[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6139 Introduced in House (IH)]

<DOC>






114th CONGRESS
  2d Session
                                H. R. 6139

  To amend title XVIII of the Social Security Act to provide Medicare 
     entitlement to immunosuppressive drugs for kidney transplant 
                              recipients.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 22, 2016

Mr. Burgess (for himself, Mr. Kind, Mr. Harper, Mr. Meehan, Ms. Herrera 
 Beutler, Mr. Cooper, Mr. Griffith, and Mr. McDermott) introduced the 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, 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 to provide Medicare 
     entitlement to immunosuppressive drugs for kidney transplant 
                              recipients.

    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 Kidney Transplant Patients Act of 2016''.

SEC. 2. MEDICARE ENTITLEMENT TO IMMUNOSUPPRESSIVE DRUGS FOR KIDNEY 
              TRANSPLANT RECIPIENTS.

    (a) 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 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) In general.--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 Coverage.--
Beginning on January 1, 2017, every individual whose insurance benefits 
under part A has 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) Conforming amendment.--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 Drugs.--Section 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, 2017, 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) In general.--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) Conforming amendments.--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 Drugs.--Section 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 Drugs.--The 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) Government Contribution.--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 after paragraph (3) 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 Drugs.--
Section 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, 2017, 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 Program.--Section 
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) Part D.--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.
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