,,ii  #aafth ,,congress  #b;d ,session  
,s4 #ccec  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,february #bg1 
#bjbj,mr4 ,cassidy 7for himself1 ,mr4   
,durbin1 ,ms4 ,ernst1 ,mrs4 ,shaheen1   
,mr4 ,whitehouse1 and ,mr4 ,young7      
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,finance  ,a ,,bill  ,to  
amend title ,,xviii of the ,social      
,security ,act to provide for extended  
months of ,medicare coverage of         
immunosuppressive drugs for kidney      
transplant patients1 and for other      
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,comprehensive      
,immunosuppressive ,drug ,coverage for  
,kidney ,transplant ,patients ,act of   
#bjbj4  #b4 ,extended months of coverage
 of immunosuppressive drugs for kidney  
transplant patients and other renal     
dialysis provisions  7a7 ,medicare      
entitlement to immunosuppressive drugs  
for kidney transplant recipients  7#a7  
,in general ,section #bbf;,a7b77#b7 of  

the ,social ,security ,act 7#db         
,u4,s4,c4 #dbf-a7;b77#b77 is amended by 
inserting 7except for eligibility for   
enrollment under part ,b solely for     
purposes of coverage of                 
immunosuppressive drugs described in    
section #ahfa7s77#b77;,j77 before 1 with
 the thirty-sixth month4  7#b7          
,individuals eligible only for coverage 
of immunosuppressive drugs  7,a7 ,in    
general ,section #ahcf of the ,social   
,security ,act 7#db ,u4,s4,c4 #acieo7 is
 amended-- 7i7 by striking ,every and   
inserting 7a7 ,in general4--,every2 and 
7ii7 by adding at the end the following 
new subsection3  7b7 ,individuals       
eligible for immunosuppressive drug     
coverage  7#a7 ,in general ,except as   
provided under paragraph 7#b71 every    
individual whose entitlement to         
insurance benefits under part ,a ends   
7whether before1 on1 or after ,january  
#a1 #bjbb7 by reason of section         
#bbf;,a7b77#b7 is eligible to enroll in 
the insurance program established by    

this part solely for purposes of        
coverage of immunosuppressive drugs in  
accordance with section #ahcg7m74  7#b7 
,exception if other coverage is         
available  7,a7 ,in general ,an         
individual described in paragraph 7#a7  
shall not be eligible for enrollment in 
the program for purposes of coverage    
described in such paragraph with respect
 to any period in which the individual1 
as determined in accordance with        
subparagraph 7,b7-- 7i7 is enrolled in a
 group health plan or group or          
individual health insurance coverage1 as
 such terms are defined in section #bgia
 of the ,public ,health ,service ,act2  
7ii7 is enrolled for coverage under the 
,,tricare for ,life program under       
section #ajhf7;d7 of title #aj1 ,united 
,states ,code2 or  7iii7 7,i7 is        
enrolled in the patient enrollment      
system of the ,department of ,veterans  
,affairs established and operated under 
section #agje of title #ch1 ,united     
,states ,code2  7,,ii7 is not required  

to enroll under section #agje of such   
title to receive immunosuppressive drugs
 described in this subsection2 or       
7,,iii7 is otherwise eligible under a   
provision of title #ch1 ,united ,states 
,code1 other than section #agaj of such 
title to receive immunosuppressive drugs
 described in this subsection4  7,b7    
,eligibility determinations  7i7 ,in    
general ,the ,secretary1 in consultation
 with the ,commissioner of ,social      
,security1 shall establish a process for
 determining whether an individual      
described in paragraph 7#a7 who is to be
 enrolled or deemed to be enrolled in   
the insurance program described in such 
paragraph meets the requirements for    
such enrollment under this subsection1  
including the requirement that the      
individual not be enrolled in other     
coverage as described in subparagraph   
7,a74  7ii7 ,attestation regarding other
 coverage ,the process established under
 clause 7i7 shall include1 at a minimum1
 a requirement that-- 7,i7 the          

