the following:

(2)

The Secretary may assess and collect fees for the initial Medicare survey from a renal dialysis facility subject to the requirements of section 1881(b) in an amount not to exceed a reasonable fee necessary to cover the costs of initial surveys conducted for purposes of determining the compliance of a renal dialysis facility with the requirements of section 1881(b). Fees may be assessed and collected under this paragraph only in such manner as would result in an aggregate amount of fees collected during any fiscal year being equal to the aggregate amount of costs for such fiscal year for initial surveys of such facilities under this section. A renal dialysis facility’s liability for such fees shall be reasonably based on the proportion of the survey costs which relate to such facility. Any funds collected under this paragraph shall be used only to conduct the initial survey of the facilities providing the fees.

(3)

Fees authorized under paragraph (2) shall be collected by the Secretary and available only to the extent and in the amount provided in advance in appropriations Acts and upon request of the Secretary, subject to the amount and usage limitations of such paragraph. Such fees so collected are authorized to remain available until expended.

.

102.

Providing choice in primary insurer

(a)

Providing patient choice in Medicare

(1)

In general

Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended—

(A)

in the last sentence, by inserting and before January 1, 2013, after prior to such date); and

(B)

by adding at the end the following new sentence: Effective for items and services furnished on or after January 1, 2013 (with respect to periods beginning on or after the date that is 42 months prior to such date), clauses (i) and (ii) shall be applied by substituting 42-month for 12-month each place it appears in the first sentence..

(2)

Effective date

The amendments made by this subsection shall take effect on the date of enactment of this Act. For purposes of determining an individual’s status under section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by paragraph (1), an individual who is within the coordinating period as of the date of enactment of this Act shall have that period extended to the full 42 months described in the last sentence of such section, as added by the amendment made by paragraph (1)(B).

(b)

Providing equitable access to insurance for individuals with kidney failure

(1)

Application of ESRD Medicare secondary payer rules to health insurance issuers

(A)

In general

Section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) is amended—

(i)

in paragraph (1)(C), in the matter before clause (i), by inserting and health insurance coverage (as defined in section 2791(b) of the Public Health Service Act) that is a qualified health plan (as defined in section 1301 of the Patient Protection and Affordable Care Act) after subparagraph (A)(v));

(ii)

in paragraph (2)(A), in the matter after clause (ii), by inserting a group health plan, large group health plan, or health insurance coverage (as defined in section 2791(b) of the Public Health Service Act) that is a qualified health plan (as defined in section 1301 of the Patient Protection and Affordable Care Act) to the extent that clause (i) applies pursuant to the application of paragraph (1)(C), after to the extent that clause (i) applies,;

(iii)

in paragraph (3)(C), by striking or a large group health plan and inserting , a large group health plan, or health insurance coverage (as defined in section 2791(b) of the Public Health Service Act) that is a qualified health plan (as defined in section 1301 of the Patient Protection and Affordable Care Act); and

(iv)

in paragraph (7), by adding at the end the following new subparagraph:

(E)

Application to certain health insurance issuers

The provisions of the previous subparagraphs of this paragraph shall apply to a health insurance issuer offering health insurance coverage (as defined in section 2791(b) of the Public Health Service Act) that is a qualified health plan (as defined in section 1301 of the Patient Protection and Affordable Care Act) in the same manner as such provisions apply to an entity, a plan administrator, or a fiduciary described in subparagraph (A), except that in applying such provisions—

(i)

the reference under subparagraph (A) to the date of the enactment of this paragraph shall be deemed a reference to the date of the enactment of this subparagraph; and

(ii)

the reference under subparagraph (A)(i) to a primary plan shall be deemed a reference to a primary plan to the extent that paragraph (2)(A)(i) applies pursuant to the application of paragraph (1)(C).

.

(B)

Effective date

The amendments made by subparagraph (A) shall apply with respect to plan years beginning on or after the date of the enactment of this Act.

(2)

Treatment of certain individuals with end stage renal disease for determining minimum essential coverage

Such section is further amended in paragraph (2), by adding at the end the following new subparagraph:

(D)

Treatment of certain individuals with end stage renal disease for determining minimum essential coverage

In determining a coverage month under subsection (c)(2)(B)(i) of section 36B of the Internal Revenue Code of 1986, with respect to an individual described in paragraph (1)(C), for purposes of the premium assistance credit under such section and the application of subsection (f)(2) of section 1402 of the Patient Protection and Affordable Care Act for determining eligibility for the reduction of cost-sharing under such section, such individual shall not be treated as having minimum essential coverage described in section 5000A(f)(1)(A)(i) (relating to coverage under Medicare) for each month that a group health plan or health insurance issuer may not take into account the individual’s eligibility or entitlement under this title pursuant to such paragraph (1)(C).

