[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5659 Introduced in House (IH)]
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114th CONGRESS
2d Session
H. R. 5659
To amend title XVIII of the Social Security Act with respect to
expanding Medicare Advantage coverage for individuals with end-stage
renal disease (ESRD).
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 7, 2016
Mr. Smith of Missouri (for himself, Mr. Lewis, Mr. Bilirakis, Mr.
Schrader, and Mr. Marino) introduced the following bill; which was
referred to the Committee on Ways and Means, and in addition to the
Committee on Energy and Commerce, 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 with respect to
expanding Medicare Advantage coverage for individuals with end-stage
renal disease (ESRD).
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Expanding Seniors Receiving Dialysis
Choice Act of 2016'' or as the ``ESRD Choice Act of 2016''.
SEC. 2. EXPANDING MEDICARE ADVANTAGE COVERAGE FOR INDIVIDUALS WITH END-
STAGE RENAL DISEASE (ESRD).
(a) Expanded MA Eligibility.--
(1) In general.--Section 1851(a)(3) of the Social Security
Act (42 U.S.C. 1395w-21(a)(3)) is amended--
(A) by striking subparagraph (B); and
(B) by striking ``eligible individual'' and all
that follows through ``In this title, subject to
subparagraph (B),'' and inserting ``eligible
individual.--In this title,''.
(2) Conforming amendments.--
(A) Section 1852(b)(1) of the Social Security Act
(42 U.S.C. 1395w-22(b)(1)) is amended--
(i) by striking subparagraph (B); and
(ii) by striking ``Beneficiaries'' and all
that follows through ``A Medicare+Choice
organization'' and inserting ``Beneficiaries.--
A Medicare Advantage organization.''.
(B) The flush sentence at the end of section
1859(b)(6) of the Social Security Act (42 U.S.C. 1395w-
28(b)(6)) is amended by striking ``may waive'' and all
that follows through ``subparagraph and''.
(b) Excluding Costs for Kidney Acquisitions From MA Benchmark.--
Section 1853 of the Social Security Act (42 U.S.C. 1395w-23) is
amended--
(1) in subsection (k)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph
(A), by striking ``paragraphs (2) and (4)'' and
inserting ``paragraphs (2), (4), and (5)''; and
(ii) in subparagraph (B)(i), by striking
``paragraphs (2) and (4)'' and inserting
``paragraphs (2), (4), and (5)''; and
(B) by adding at the end the following new
paragraph:
``(5) Exclusion of costs for kidney acquisitions from
capitation rates.--After determining the applicable amount for
an area for a year under paragraph (1) (beginning with 2019),
the Secretary shall adjust such applicable amount to exclude
from such applicable amount the Secretary's estimate of the
standardized costs for payments for organ acquisitions for
kidney transplants covered under this title (including expenses
covered under section 1881(d)) in the area for the year.''; and
(2) in subsection (n)(2)--
(A) in subparagraph (A)(i), by inserting ``and, for
2019 and subsequent years, the exclusion of payments
for organ acquisitions for kidney transplants from the
capitation rate as described in subsection (k)(5)''
before the semicolon at the end;
(B) in subparagraph (E), in the matter preceding
clause (i), by striking ``subparagraph (F)'' and
inserting ``subparagraphs (F) and (G)''; and
(C) by adding at the end the following new
subparagraph:
``(G) Application of kidney acquisitions
adjustment.--The base payment amount specified in
subparagraph (E) for a year (beginning with 2019) shall
be adjusted in the same manner under paragraph (5) of
subsection (k) as the applicable amount is adjusted
under such subsection.''.
(c) FFS Coverage of Kidney Acquisitions.--
(1) In general.--Section 1852(a)(1)(B)(i) of the Social
Security Act (42 U.S.C. 1395w-22(a)(1)(B)(i)) is amended by
inserting ``or coverage for organ acquisitions for kidney
transplants, including as covered under section 1881(d),''
after ``hospice care''.
(2) Conforming amendment.--Section 1851(i) of the Social
Security Act (42 U.S.C. 1395w-21(i)) is amended by adding at
the end the following new paragraph:
``(3) FFS payment for expenses for kidney acquisitions.--
Paragraphs (1) and (2) do not apply with respect to expenses
for organ acquisitions for kidney transplants described in
section 1852(a)(1)(B)(i).''.
(d) Expanded MA Education.--Section 1851(d)(2)(A)(iii) of the
Social Security Act (42 U.S.C. 1395w-21(d)(2)(A)(iii)) is amended by
inserting before the period at the end the following: ``, including any
additional information that individuals determined to have end-stage
renal disease may need to make informed decisions with respect to such
an election''.
(e) Report.--Not later than April 1, 2022, the Administrator of the
Centers for Medicare & Medicaid Services shall submit to Congress a
report on the impact of the amendments made by this section on spending
under the traditional Medicare fee-for-service program under parts A
and B of title XVIII of the Social Security Act as well as on spending
under parts C and D of such title. The report shall include an
assessment of the risk adjustment payment methodologies under such
parts C and D and their adequacy with respect to individuals with end-
stage renal disease and such recommendations as the Administrator deems
appropriate.
(f) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after January 1, 2020.
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