,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #eecd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #bc1         
#bjai,mr4 ,k9d 7= himself1 ,mr4         
,burgess1 ,ms4 ,e%oo1 ,mr4 ,smi? (      
,miss\ri1 ,mr4 ,mc,eachin1 & ,ms4 ,h]r]a
 ,beutl]7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = ext5d$ mon?s ( ,m$ic>e cov]age
 ( immunosuppressive drugs = kidney     
transplant pati5ts1 & = o!r purposes4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,compreh5sive ,immunosuppressive ,drug
 ,cov]age = ,kidney ,transplant ,pati5ts
 ,act ( #bjai4  #b4 ,ext5d$ mon?s (     
cov]age ( immunosuppressive drugs =     
kidney transplant pati5ts & o!r r5al    
dialysis provisions  7a7 ,m$ic>e        

entitlem5t to immunosuppressive drugs = 
kidney transplant recipi5ts  7#a7 ,9    
g5]al ,section #bbf;,a7b77#b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#dbf-a7;b77#b77 is am5d$ by ins]t+      
7except = eligibility = enrollm5t "u "p 
,b solely = purposes ( cov]age (        
immunosuppressive drugs describ$ 9      
section #ahfa7s77#b77;,j77 be=e 1 ) !   
?irty-six? mon?4  7#b7 ,individuals     
eligible only = cov]age (               
immunosuppressive drugs  7,a7 ,9 g5]al  
,section #ahcf ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acieo7 is am5d$--  
7i7 by /rik+ ,e & ins]t+ 7a7 ,9         
g5]al4--,e2 &  7ii7 by add+ at ! end !  
foll[+ new subsection3  7b7 ,individuals
 eligible = immunosuppressive drug      
cov]age  7#a7 ,9 g5]al ,except z provid$
 "u p>agraph 7#b71 e individual ^:      
insurance b5efits "u "p ,a h end$ 7:e!r 
be=e1 on1 or aft] ,janu>y #a1 #bjbb7 by 
reason ( section #bbf;,a7b77#b7 is      
eligible to enroll 9 ! insurance program
 e/abli%$ by ?is "p solely = purposes ( 

cov]age ( immunosuppressive drugs 9     
accordance ) section #ahcg7m74  7#b7    
,exception if o!r heal? insurance       
cov]age is available  7,a7 ,9 g5]al ,an 
individual describ$ 9 p>agraph 7#a7 %all
 n be eligible = enrollm5t 9 ! insurance
 program describ$ 9 su* p>agraph )      
respect to any p]iod 9 :i* !            
individual--  7i7 is enroll$ 9 a gr\p   
heal? plan1 z def9$ 9 section           
#bgia7;a77#a7 ( ! ,public ,heal? ,s]vice
 ,act1 or individual heal? insurance    
cov]age1 z def9$ 9 section #bgia7;b77#e7
 ( su* ,act1 z det]m9$ 9 accordance )   
subp>agraph 7,b72  7ii7 is eligible =   
b5efits "u-- 7,i7 a ,/ate plan "u title 
,,xix2  7,,ii7 a ,/ate *ild heal? plan  
"u title ,,xxi2 or  7,,iii7 ! ,,tric>e  
program "u *apt] #ee ( title #aj1 ,unit$
 ,/ates ,code2  7iii7 is enroll$ 9 a    
heal? b5efits plan "u *apt] #hi ( title 
#e1 ,unit$ ,/ates ,code2  7iv7 is       
eligible = heal? c>e b5efits "u ! laws  
adm9i/]$ by ! ,secret>y ( ,vet]ans      
,affairs2 or  7v7 is eligible to receive

 s]vices f ! ,indian ,heal? ,s]vice4    
7,b7 ,eligibility det]m9ations  7i7 ,9  
g5]al ,! ,secret>y1 9 consultation ) !  
,adm9i/rator ( ,social ,security1 %all  
e/abli% proc$ures = det]m9+ :e!r an     
individual describ$ 9 p>agraph 7#a7 :o  
is to be enroll$ 9 ! insurance program  
describ$ 9 su* p>agraph meets !         
requirem5ts = su* enrollm5t "u ?is      
subsection1 includ+ ! requirem5t t !    
individual n h o!r heal? insurance      
cov]age z describ$ 9 subp>agraph 7,a74  
7ii7 ,atte/ation reg>d+ o!r cov]age ,!  
proc$ures e/abli%$ "u clause 7i7 %all   
include a requirem5t t-- 7,i7 !         
individual provide to ! ,secret>y an    
atte/ation t ! individual does n h su*  
o!r heal? insurance cov]age2 &  7,,ii7  
update su* atte/ation-- 7aa7 on an      
annual basis2 or  7bb7 if ! heal?       
insurance cov]age situation ( !         
individual has *ang$4  7,c7             
,id5tification & r$uction ( improp]     
paym5ts ,! ,secret>y1 9 consultation ) !
 ,adm9i/rator ( ,social ,security1      