.

103.

Protecting individuals with kidney failure from unfair practices

(a)

In general

Section 1862(b)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)(ii)) is amended to read as follows:

(ii)

may not differentiate in the benefits it provides between individuals having end stage renal disease and other individuals covered by such plan or issuer on the basis of the existence of end stage renal disease, the need for renal dialysis, or in any other manner, and such plan—

(I)

shall provide adequate, advanced, written notification to patients regarding changes to benefits for dialysis services, new restrictions on out-of-network access, or reductions in rates paid for out-of-network benefits for such services;

(II)

shall allow patients to continue using their existing provider or facility of such services for at least 24 months following the date of notice of any change by the plan or issuer in the dialysis services network of the plan or issuer;

(III)

shall hold patients harmless from provider network changes with respect to such services if such changes require unreasonable drive time or disrupt the physician-patient relationship;

(IV)

may not restrict the duration or number of dialysis sessions for patients, such as based on a fixed number of treatments per week, to less than the number for which payment may be made pursuant to section 1881(b)(1);

(V)

may not require assignment of benefits for such services;

(VI)

shall ensure that out-of-pocket payments for such services (including if made on behalf of the individual involved) are counted towards meeting any out-of-pocket maximum applied under an MA plan under part C and not treated as routine for purposes of calculating beneficiary copayments;

(VII)

may not deny or limit coverage for patients for such services if premiums, copayments, or other payments are made by third parties on their behalf; and

(VIII)

shall meet minimum network adequacy standards specified by the Secretary with respect to such services;

.

(b)

Effective Date

The amendment made by subsection (a) shall apply to group health plans and qualified health plans as of January 1, 2014.

II

Supporting research to improve access to high-quality kidney care

201.

Understanding the progression of kidney disease in minority populations

Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall complete a study (and submit a report to Congress) on—

(1)

the social, behavioral, and biological factors leading to kidney disease; and

(2)

efforts to slow the progression of kidney disease in minority populations that are disproportionately affected by such disease.

202.

Recommendations on dialysis quality and care management research gaps

Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report regarding the research gaps with respect to the development of quality metrics and care management metrics for patients with end-stage renal disease, including pediatric and home dialysis patients. Such report shall include recommendations about undertaking research to fill such gaps and prioritizing such research.

203.

GAO study on transportation barriers to access kidney care

(a)

In General

The Comptroller General of the United States shall conduct an evaluation of the transportation barriers facing dialysis patients that result in less than 100 percent compliance with their plan of care under the Medicare program.

(b)

Specific Matters Evaluated

In conducting the evaluation under subsection (a), the Comptroller General shall examine—

(1)

the costs associated with providing dialysis services;

(2)

the number and characteristics of patients who miss at least 2 dialysis treatments during a month or have shortened treatments because of barriers to transportation; and

(3)

the potential sources of providing dialysis patients with such transportation services.

(c)

Report

Not later than the date that is 6 months after the date of the enactment of this Act, 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.

III

Improving access to preventive care for individuals with kidney disease

301.

Improving access to medicare kidney disease education

(a)

In general

Section 1861(ggg)(2) of the Social Security Act (42 U.S.C. 1395x(ggg)(2)) is amended—

(1)

by striking subparagraph (B); and

(2)

in subparagraph (A)—

(A)

by striking (A) after (2);

(B)

by striking and at the end of clause (i);

(C)

by striking the period at the end of clause (ii) and inserting ; and;

(D)

by redesignating clauses (i) and (ii) as subparagraphs (A) and (B), respectively; and

(E)

by adding at the end the following:

(C)

a renal dialysis facility subject to the requirements of section 1881(b)(1) with personnel who—

(i)

provide the services described in paragraph (1); and

(ii)

is a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in subsection (aa)(5)).

.

(b)

Payment to Renal Dialysis Facilities

Section 1881(b) of such Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following new paragraph:

(15)

For purposes of paragraph (14), the single payment for renal dialysis services under such paragraph shall not take into account the amount of payment for kidney disease education services (as defined in section 1861(ggg)). Instead, payment for such services shall be made to the renal dialysis facility on an assignment-related basis under section 1848.

.

(c)

Providing education services to individuals with kidney failure

Section 1861(ggg)(1)(A) of the Social Security Act (42 U.S.C. 1395x(ggg)(1)(A)) is amended—

(1)

by inserting or stage V after stage IV; and

(2)

by inserting and who is not receiving dialysis services after chronic kidney disease.

(d)

Effective Date

The amendments made by this section apply to kidney disease education services furnished on or after January 1, 2013.