S 323 ISCommentsClose CommentsPermalink

113th CONGRESSCommentsClose CommentsPermalink

1st SessionCommentsClose CommentsPermalink

S. 323CommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

IN THE SENATE OF THE UNITED STATESCommentsClose CommentsPermalink

February 13, 2013CommentsClose CommentsPermalink

Mr. DURBIN (for himself and Mr. COCHRAN) introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

A BILLCommentsClose CommentsPermalink

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.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.

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

SEC. 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-CommentsClose CommentsPermalink





(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 in section 1861(s)(2)(J))’ before ‘, with the thirty-sixth month’.CommentsClose CommentsPermalink





(2) INDIVIDUALS ELIGIBLE ONLY FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS-CommentsClose CommentsPermalink





(A) Section 1836 of the Social Security Act (42 U.S.C. 1395o) is amended--CommentsClose CommentsPermalink





(i) by striking ‘Every’ and inserting ‘(a) In General- Every’; andCommentsClose CommentsPermalink





(ii) by inserting at the end the following new subsection:CommentsClose CommentsPermalink





‘(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 of section 226A(b)(2) is eligible for enrollment in the insurance program established by this part solely for purposes of coverage of immunosuppressive drugs.’.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENT- Sections 1837, 1838, and 1839 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.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(m)(1) Any individual who is eligible under section 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.CommentsClose CommentsPermalink





‘(2) An individual described in paragraph (1) may enroll beginning on the first day of the third month before the month in which the individual first satisfies section 1836(b).CommentsClose CommentsPermalink





‘(3) 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, 2014, shall be deemed to have enrolled in the medical insurance program established by this part for purposes of coverage of immunosuppressive drugs.’.CommentsClose CommentsPermalink





(4) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS-CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(g) In the case of an individual described in section 1836(b), the following rules shall apply:CommentsClose CommentsPermalink





‘(1) In the case of such an individual who is deemed to have enrolled in part B for coverage of immunosuppressive drugs under section 1837(m)(3), such individual’s coverage period shall begin on the first day of the month in which the individual first satisfies section 1836(b).CommentsClose CommentsPermalink





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





‘(3) The provisions of subsections (b) and (d) shall apply with respect to an individual described in paragraph (1) or (2).CommentsClose CommentsPermalink





‘(4) 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 section 226(a), 226(b), or 226A.’.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENTS- Section 1838(b) of the Social Security Act (42 U.S.C. 1395q(b)) is amended, in the matter following paragraph (2), by adding ‘or section 1837(m)(3)’ after ‘section 1837(f)’ each place it appears.CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(A) 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.’; andCommentsClose CommentsPermalink





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





‘(j) Determination of Premium for Individuals Only Eligible for Coverage of Immunosuppressive Drugs- The Secretary shall, 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 under section 1836(b). Such premium shall be equal to 35 percent of the monthly actuarial rate for enrollees age 65 and over, determined according to paragraph (1), 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. Such amount shall be adjusted in accordance with subsections (c) and (f).’.CommentsClose CommentsPermalink





(6) GOVERNMENT CONTRIBUTION- Section 1844(a) of the Social Security Act (42 U.S.C. 1395w(a)) is amended--CommentsClose CommentsPermalink





(A) in paragraph (3), by striking the period at the end and inserting ‘; plus’;CommentsClose CommentsPermalink





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





‘(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 under section 1839(j) instead of 50 percent of the actuarial rate for individuals who enroll only for the purpose of coverage of immunosuppressive drugs under section 1836(b).’; andCommentsClose CommentsPermalink





(C) by adding at the end the following flush matter:CommentsClose CommentsPermalink





‘The Government contribution under paragraph (4) shall be treated as premiums payable and deposited for purposes of subparagraphs (A) and (B) of paragraph (1).’.CommentsClose CommentsPermalink





(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 under section 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 under sections 226(a) or 226(b), or entitled to or eligible for benefits under this title under section 226A, the provisions of subparagraphs (A) and (B), and the time limitations under this subparagraph, respectively, shall apply.’.CommentsClose CommentsPermalink





(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 inserting ‘or an individual who is enrolled under part B for the purpose of coverage of immunosuppressive drugs under section 1836(b)’ after ‘section 1818’.CommentsClose CommentsPermalink





(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 under section 1836(b))’ before the period at the end.CommentsClose CommentsPermalink