H.R. 5534 — what changed

changed This Act may be cited as the “Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019”.2020”.

“(b) Individuals eligible for immunosuppressive drug coverage

changed “(1) In general—Except as provided under paragraph (2), every individual whose entitlement to insurance benefits under part A have ended ends (whether before, on, or after January 1, 2022) 2023) by reason of section 226A(b)(2) is eligible to enroll or to be deemed to have enrolled in the medical insurance program established by this part solely for purposes of coverage of immunosuppressive drugs in accordance with section 1837(m).

changed “(2) Exception if other health insurance coverage is available

changed “(A) In general—An individual described in paragraph (1) shall not be eligible for enrollment in the insurance program for purposes of coverage described in such paragraph with respect to any period in which the individual—individual, as determined in accordance with subparagraph (B)—

changed “(i) is enrolled in a group health plan, as defined in section 2791(a)(1) of the Public Health Service Act, plan or group or individual health insurance coverage, as such terms are defined in section 2791(b)(5) 2791 of such Act, as determined in accordance with subparagraph (B);the Public Health Service Act;

changed “(ii) is eligible enrolled for benefits under—coverage under the TRICARE for Life program under section 1086(d) of title 10, United States Code;

changed “(I) “(iii) is enrolled under a State plan (or waiver of such plan) under title XIX;

changed “(II) “(iv) is enrolled under a State child health plan under title XXI; or

changed “(III) the TRICARE program under chapter 55 of title 10, United States Code;“(v)

changed “(iii) “(I) is enrolled in a health benefits plan the patient enrollment system of the Department of Veterans Affairs established and operated under chapter 89 section 1705 of title 5, 38, United States Code;

changed “(iv) “(II) is eligible for health care benefits not required to enroll under the laws administered by the Secretary section 1705 of Veterans Affairs; such title to receive immunosuppressive drugs described in this subsection; or

changed “(v) “(III) is otherwise eligible under a provision of title 38, United States Code, other than section 1710 of such title to receive services from the Indian Health Service.immunosuppressive drugs described in this subsection.

“(B) Eligibility determinations

changed “(i) In general—The Secretary, in consultation coordination with the Administrator Commissioner of Social Security, shall establish procedures a process for determining whether an individual described in paragraph (1) who is to be enrolled or deemed to be enrolled in the medical insurance program described in such paragraph meets the requirements for such enrollment under this subsection, including the requirement that the individual not have be enrolled in other health insurance coverage as described in subparagraph (A).

changed “(ii) Attestation regarding other coverage—The procedures process established under clause (i) shall include include, at a minimum, a requirement that—

changed “(I) the individual provide to the Secretary Commissioner an attestation that the individual is not enrolled and does not have expect to enroll in such other health insurance coverage; and

changed “(II) update the individual agree to notify the Commissioner within 60 days of enrollment in such attestation—other coverage.”

removed “(aa) on an annual basis; or

removed “(bb) if the health insurance coverage situation of the individual has changed.

removed “(C) Identification and reduction of improper payments—The Secretary, in consultation with the Administrator of Social Security, shall—

removed “(i) establish procedures to ensure that any information provided with respect to other health insurance coverage described in subparagraph (A) of this paragraph for an individual described in paragraph (1) is provided to the appropriate medicare administrative contractor for purposes of identifying any improper payments made with respect to immunosuppressive drug coverage under this part; and

removed “(ii) provide education to prevent or reduce such improper payments, including education through the improper payment outreach and education program under section 1847A9(h).”

“(m)

changed “(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 under section 1836(b) may enroll or be deemed to have enrolled only in such manner and form as may be prescribed by regulations, and only during an enrollment period described in this subsection.

changed “(2) An individual described in paragraph (1) whose entitlement for hospital insurance benefits under part A ends by reason of section 226A(b)(2) prior to January 1, 2022, 2023, may enroll beginning on October 1, 2022, or the first day of the third month before the month in on which the individual first satisfies section 1836(b), or a date specified by the Secretary prior to the first date on which coverage is effective under section 1838(g)(2), whichever is later. In implementing the preceding sentence, the Secretary shall consider procedures to expedite the enrollment of such an individual if practicable for purposes of providing continued coverage of immunosuppressive drugs for such individual pursuant to section 1838(g)(2).later.

changed “(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, 2022, 2023, shall be deemed to have enrolled in the medical insurance program established by this part for purposes of coverage of immunosuppressive drugs.

changed “(4) The Secretary shall establish a process under which an individual described in paragraph (1) whose other health insurance coverage described in section 1836(b)(2)(A), or coverage under this part (including the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs) is terminated voluntarily or involuntary may enroll or reenroll, if applicable, in the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs.”

“(g) In the case of an individual described in section 1836(b)(1), 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).

changed “(2) In the case of such an individual who enrolls (or reenrolls) reenrolls, if applicable) in part B for coverage of immunosuppressive drugs under paragraph (2) or (4) of section 1837(m), such individual’s coverage period shall begin on January 1, 2022 (or such earlier date as the Secretary may specify if practicable for purposes of providing continued coverage of immunosuppressive drugs for such an individual), 2023, or the month following the month in which the individual so enrolls (or reenrolls), 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) or 226A or is no longer eligible for such coverage as a result of the application of section 1836(b)(2).

changed “(5) The Secretary may conduct public education activities to raise awareness of the availability of more comprehensive, qualified health plans for beneficiaries individuals eligible under section 1836(b) to enroll or to be deemed enrolled in the medical insurance program established under this subsection.”part for purposes of coverage of immunosuppressive drugs.”

changed “(j) Determination of premium for individuals only eligible for coverage of immunosuppressive drugs—The Secretary shall, during September of each year (beginning with 2021), 2022), determine and promulgate a monthly premium rate for the succeeding calendar year for individuals who enroll enrolled 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, over (as would be determined according in accordance with subsection (a)(1) if the reference to paragraph (1), “one-half” in such subsection were a reference to “100 percent”) 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), (f), and (i), but shall not be adjusted under subsection (b).”

removed “(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).”