[Congressional Record Volume 162, Number 142 (Tuesday, September 20, 2016)]
[House]
[Pages H5679-H5681]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
EXPANDING SENIORS RECEIVING DIALYSIS CHOICE ACT OF 2016
Mr. SMITH of Missouri. Mr. Speaker, I move to suspend the rules and
pass the bill (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), as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5659
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.--
[[Page H5680]]
(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) 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) Sense of Congress Regarding Application of Appropriate
Medicare Advantage Risk Adjustment for Payment for Increased
ESRD Enrollees.--It is the sense of Congress that in
implementing the policies under this section, the Centers for
Medicare & Medicaid Services should provide, in an accurate
and transparent manner, for risk adjustment to payment under
the Medicare Advantage program to account for the increased
enrollment in Medicare Advantage plans of individuals with
end-stage renal disease.
(e) 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''.
(f) 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.
(g) Effective Date.--The amendments made by this section
shall apply to plans years beginning on or after January 1,
2020.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Missouri (Mr. Smith) and the gentleman from Michigan (Mr. Levin) each
will control 20 minutes.
The Chair recognizes the gentleman from Missouri.
{time} 1645
General Leave
Mr. SMITH of Missouri. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days within which to revise and extend
their remarks and include extraneous material on H.R. 5659, currently
under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Missouri?
There was no objection.
Mr. SMITH of Missouri. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I stand today in support of H.R. 5659, the ESRD Choice
Act, and thank the Speaker for taking this effort up today on the
floor.
This bipartisan legislation expands access to high-quality,
affordable healthcare coverage options for Americans suffering from
serious kidney illness. End-stage renal disease, or ESRD, is the only
preexisting condition that explicitly prevents patients from enrolling
in Medicare Advantage.
This bill removes a harmful Federal restriction that has, for too
long, blocked patients with ESRD from enrolling in Medicare Advantage
plans. The question is: Why should kidney disease patients be denied a
choice all other Medicare beneficiaries have? The short answer is: They
shouldn't. These patients should have the same option to choose
Medicare Advantage.
Once this bill is passed and signed into law, my colleagues and I
will be constantly watching the bureaucrats at the Centers for Medicare
and Medicaid Services to make sure they fulfill their responsibilities
to properly risk adjust payments to plans in an accurate and
transparent manner. The bill requires a report of the effects of this
legislation on risk adjustment, and I will be watching to make sure
they get it right.
I also want to recognize the hard work that went into this bill and
specifically thank Mr. Lewis, Mr. Bilirakis, Mr. Schrader, and Mr.
Marino, as well as the Committee on Ways and Means and the Committee on
Energy and Commerce for the hard work to remove the last preexisting
conditions in Medicare Advantage.
The benefits of Medicare Advantage should be extended to all ESRD
patients. It is right thing to do, and now is the time to get it done.
I reserve the balance of my time.
Mr. LEVIN. I yield myself such time as I may consume.
Mr. Speaker, more than 80 percent of the approximately 640,000
Americans living with kidney failure, or end-stage renal disease, are
covered under Medicare. Unfortunately, those individuals who receive
Medicare coverage as a result of their ESRD do not have access to
managed care plans under the Medicare Advantage program.
This bill would make a commonsense change and enable Medicare
beneficiaries with ESRD to have the same choices as all other Medicare
beneficiaries. H.R. 5659 would help make sure ESRD beneficiaries in
Medicare have access to the coordinated services, flexibility, and
integrated care they need to fit their own individual needs.
I want to thank my fellow colleague on the Ways and Means Committee,
the gentleman from Georgia (Mr. Lewis), for his dedication and his hard
work over the past years on this important bipartisan legislation. I
look forward to it advancing swiftly to the President's desk to be
signed into law.
I yield back the balance of my time.
Mr. SMITH of Missouri. Mr. Speaker, I yield myself such time as I may
consume.
The legislation expands access to a program that has improved
millions of lives. This is just one of the bipartisan solutions
Americans deserve, and these are the types of solutions I hope to
continue working with the chairman and my colleagues in delivering as
we work to improve our healthcare system.
Dozens of folks back home in southeast and south central Missouri
have contacted me with their support for this bill. Do you know what
they tell me? They want a choice.
I am pleased that the House is acting on our bill today since it
follows one of our core principles as we look at health care,
increasing patients' options and control over their care. I urge my
colleagues to support the bill.
[[Page H5681]]
I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Missouri (Mr. Smith) that the House suspend the rules
and pass the bill, H.R. 5659, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. AMASH. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this motion will be postponed.
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