113 HR 1325 IH: Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013
U.S. House of Representatives
2013-03-21
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the
Comprehensive Immunosuppressive Drug
Coverage for Kidney Transplant Patients Act of
2013
.
2.Medicare
entitlement to immunosuppressive drugs for kidney transplant
recipients
(a)Kidney
transplant recipientsSection 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
.
(b)Individuals
eligible only for coverage of immunosuppressive drugs
(1)Section 1836 of the Social Security Act (42 U.S.C. 1395o)
is amended—
(A)by striking
Every
and inserting (a)
In
general.—Every
; and
(B)by inserting at
the end the following new subsection:
(b)Individuals
eligible for immunosuppressive drug coverageBeginning 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.
.
(2)Sections 1837, 1838, and 1839 of the Social Security
Act (42 U.S.C. 1395(o), 42 U.S.C. 1395(p), 42 U.S.C. 1395(q)) are each amended
by striking 1836
and inserting 1836(a)
each place
it appears.
(c)Enrollment for
individuals only eligible for coverage of immunosuppressive
drugsSection 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 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.
(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).
(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.
.
(d)Coverage period
for individuals only eligible for coverage of immunosuppressive drugs
(1)Section 1838 of the Social Security Act (42 U.S.C.
1395(q)) is amended by adding at the end the following new subsection:
(g)In the case of an
individual described in section 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 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).
(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.
(3)The provisions of
subsections (b) and (d) shall apply with respect to an individual described in
paragraph (1) or (2).
(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.
.
(2)Section 1838(b) is amended in the matter following
paragraph (2) by adding or section 1837(m)(3)
after
section 1837(f)
each place it appears.
(e)Premiums for
individuals only eligible for coverage of immunosuppressive
drugsSection 1839 of the Social Security Act (42 U.S.C. 1395r)
is amended—
(1)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.
; and
(2)by adding at the
end the following new subsection:
(j)Determination of
premium for individuals only eligible for coverage of immunosuppressive
drugsThe 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).
.
(f)Section 1844(a) of the Social Security Act (42
U.S.C. 1395(w)) is amended—
(1)in paragraph (3),
by striking the period at the end and inserting ; plus
;
(2)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 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).
;
and
(3)by adding at the
end the following flush matter:
The
Government contribution under paragraph (4) shall be treated as premiums
payable and deposited for purposes of subparagraphs (A) and (B) of paragraph
(1)..
(g)Extension of
secondary payer requirements for ESRD beneficiaries eligible for coverage of
immunosuppressive drugsSection 1862(b)(1)(C) (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.
.
(h)Ensuring
coverage under the Medicare savings programSection 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
.
(i)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.