individual provide to the ,commissioner 
an attestation that the individual is   
not enrolled in such other coverage2 and
  7,,ii7 the individual notify the      
,secretary within #fj days of any change
 in the insurance coverage of the       
individual4  4  7,b7 ,conforming        
amendment ,sections #ahcg1 #ahch1 and   
#ahci of the ,social ,security ,act 7#db
 ,u4,s4,c4 #aciep1 #db ,u4,s4,c4 #acieq1
 #db ,u4,s4,c4 #acier7 are each amended 
by striking #ahcf and inserting         
#ahcf7;a7 each place it appears4  7b7   
,enrollment for individuals only        
eligible for coverage of                
immunosuppressive drugs ,section #ahcg  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciep7 is amended by adding  
at the end the following new subsection3
  7m7 7#a7 ,any individual who is       
eligible under section #ahcf7;b7 to     
enroll in the medical insurance program 
established under this part for purposes
 of coverage of immunosuppressive drugs 
may enroll only in such manner and form 

as may be prescribed by regulations1 and
 only during an enrollment period       
described in this subsection4  7#b7 ,an 
individual described in paragraph 7#a7  
whose entitlement for hospital insurance
 benefits under part ,a ends by reason  
of section #bbf;,a7b77#b7 prior to      
,january #a1 #bjbb1 may enroll beginning
 on the first day of the third month    
before the month in which the individual
 first satisfies section #ahcf7;b74     
7#c7 ,an individual described in        
paragraph 7#a7 whose entitlement for    
hospital insurance benefits under part  
,a ends by reason of section            
#bbf;,a7b77#b7 on or after ,january #a1 
#bjbb1 shall be deemed to have enrolled 
in the medical insurance program        
established by this part for purposes of
 coverage of immunosuppressive drugs4   
7#d7 ,the ,secretary shall establish a  
process under which an individual       
described in paragraph 7#a7 whose other 
coverage described in section           
#ahcf7;b77#b77;,a71 or coverage under   

this part 7including the medical        
insurance program established under this
 part for purposes of coverage of       
immunosuppressive drugs7 is terminated  
voluntarily or involuntary may enroll or
 reenroll1 if applicable1 in the medical
 insurance program established under    
this part for purposes of coverage of   
immunosuppressive drugs4  4  7c7        
,coverage period for individuals only   
eligible for coverage of                
immunosuppressive drugs  7#a7 ,in       
general ,section #ahch of the ,social   
,security ,act 7#db ,u4,s4,c4 #acieq7 is
 amended by adding at the end the       
following new subsection3  7g7 ,in the  
case of an individual described in      
section #ahcf7;b77#a71 the following    
rules shall apply3 7#a7 ,in the case of 
such an individual who is deemed to have
 enrolled in part ,b for coverage of    
immunosuppressive drugs under section   
#ahcg7m77#c71 such individual's coverage
 period shall begin on the first day of 
the month in which the individual first 

satisfies section #ahcf7;b74  7#b7 ,in  
the case of such an individual who      
enrolls 7or reenrolls1 if applicable7 in
 part ,b for coverage of                
immunosuppressive drugs under paragraph 
7#b7 or 7#d7 of section #ahcg7m71 such  
individual's coverage period shall begin
 on ,january #a1 #bjbb1 or the month    
following the month in which the        
individual so enrolls 7or reenrolls71   
whichever is later4  7#c7 ,the          
provisions of subsections 7b7 and 7d7   
shall apply with respect to an          
individual described in paragraph 7#a7  
or 7#b74  7#d7 ,in addition to the      
reasons for termination under subsection
 7b71 the coverage period of an         
individual described in paragraph 7#a7  
or 7#b7 shall end when the individual   
becomes entitled to benefits under this 
title under section #bbf7;a7 or #bbf;,a 
or is no longer eligible for such       
coverage as a result of the application 
of section #ahcf7;b77#b74  7#e7 ,the    
,secretary may conduct public education 

