I
119THCONGRESS
1
STSESSION 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
MARCH18, 2025
Mr. K
ELLYof Pennsylvania (for himself, Ms. CLARKEof New York, Mr.
D
UNNof Florida, Mr. DAVISof Illinois, Mr. JOYCEof Pennsylvania, and
Mr. R
UIZ) introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction 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 Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Restore Protections 4
for Dialysis Patients Act’’. 5
SEC. 2. PURPOSES. 6
The purposes of this Act are the following: 7
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(1) To restore the MSPA’s protections for 1
ESRD patients by ensuring that private health plans 2
do not discriminate against such patients or ad-3
versely classify dialysis as compared to other covered 4
medical services. 5
(2) To prohibit health insurance plans from 6
shifting primary responsibility for covering the cost 7
of health care services needed by patients with 8
ESRD to the Medicare program. 9
(3) To affirm Congress’ intent by clarifying 10
that singling out dialysis services for disfavored 11
treatment through coverage limitations as compared 12
to other covered health services constitutes inappro-13
priate differentiations between the benefits provided 14
to individuals having ESRD and other individuals, 15
but does not change a plan’s current ability to limit 16
which renal dialysis providers it includes in the pro-17
vider network it elects to offer its enrollees. 18
SEC. 3. CLARIFICATION AND PRESERVATION OF PROHIBI-19
TION UNDER THE MEDICARE PROGRAM. 20
Section 1862(b)(1)(C) of the Social Security Act (42 21
U.S.C. 1395y(b)(1)(C)) is amended— 22
(1) by striking clause (ii) and inserting the fol-23
lowing new clause: 24
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‘‘(ii) may not on any basis (including 1
the diagnosis of end stage renal disease or 2
the need for renal dialysis) or in any man-3
ner— 4
‘‘(I) differentiate (or have the ef-5
fect of differentiating) in the benefits 6
it provides between individuals having 7
end stage renal disease and other in-8
dividuals covered by such plan; or 9
‘‘(II) apply a limitation on bene-10
fits (including on network composi-11
tion) under the plan that will dispar-12
ately affect individuals having end 13
stage renal disease;’’; and 14
(2) by adding at the end of the matter following 15
clause (ii) the following new sentences: ‘‘Nothing in 16
this subsection shall be construed as requiring a 17
group health plan to include a particular renal dialy-18
sis provider or a particular number of renal dialysis 19
providers as part of the provider network the group 20
health plan elects to offer its enrollees. The Sec-21
retary shall enforce this subparagraph consistent 22
with the nonconformance determination require-23
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ments set forth in part 411 of title 42, Code of Fed-1
eral Regulations.’’. 2
Æ
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