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S. 323 (113th): Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013

The text of the bill below is as of Feb 13, 2013 (Introduced).


II

113th CONGRESS

1st Session

S. 323

IN THE SENATE OF THE UNITED STATES

February 13, 2013

(for himself andMr. Cochran) introduced the following bill; which was read twice and referred to theCommittee 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 other renal dialysis provisions.

1.

Short title

This Act may be cited as the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013 .

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)

Kidney transplant recipients

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 insection 1861(s)(2)(J))before, with the thirty-sixth month.

(2)

Individuals eligible only for coverage of immunosuppressive drugs

(A)

Section 1836 of the Social Security Act(42 U.S.C. 1395o)is amended—

(i)

by strikingEveryand inserting(a)In general.—Every; and

(ii)

by inserting at the end the following new subsection:

(b)

Individuals eligible for immunosuppressive drug coverage

Beginning on January 1, 2014, every individual whose insurance benefits under part A have ended (whether before, on, or after such date) by reason ofsection 226A(b)(2)is eligible for enrollment in the insurance program established by this part solely for purposes of coverage of immunosuppressive drugs.

.

(B)

Conforming amendment

Sections 1837,1838, and1839 of the Social Security Act(42 U.S.C. 1395(p),42 U.S.C. 1395(q),42 U.S.C. 1395(r)) are each amended by striking 1836 and inserting 1836(a) each place it appears.

(3)

Enrollment for individuals only eligible for coverage of immunosuppressive drugs

Section 1837 of the Social Security Act(42 U.S.C. 1395(p))is amended by adding at the end the following new subsection:

(m)
(1)

Any individual who is eligible undersection 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 inparagraph (1)may enroll beginning on the first day of the third month before the month in which the individual first satisfiessection 1836(b).

(3)

An individual described inparagraph (1)whose entitlement for hospital insurance benefits under part A ends by reason ofsection 226A(b)(2)on or after January 1, 2014, shall be deemed to have enrolled in the medical insurance program established by this part for purposes of coverage of immunosuppressive drugs.

.

(4)

Coverage period for individuals only eligible for coverage of immunosuppressive drugs

(A)

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 insection 1836(b), 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 undersection 1837(m)(3), such individual’s coverage period shall begin on the first day of the month in which the individual first satisfiessection 1836(b).

(2)

In the case of such an individual who enrolls in part B for coverage of immunosuppressive drugs undersection 1837(m)(2), such individual’s coverage period shall begin on the first day of the month in which the individual first satisfiessection 1836(b)or the month following the month in which the individual so enrolls, whichever is later.

(3)

The provisions ofsubsections (b)and(d)shall apply with respect to an individual described inparagraph (1)or(2).

(4)

In addition to the reasons for termination undersubsection (b), the coverage period of an individual described inparagraph (1)or(2)shall end when the individual becomes entitled to benefits under this title undersection 226(a),226(b), or226A.

.

(B)

Conforming amendments

Section 1838(b) of the Social Security Act(42 U.S.C. 1395q(b))is amended, in the matter followingparagraph (2), by addingorsection 1837(m)(3) after section 1837(f) each place it appears.

(5)

Premiums for individuals only eligible for coverage of immunosuppressive drugs

Section 1839 of the Social Security Act(42 U.S.C. 1395r)is amended—

(A)

insubsection (b), by adding at the end the following new sentence:No increase in the premium shall be effected for individuals who are enrolled pursuant tosection 1836(b)for coverage only of immunosuppressive drugs.; and

(B)

by adding at the end the following new subsection:

(j)

Determination of premium for individuals only eligible for coverage of immunosuppressive drugs

TheSecretaryshall, during September of each year, 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 undersection 1836(b). Such premium shall be equal to 35 percent of the monthly actuarial rate for enrollees age 65 and over, determined according toparagraph (1), for that succeeding calendar year. The monthly premium of each individual enrolled for coverage of immunosuppressive drugs undersection 1836(b)for each month shall be the amount promulgated in this subsection. Such amount shall be adjusted in accordance withsubsections (c)and(f).

.

(6)

Government contribution

Section 1844(a) of the Social Security Act(42 U.S.C. 1395w(a))is amended—

(A)

inparagraph (3), by striking the period at the end and inserting; plus;

(B)

by adding at the end 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 undersection 1839(j)instead of 50 percent of the actuarial rate for individuals who enroll only for the purpose of coverage of immunosuppressive drugs undersection 1836(b).

; and

(C)

by adding at the end the following flush matter:

The Government contribution underparagraph (4)shall be treated as premiums payable and deposited for purposes ofsubparagraphs (A)and(B) of paragraph (1).

.

(7)

Extension of secondary payer requirements for ESRD beneficiaries eligible for coverage of immunosuppressive drugs

Section 1862(b)(1)(C) of the Social Security Act(42 U.S.C. 1395(y)(b)(1))is amended by adding at the end the following new sentence:With regard to immunosuppressive drugs furnished to an individual who enrolls for the purpose of coverage of immunosuppressive drugs undersection 1836(b)on or after January 1, 2014, this subparagraph shall apply without regard to any time limitation, except that when such individual becomes entitled to benefits under this title undersections 226(a)or226(b), or entitled to or eligible for benefits under this title undersection 226A, the provisions ofsubparagraphs (A)and(B), and the time limitations under this subparagraph, respectively, shall apply..

(8)

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 insertingor an individual who is enrolled under part B for the purpose of coverage of immunosuppressive drugs undersection 1836(b) after section 1818 .

(9)

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 undersection 1836(b))before the period at the end.