Section 1 Short title
This Act may be cited as the “Restore Protections for Dialysis Patients Act”.
Restore Protections for Dialysis Patients Act
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.
Sec. 2 Purposes
The purposes of this Act are—
to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act;
to prohibit health insurance plans from shifting primary responsibility for covering the cost of health care services needed by patients with end stage renal disease (ESRD) to the Medicare program; and
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 with 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—
by striking clause (ii) and inserting the following new clause:
“(ii) may not differentiate, directly or indirectly, in the benefits it provides between individuals obtaining renal dialysis or having end stage renal disease and other individuals covered by such plan on the basis of—
“(I) the diagnosis of end stage renal disease;
“(II) the need for renal dialysis; or
“(III) in any other manner;”
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 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.”.