%all--  7i7 e/abli% proc$ures to ensure 
t any in=mation provid$ ) respect to o!r
 heal? insurance cov]age describ$ 9     
subp>agraph 7,a7 ( ?is p>agraph = an    
individual describ$ 9 p>agraph 7#a7 is  
provid$ to ! appropriate m$ic>e         
adm9i/rative contractor = purposes (    
id5tify+ any improp] paym5ts made )     
respect to immunosuppressive drug       
cov]age "u ?is "p2 &  7ii7 provide      
education to prev5t or r$uce su* improp]
 paym5ts1 includ+ education ?r\gh !     
improp] paym5t outrea* & education      
program "u section #ahdg;,a#i7;h74  4   
7,b7 ,con=m+ am5dm5t ,sections #ahcg1   
#ahch1 & #ahci ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciep1 #db         
,u4,s4,c4 #acieq1 #db ,u4,s4,c4 #acier7 
are ea* am5d$ by /rik+ #ahcf & ins]t+   
#ahcf7;a7 ea* place x appe>s4  7b7      
,enrollm5t = individuals only eligible =
 cov]age ( immunosuppressive drugs      
,section #ahcg ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciep7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  

7m7  7#a7 ,any individual :o is eligible
 "u section #ahcf7;b7 to enroll 9 !     
m$ical insurance program e/abli%$ "u ?is
 "p = purposes ( cov]age (              
immunosuppressive drugs may enroll only 
9 su* mann] & =m z may be prescrib$ by  
regulations1 & only dur+ an enrollm5t   
p]iod describ$ 9 ?is subsection4  7#b7  
,an individual describ$ 9 p>agraph 7#a7 
^: entitlem5t = hospital insurance      
b5efits "u "p ,a ends by reason (       
section #bbf;,a7b77#b7 prior to ,janu>y 
#a1 #bjbb1 may enroll beg9n+ on ! fir/  
day ( ! ?ird mon? be=e ! mon? 9 :i* !   
individual fir/ satisfies section       
#ahcf7;b71 or a date specifi$ by !      
,secret>y prior to ! fir/ date on :i*   
cov]age is effective "u section         
#ahch7;g77#b71 :i*ev] is lat]4 ,9       
implem5t+ ! prec$+ s5t5ce1 ! ,secret>y  
%all consid] proc$ures to exp$ite !     
enrollm5t ( su* an individual if        
practicable = purposes ( provid+ cont9u$
 cov]age ( immunosuppressive drugs = su*
 individual pursuant to section         

#ahch7;g77#b74  7#c7 ,an individual     
describ$ 9 p>agraph 7#a7 ^: entitlem5t =
 hospital insurance b5efits "u "p ,a    
ends by reason ( section #bbf;,a7b77#b7 
on or aft] ,janu>y #a1 #bjbb1 %all be   
deem$ to h enroll$ 9 ! m$ical insurance 
program e/abli%$ by ?is "p = purposes ( 
cov]age ( immunosuppressive drugs4  7#d7
 ,! ,secret>y %all e/abli% a process "u 
:i* an individual describ$ 9 p>agraph   
7#a7 ^: o!r heal? insurance cov]age     
describ$ 9 section #ahcf7;b77#b77;,a71  
or cov]age "u ?is "p 7includ+ ! m$ical  
insurance program e/abli%$ "u ?is "p =  
purposes ( cov]age ( immunosuppressive  
drugs7 is t]m9at$ volunt>ily or         
involunt>y may enroll or re5roll1 if    
applicable1 9 ! m$ical insurance program
 e/abli%$ "u ?is "p = purposes ( cov]age
 ( immunosuppressive drugs4  4  7c7     
,cov]age p]iod = individuals only       
eligible = cov]age ( immunosuppressive  
drugs  7#a7 ,9 g5]al ,section #ahch ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acieq7 is am5d$ by add+ at ! end !     

foll[+ new subsection3  7g7 ,9 ! case ( 
an individual describ$ 9 section        
#ahcf7;b77#a71 ! foll[+ rules %all      
apply3 7#a7 ,9 ! case ( su* an          
individual :o is deem$ to h enroll$ 9 "p
 ,b = cov]age ( immunosuppressive drugs 
"u section #ahcg7m77#c71 su*            
individual's cov]age p]iod %all beg9 on 
! fir/ day ( ! mon? 9 :i* ! individual  
fir/ satisfies section #ahcf7;b74  7#b7 
,9 ! case ( su* an individual :o enrolls
 7or re5rolls7 9 "p ,b = cov]age (      
immunosuppressive drugs "u p>agraph 7#b7
 or 7#d7 ( section #ahcg7m71 su*        
individual's cov]age p]iod %all beg9 on 
,janu>y #a1 #bjbb 7or su* e>li] date z !
 ,secret>y may specify if practicable = 
purposes ( provid+ cont9u$ cov]age (    
immunosuppressive drugs = su* an        
individual71 or ! mon? foll[+ ! mon? 9  
:i* ! individual s enrolls 7or          
re5rolls71 :i*ev] is lat]4  7#c7 ,!     
provisions ( subsections 7b7 & 7d7 %all 
apply ) respect to an individual        
describ$ 9 p>agraph 7#a7 or 7#b74  7#d7 

