1.
This Act may be cited as the
Comprehensive Immunosuppressive Drug
Coverage for Transplant Patients Act of 2005
.
2.
Comprehensive coverage of immunosuppressive drugs under the
medicare program
(a)
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)
The amendments made by this
section shall apply to drugs furnished on or after the date of enactment of
this Act.
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)
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 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)
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)
The amendments made by this
section shall apply to drugs furnished on or after the date of enactment of
this Act.
4.
Plans required to maintain coverage of immunosuppressive
drugs
(a)
Application to certain health insurance coverage
(1)
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:
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)
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)
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:
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)
(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:
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)
The amendments made by this
section shall apply to plan years beginning on or after January 1, 2006.