Official Summaries

Restore Protections for Dialysis Patients Act

This bill specifies certain requirements for private health insurers regarding coverage of individuals with end stage renal disease (ESRD) who are also covered under Medicare. 

In particular, the bill specifies that insurers may not limit benefits, including limiting network composition, in a manner that will affect ESRD Medicare beneficiaries differently compared to others without ESRD. The bill additionally specifies that insurers are not required to include a particular renal dialysis provider or a particular number of such providers as part of their networks. 

Current Full Text

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

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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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