Plain English
GovGreed Synthesis ·
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.
Market Impact Map
Full Bill Text
119 HR 2199 IH: Restore Protections for Dialysis Patients Act U.S. House of Representatives 2025-03-18 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. I 119th CONGRESS 1st Session H. R. 2199 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. 1. Short title This Act may be cited as the Restore Protections for Dialysis Patients Act . 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. 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. .
Loading intelligence layer…