119-hr2199

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2199 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 2199

To amend title XVIII of the Social Security Act to clarify and preserve 
 the breadth of the protections under the Medicare Secondary Payer Act.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 March 18, 2025

 Mr. Kelly of Pennsylvania (for himself, Ms. Clarke of New York, Mr. 
Dunn of Florida, Mr. Davis of Illinois, Mr. Joyce of Pennsylvania, and 
 Mr. Ruiz) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
 and Commerce, 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 clarify and preserve 
 the breadth of the protections under the Medicare Secondary Payer Act.

 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 ``Restore Protections for Dialysis 
Patients Act''.

SEC. 2. PURPOSES.

 The purposes of this Act are the following:

    (1) To restore the MSPA's protections for ESRD patients by 
 ensuring that private health plans do not discriminate against 
 such patients or adversely classify dialysis as compared to 
 other covered medical services.

    (2) To prohibit health insurance plans from shifting 
 primary responsibility for covering the cost of health care 
 services needed by patients with ESRD to the Medicare program.

    (3) To affirm Congress' intent by clarifying that singling 
 out dialysis services for disfavored treatment through coverage 
 limitations as compared to other covered health services 
 constitutes inappropriate differentiations between the benefits 
 provided to individuals having ESRD and other individuals, but 
 does not change a plan's current ability to limit which renal 
 dialysis providers it includes in the provider network it 
 elects to offer its enrollees.

SEC. 3. CLARIFICATION AND PRESERVATION OF PROHIBITION UNDER THE 
 MEDICARE PROGRAM.

 

Section 1862

    (b)

    (1)
            (C) of the Social Security Act (42 U.S.C. 
1395y

    (b)

    (1)
            (C) ) is amended--

    (1) by striking clause
            (ii) and inserting the following new 
 clause:
 ``
            (ii) may not on any basis (including the 
 diagnosis of end stage renal disease or the 
 need for renal dialysis) or in any manner--
 ``
            (I) differentiate (or have the 
 effect of differentiating) in the 
 benefits it provides between 
 individuals having end stage renal 
 disease and other individuals covered 
 by such plan; or
 ``
            (II) apply a limitation on 
 benefits (including on network 
 composition) under the plan that will 
 disparately affect individuals having 
 end stage renal disease;''; and

    (2) by adding at the end of the matter following clause
            (ii) the following new sentences: ``Nothing in this subsection 
 shall be construed as requiring a group health plan to include 
 a particular renal dialysis provider or a particular number of 
 renal dialysis providers as part of the provider network the 
 group health plan elects to offer its enrollees. The Secretary 
 shall enforce this subparagraph consistent with the 
 nonconformance determination requirements set forth in part 411 
 of title 42, Code of Federal Regulations.''.
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