[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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