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This bill would strengthen and clarify protections for people with end-stage renal disease, especially those who need dialysis. It says private health plans should not treat dialysis patients worse than other people, should not use coverage rules that push their costs onto Medicare, and should not limit benefits in a way that unfairly hurts these patients. At the same time, the bill makes clear that health plans would still be allowed to choose which dialysis providers are in their networks; they would just not be required to include any specific provider or a certain number of providers.
- It aims to stop private health plans from discriminating against people with end-stage renal disease or treating dialysis differently from other covered medical care.
- It would prevent health plans from shifting the main responsibility for paying dialysis-related health costs onto Medicare.
- It clarifies that plans cannot use benefit limits or network rules in a way that has a worse effect on people who need dialysis.
- It also states that plans do not have to include any particular dialysis provider, or any set number of providers, in their networks.
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]
[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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