[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 173 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                 S. 173

  To amend title XVIII of the Social Security Act to provide adequate 
 coverage for immunosuppressive drugs furnished to beneficiaries under 
      the medicare program that have received an organ transplant.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 26, 2005

Mr. DeWine (for himself and Mr. Durbin) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide adequate 
 coverage for immunosuppressive drugs furnished to beneficiaries under 
      the medicare program that have received an organ transplant.

    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 ``Comprehensive Immunosuppressive Drug 
Coverage for Transplant Patients Act of 2005''.

SEC. 2. COMPREHENSIVE COVERAGE OF IMMUNOSUPPRESSIVE DRUGS UNDER THE 
              MEDICARE PROGRAM.

    (a) In General.--Section 1861(s)(2)(J) of the Social Security Act 
(42 U.S.C. 1395x(s)(2)(J)) is amended by striking ``, to an individual 
who receives'' and all that follows before the semicolon at the end and 
inserting ``to an individual who has received an organ transplant''.
    (b) Effective Date.--The amendments made by this section shall 
apply to drugs furnished on or after the date of enactment of this Act.

SEC. 3. PROVISION OF APPROPRIATE COVERAGE OF IMMUNOSUPPRESSIVE DRUGS 
              UNDER THE MEDICARE PROGRAM FOR ORGAN TRANSPLANT 
              RECIPIENTS.

    (a) Continued Entitlement to Immunosuppressive Drugs.--
            (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 coverage of immunosuppressive drugs 
        under section 1861(s)(2)(J))'' after ``shall end''.
            (2) Other transplant recipients.--The flush matter 
        following paragraph (2)(C)(ii)(II) of section 226(b) of the 
        Social Security Act (42 U.S.C. 426(b)) is amended by striking 
        ``of this subsection)'' and inserting ``of this subsection and 
        except for coverage of immunosuppressive drugs under section 
        1861(s)(2)(J))''.
            (3) Application.--Section 1836 of the Social Security Act 
        (42 U.S.C. 1395o) is amended--
                    (A) by striking ``Every individual who'' and 
                inserting ``(a) In General.--Every individual who''; 
                and
                    (B) by adding at the end the following new 
                subsection:
    ``(b) Special Rules Applicable to Individuals Only Eligible for 
Coverage of Immunosuppressive Drugs.--
            ``(1) In general.--In the case of an individual whose 
        eligibility for benefits under this title has ended except for 
        the coverage of immunosuppressive drugs by reason of section 
        226(b) or 226A(b)(2), the following rules shall apply:
                    ``(A) The individual shall be deemed to be enrolled 
                under this part for purposes of receiving coverage of 
                such drugs.
                    ``(B) The individual shall be responsible for the 
                full amount of the premium under section 1839 in order 
                to receive such coverage.
                    ``(C) The provision of such drugs shall be subject 
                to the application of--
                            ``(i) the deductible under section 1833(b); 
                        and
                            ``(ii) the coinsurance amount applicable 
                        for such drugs (as determined under this part).
                    ``(D) If the individual is an inpatient of a 
                hospital or other entity, the individual is entitled to 
                receive coverage of such drugs under this part.
            ``(2) Establishment of procedures in order to implement 
        coverage.--The Secretary shall establish procedures for--
                    ``(A) identifying beneficiaries that are entitled 
                to coverage of immunosuppressive drugs by reason of 
                section 226(b) or 226A(b)(2); and
                    ``(B) distinguishing such beneficiaries from 
                beneficiaries that are enrolled under this part for the 
                complete package of benefits under this part.''.
            (4) Technical amendment.--Subsection (c) of section 226A of 
        the Social Security Act (42 U.S.C. 426-1), as added by section 
        201(a)(3)(D)(ii) of the Social Security Independence and 
        Program Improvements Act of 1994 (Public Law 103-296; 108 Stat. 
        1497), is redesignated as subsection (d).
    (b) Extension of Secondary Payer Requirements for ESRD 
Beneficiaries.--Section 1862(b)(1)(C) of the Social Security Act (42 
U.S.C. 1395y(b)(1)(C)) is amended by adding at the end the following 
new sentence: ``With regard to immunosuppressive drugs furnished on or 
after the date of enactment of the Comprehensive Immunosuppressive Drug 
Coverage for Transplant Patients Act of 2005, this subparagraph shall 
be applied without regard to any time limitation.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to drugs furnished on or after the date of enactment of this Act.

SEC. 4. PLANS REQUIRED TO MAINTAIN COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

    (a) Application to Certain Health Insurance Coverage.--
            (1) In general.--Subpart 2 of part A of title XXVII of the 
        Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
        amended by adding at the end the following:

``SEC. 2707. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

    ``A group health plan (and a health insurance issuer offering 
health insurance coverage in connection with a group health plan) shall 
provide coverage of immunosuppressive drugs that is at least as 
comprehensive as the coverage provided by such plan or issuer on the 
day before the date of enactment of the Comprehensive Immunosuppressive 
Drug Coverage for Transplant Patients Act of 2005, and such requirement 
shall be deemed to be incorporated into this section.''.
            (2) Conforming amendment.--Section 2721(b)(2)(A) of the 
        Public Health Service Act (42 U.S.C. 300gg-21(b)(2)(A)) is 
        amended by inserting ``(other than section 2707)'' after 
        ``requirements of such subparts''.
    (b) Application to Group Health Plans and Group Health Insurance 
Coverage Under the Employee Retirement Income Security Act of 1974.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1185 et seq.) is amended by adding at the end the 
        following new section:

``SEC. 714. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

    ``A group health plan (and a health insurance issuer offering 
health insurance coverage in connection with a group health plan) shall 
provide coverage of immunosuppressive drugs that is at least as 
comprehensive as the coverage provided by such plan or issuer on the 
day before the date of enactment of the Comprehensive Immunosuppressive 
Drug Coverage for Transplant Patients Act of 2005, and such requirement 
shall be deemed to be incorporated into this section.''.
            (2) Conforming amendments.--
                    (A) Section 732(a) of the Employee Retirement 
                Income Security Act of 1974 (29 U.S.C. 1191(a)) is 
                amended by striking ``section 711'' and inserting 
                ``sections 711 and 714''.
                    (B) The table of contents in section 1 of the 
                Employee Retirement Income Security Act of 1974 is 
                amended by inserting after the item relating to section 
                713 the following new item:

``Sec. 714. Coverage of immunosuppressive drugs''.
    (c) Application to Group Health Plans Under the Internal Revenue 
Code of 1986.--Subchapter B of chapter 100 of the Internal Revenue Code 
of 1986 is amended--
            (1) in the table of sections, by inserting after the item 
        relating to section 9812 the following new item:

``Sec. 9813. Coverage of immunosuppressive drugs'';
        and
            (2) by inserting after section 9812 the following:

``SEC. 9813. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

    ``A group health plan shall provide coverage of immunosuppressive 
drugs that is at least as comprehensive as the coverage provided by 
such plan on the day before the date of enactment of the Comprehensive 
Immunosuppressive Drug Coverage for Transplant Patients Act of 2005, 
and such requirement shall be deemed to be incorporated into this 
section.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to plan years beginning on or after January 1, 2006.
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