Bill > S1173

This bill aims to restore and clarify protections for individuals with end-stage renal disease (ESRD) under the Medicare Secondary Payer provisions. Specifically, the bill prohibits private health insurance plans from discriminating against ESRD patients by limiting or differentiating dialysis services compared to other medical services. The legislation ensures that health plans cannot shift the primary responsibility of covering healthcare costs for ESRD patients to Medicare, and it affirms that singling out dialysis services for unfavorable treatment is inappropriate. However, the bill does not require health plans to include any specific number of dialysis providers in their network. The bill amends Section 1862(b)(1)(C) of the Social Security Act to explicitly prevent health plans from: (1) differentiating benefits between ESRD patients and other covered individuals, and (2) applying benefit limitations that would disproportionately affect ESRD patients. The legislation provides clear enforcement guidelines for the Secretary of Health and Human Services to ensure compliance with these protections, while maintaining plans' flexibility in provider network composition.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/1173/all-info