S1173-119

1. Short title This Act may be cited as the Restore Protections for Dialysis Patients Act.

2. Purposes The purposes of this Act are the following: 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. 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. 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.

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: may not on any basis (including the diagnosis of end-stage renal disease or the need for renal dialysis) or in any manner— 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 apply a limitation on benefits (including on network composition) under the plan that will disparately affect individuals having end-stage renal disease; 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).. (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