119-s1173

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1173 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 1173

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 SENATE OF THE UNITED STATES

 March 27, 2025

 Mr. Cassidy (for himself, Mr. Booker, Mr. Cramer, and Mr. Heinrich) 
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 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 protections under Medicare Secondary Payer 
 provisions for individuals with end-stage renal disease by 
 ensuring that private health plans do not discriminate against 
 such individuals 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 individuals with end-stage renal disease to 
 the Medicare program.

    (3) To affirm the intent of Congress 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 with end-stage renal disease 
 and other individuals, but does not change a plan's 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:
 ``
            (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: ``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 described in part 411 
 of title 42, Code of Federal Regulations (or any successor 
 regulation).''.
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