,9 addition to ! reasons = t]m9ation "u 
subsection 7b71 ! cov]age p]iod ( an    
individual describ$ 9 p>agraph 7#a7 or  
7#b7 %all end :5 ! individual becomes   
entitl$ to b5efits "u ?is title "u      
section #bbf7;a7 or #bbf;,a or is no    
long] eligible = su* cov]age z a result 
( ! application ( section #ahcf7;b77#b74
  7#e7 ,! ,secret>y may conduct public  
education activities to raise aw>5ess ( 
! availability ( m compreh5sive1        
qualifi$ heal? plans = b5efici>ies      
eligible "u ?is subsection4  4  7#b7    
,con=m+ am5dm5ts ,section #ahch7;b7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acieq7b77 is am5d$1 9 ! matt] foll[+   
p>agraph 7#b71 by ins]t+ or section     
#ahcg7m77#c7 aft] section #ahcg7;f7 ea* 
place x appe>s4  7d7 ,premiums =        
individuals only eligible = cov]age (   
immunosuppressive drugs ,section #ahci (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acier7 is am5d$-- 7#a7 9 subsection   
7b71 by add+ at ! end ! foll[+ new      
s5t5ce3 ,no increase 9 ! premium %all be

 effect$ = individuals :o are enroll$   
pursuant to section #ahcf7;b7 = cov]age 
only ( immunosuppressive drugs42 &  7#b7
 by add+ at ! end ! foll[+ new          
subsection3  7j7 ,det]m9ation ( premium 
= individuals only eligible = cov]age ( 
immunosuppressive drugs ,! ,secret>y    
%all1 dur+ ,septemb] ( ea* ye> 7beg9n+ )
 #bjba71 det]m9e & promulgate a mon?ly  
premium rate = ! succe$+ cal5d> ye> =   
individuals :o enroll only = ! purpose (
 cov]age ( immunosuppressive drugs "u   
section #ahcf7;b74 ,su* premium %all be 
equal to #ce p]c5t ( ! mon?ly actu>ial  
rate = enrollees age #fe & ov]1 det]m9$ 
accord+ to p>agraph 7#a71 = t succe$+   
cal5d> ye>4 ,! mon?ly premium ( ea*     
individual enroll$ = cov]age (          
immunosuppressive drugs "u section      
#ahcf7;b7 = ea* mon? %all be ! am\nt    
promulgat$ 9 ?is subsection4 ,su* am\nt 
%all be adju/$ 9 accordance )           
subsections 7c71 7f71 & 7i71 b %all n be
 adju/$ "u subsection 7b74  4  7e7      
,gov]nm5t contribution ,section         

#ahdd7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciew7a77 is am5d$--    
7#a7 9 p>agraph 7#c71 by /rik+ ! p]iod  
at ! end & ins]t+ 2 plus2  7#b7 by      
ins]t+ aft] p>agraph 7#c7 ! foll[+ new  
p>agraph3  7#d7 a ,gov]nm5t contribution
 equal to ! e/imat$ aggregate r$uction 9
 premiums payable "u "p ,b t results f  
e/abli%+ ! premium at #ce p]c5t ( !     
actu>ial rate "u section #ahci7;j7      
in/ead ( #ej p]c5t ( ! actu>ial rate =  
individuals :o enroll only = ! purpose (
 cov]age ( immunosuppressive drugs "u   
section #ahcf7;b74  2 &  7#c7 by add+ ! 
foll[+ s5t5ce at ! end ( ! flu% matt]   
foll[+ p>agraph 7#d71 z add$ by p>agraph
 7#b7 ( ?is subsection3  ,! ,gov]nm5t   
contribution "u p>agraph 7#d7 %all be   
treat$ z premiums payable & deposit$ =  
purposes ( subp>agraphs 7,a7 & 7,b7 (   
p>agraph 7#a74 4  7f7 ,ensur+ cov]age "u
 ! ,m$ic>e sav+s program ,section       
#aije7p77#a77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acif;d7p77#a77;,a77
 is am5d$ by ins]t+ or an individual :o 

is enroll$ "u "p ,b = ! purpose (       
cov]age ( immunosuppressive drugs "u    
section #ahcf7;b7 aft] section #ahah4   
7g7 ,"p ,d ,section                     
#ahfj;,d-#a7;a77#c77;,a7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#aja7;a77#c77;,a77 is am5d$ by   
ins]t+ 7b n includ+ an individual       
enroll$ solely = cov]age (              
immunosuppressive drugs "u section      
#ahcf7;b77 be=e ! p]iod at ! end4