HR 2199
Restore Protections for Dialysis Patients Act
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Bill overview
This bill, the Restore Protections for Dialysis Patients Act, aims to strengthen protections for individuals with end-stage renal disease (ESRD) who rely on Medicare coverage. It specifically prohibits private health insurers from unfairly limiting benefits or network access based on a patient’s ESRD diagnosis. The bill clarifies that insurers cannot treat dialysis care differently than other covered medical services and prevents them from shifting primary responsibility for costs to Medicare. It reinforces Congress’s intention to ensure equitable coverage for ESRD patients.
Key provisions
- Prohibits private health insurers from differentiating benefits based on ESRD diagnosis.
- Prevents insurers from limiting network composition in a way that disproportionately affects ESRD patients.
- Prevents insurers from shifting primary responsibility for ESRD care costs to Medicare.
- Clarifies that including a specific dialysis provider in a network is not a requirement.
- Addresses the Medicare Secondary Payer Act (MSPA) to ensure broader protections for ESRD patients.
Who is affected
- Individuals with end-stage renal disease (ESRD)
- Private health insurance companies
- Medicare beneficiaries
- Healthcare providers specializing in renal dialysis
Notable changes
- Strengthens the MSPA to better protect ESRD patients from discriminatory coverage practices.
- Explicitly prohibits differential treatment of dialysis services compared to other covered medical services.
Sponsors
Official sponsors from legislative records.
Primary sponsor
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119th CONGRESS — 1st Session
H. R. 2199
IN THE HOUSE OF REPRESENTATIVES
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.
This Act may be cited as the Restore Protections for Dialysis Patients Act
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The purposes of this Act are the following:
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:
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 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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