II 111th CONGRESS 1st Session S. 565 IN THE SENATE OF THE UNITED STATES March 10, 2009 Mr. Durbin (for himself, Mr. Cochran, Mr. Levin, and Mr. Dorgan) 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 continued entitlement to coverage for immunosuppressive drugs furnished to beneficiaries under the Medicare Program that have received a kidney transplant and whose entitlement to coverage would otherwise expire, and for other purposes.

1.

Short title

This Act may be cited as the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2009.

2.

Provision of appropriate coverage of immunosuppressive drugs under the Medicare Program for kidney 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)

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 eligible only 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 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 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. . (3)

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 Kidney Transplant Patients Act of 2009, 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.

3.

Plans required to maintain coverage of immunosuppressive drugs for kidney transplant recipients

(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:

2708.

Coverage of immunosuppressive drugs for kidney transplant recipients

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 in connection with a kidney transplant 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 Kidney Transplant Patients Act of 2009, 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 2708) 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:

715.

Coverage of immunosuppressive drugs for kidney transplant recipients

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 in connection with a kidney transplant 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 Kidney Transplant Patients Act of 2009, 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. 1191a(a)) is amended by striking section 711 and inserting sections 711 and 715. (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 714 the following new item: Sec. 715. 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 9813 the following new item: Sec. 9814. Coverage of immunosuppressive drugs for kidney transplant recipients. ; and(2)by inserting after section 9813 the following:

9814.

Coverage of immunosuppressive drugs for kidney transplant recipients

A group health plan shall provide coverage of immunosuppressive drugs in connection with a kidney transplant 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 Kidney Transplant Patients Act of 2009, 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, 2010.