HR 6011 IHCommentsClose CommentsPermalink

112th CONGRESSCommentsClose CommentsPermalink

2d SessionCommentsClose CommentsPermalink

H. R. 6011CommentsClose CommentsPermalink

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

IN THE HOUSE OF REPRESENTATIVESCommentsClose CommentsPermalink

June 21, 2012CommentsClose CommentsPermalink

Mr. LEWIS of Georgia 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 concernedCommentsClose CommentsPermalink

A BILLCommentsClose CommentsPermalink

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

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 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’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink





Sec. 102. Providing choice in primary insurer.CommentsClose CommentsPermalink





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

TITLE II--SUPPORTING RESEARCH TO IMPROVE ACCESS TO HIGH-QUALITY KIDNEY CARE

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





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





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

TITLE III--IMPROVING ACCESS TO PREVENTIVE CARE FOR INDIVIDUALS WITH KIDNEY DISEASE

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

TITLE I--PROVIDING EQUITABLE ACCESS TO CARE FOR INDIVIDUALS WITH KIDNEY DISEASECommentsClose CommentsPermalink

SEC. 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--CommentsClose CommentsPermalink





(1) by redesignating subsection (e) as subsection (f);CommentsClose CommentsPermalink





(2) by inserting after subsection (d) the following new subsection:CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’; andCommentsClose CommentsPermalink





(3) in subsection (f), as so redesignated--CommentsClose CommentsPermalink





(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)’; andCommentsClose CommentsPermalink





(B) by adding at the end the following:CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink

SEC. 102. PROVIDING CHOICE IN PRIMARY INSURER.

(a) Providing Patient Choice in Medicare-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended--CommentsClose CommentsPermalink





(A) in the last sentence, by inserting ‘and before January 1, 2013,’ after ‘prior to such date)’; andCommentsClose CommentsPermalink





(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.’.CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(b) Providing Equitable Access to Insurance for Individuals With Kidney Failure-CommentsClose CommentsPermalink





(1) APPLICATION OF ESRD MEDICARE SECONDARY PAYER RULES TO HEALTH INSURANCE ISSUERS-CommentsClose CommentsPermalink





(A) IN GENERAL- Section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) is amended--CommentsClose CommentsPermalink





(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))’;CommentsClose CommentsPermalink





(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,’;CommentsClose CommentsPermalink





(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)’; andCommentsClose CommentsPermalink





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





‘(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--CommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(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).’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(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).’.CommentsClose CommentsPermalink

SEC. 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:CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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);CommentsClose CommentsPermalink





‘(V) may not require assignment of benefits for such services;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(VIII) shall meet minimum network adequacy standards specified by the Secretary with respect to such services;’.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) shall apply to group health plans and qualified health plans as of January 1, 2014.CommentsClose CommentsPermalink

TITLE II--SUPPORTING RESEARCH TO IMPROVE ACCESS TO HIGH-QUALITY KIDNEY CARECommentsClose CommentsPermalink

SEC. 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--CommentsClose CommentsPermalink





(1) the social, behavioral, and biological factors leading to kidney disease; andCommentsClose CommentsPermalink





(2) efforts to slow the progression of kidney disease in minority populations that are disproportionately affected by such disease.CommentsClose CommentsPermalink

SEC. 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.CommentsClose CommentsPermalink

SEC. 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.CommentsClose CommentsPermalink





(b) Specific Matters Evaluated- In conducting the evaluation under subsection (a), the Comptroller General shall examine--CommentsClose CommentsPermalink





(1) the costs associated with providing dialysis services;CommentsClose CommentsPermalink





(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; andCommentsClose CommentsPermalink





(3) the potential sources of providing dialysis patients with such transportation services.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

TITLE III--IMPROVING ACCESS TO PREVENTIVE CARE FOR INDIVIDUALS WITH KIDNEY DISEASECommentsClose CommentsPermalink

SEC. 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--CommentsClose CommentsPermalink





(1) by striking subparagraph (B); andCommentsClose CommentsPermalink





(2) in subparagraph (A)--CommentsClose CommentsPermalink





(A) by striking ‘(A)’ after ‘(2)’;CommentsClose CommentsPermalink





(B) by striking ‘and’ at the end of clause (i);CommentsClose CommentsPermalink





(C) by striking the period at the end of clause (ii) and inserting ‘; and’;CommentsClose CommentsPermalink





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





(E) by adding at the end the following:CommentsClose CommentsPermalink





‘(C) a renal dialysis facility subject to the requirements of section 1881(b)(1) with personnel who--CommentsClose CommentsPermalink





‘(i) provide the services described in paragraph (1); andCommentsClose CommentsPermalink





‘(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)).’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(1) by inserting ‘or stage V’ after ‘stage IV’; andCommentsClose CommentsPermalink





(2) by inserting ‘and who is not receiving dialysis services’ after ‘chronic kidney disease’.CommentsClose CommentsPermalink





(d) Effective Date- The amendments made by this section apply to kidney disease education services furnished on or after January 1, 2013.CommentsClose CommentsPermalink