[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6011 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 6011
To amend title XVIII of the Social Security Act to improve Medicare
benefits for individuals with kidney disease, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 21, 2012
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 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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
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''.
(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.
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.
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.''.
SEC. 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).''.
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:
``(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.
TITLE II--SUPPORTING RESEARCH TO IMPROVE ACCESS TO HIGH-QUALITY KIDNEY
CARE
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--
(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.
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.
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.
(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.
TITLE III--IMPROVING ACCESS TO PREVENTIVE CARE FOR INDIVIDUALS WITH
KIDNEY DISEASE
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--
(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.
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