S 1173
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 prevents private health insurers from unfairly limiting benefits or discriminating against ESRD patients compared to other insured individuals. Specifically, the bill clarifies that insurers cannot create coverage restrictions that disproportionately affect dialysis patients and prohibits shifting primary responsibility for their care to Medicare. The legislation reinforces existing Medicare Secondary Payer Act provisions to ensure equitable access to renal dialysis services.
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119th CONGRESS — 1st Session
S. 1173
IN THE SENATE OF THE UNITED STATES
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:
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).
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