activities to raise awareness of the    
availability of more comprehensive1     
qualified health plans for beneficiaries
 eligible under this subsection4  4     
7#b7 ,conforming amendments ,section    
#ahch7;b7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acieq7b77 is amended1 in
 the matter following paragraph 7#b71 by
 inserting or section #ahcg7m77#c7 after
 section #ahcg7;f7 each place it        
appears4  7d7 ,premiums for individuals 
only eligible for coverage of           
immunosuppressive drugs ,section #ahci  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acier7 is amended-- 7#a7 in  
subsection 7b71 by adding at the end the
 following new sentence3 ,no increase in
 the premium shall be effected for      
individuals who are enrolled pursuant to
 section #ahcf7;b7 for coverage only of 
immunosuppressive drugs42 and  7#b7 by  
adding at the end the following new     
subsection3  7j7 ,determination of      
premium for individuals only eligible   
for coverage of immunosuppressive drugs 

,the ,secretary shall1 during ,september
 of each year 7beginning with #bjba71   
determine and promulgate a monthly      
premium rate for the succeeding calendar
 year for individuals who enroll only   
for the purpose of coverage of          
immunosuppressive drugs under section   
#ahcf7;b74 ,such premium shall be equal 
to #ce percent of the monthly actuarial 
rate for enrollees age #fe and over1    
determined according to paragraph 7#a71 
for that succeeding calendar year4 ,the 
monthly premium of each individual      
enrolled for coverage of                
immunosuppressive drugs under section   
#ahcf7;b7 for each month shall be the   
amount promulgated in this subsection4  
,such amount shall be adjusted in       
accordance with subsections 7c71 7f71   
and 7i71 but shall not be adjusted under
 subsection 7b74  4  7e7 ,government    
contribution ,section #ahdd7;a7 of the  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew7a77 is amended-- 7#a7 in         
paragraph 7#c71 by striking the period  

at the end and inserting 2 plus2  7#b7  
by inserting after paragraph 7#c7 the   
following new paragraph3  7#d7 a        
,government contribution equal to the   
estimated aggregate reduction in        
premiums payable under part ,b that     
results from establishing the premium at
 #ce percent of the actuarial rate under
 section #ahci7;j7 instead of #ej       
percent of the actuarial rate for       
individuals who enroll only for the     
purpose of coverage of immunosuppressive
 drugs under section #ahcf7;b74  2 and  
7#c7 by adding the following sentence at
 the end of the flush matter following  
paragraph 7#d71 as added by paragraph   
7#b7 of this subsection3 ,the           
,government contribution under paragraph
 7#d7 shall be treated as premiums      
payable and deposited for purposes of   
subparagraphs 7,a7 and 7,b7 of paragraph
 7#a74 4  7f7 ,ensuring coverage under  
the ,medicare savings program ,section  
#aije7p77#a77;,a7 of the ,social        
,security ,act 7#db ,u4,s4,c4           

#acif;d7p77#a77;,a77 is amended by      
inserting or an individual who is       
enrolled under part ,b for the purpose  
of coverage of immunosuppressive drugs  
under section #ahcf7;b7 after section   
#ahah4  7g7 ,part ,d ,section           
#ahfj;,d-#a7;a77#c77;,a7 of the ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#aja7;a77#c77;,a77 is amended by 
inserting 7but not including an         
individual enrolled solely for coverage 
of immunosuppressive drugs under section
 #ahcf7;b77 before the period at the    
end4  #c4 ,,gao study and report  7a7   
,study ,the ,comptroller ,general of the
 ,united ,states 7in this section       
referred to as the ,comptroller         
,general7 shall conduct a study on the  
implementation of coverage of           
immunosuppressive drugs for kidney      
transplant patients under the ,medicare 
program pursuant to the provisions of1  
and amendments made by this ,act4 ,such 
study shall include the identification1 
after implementation of such coverage1  

of any leakage in the eligibility1      
enrollment1 and coverage processes      
relating to such coverage in order to   
address program integrity issues4  7b7  
,report ,not later than ,january #a1    
#bjbd1 the ,comptroller ,general shall  
submit to ,congress a report on the     
study conducted under subsection 7a71   
together with recommendations for such  
legislation and administrative action as
 the ,comptroller ,general determines   
appropriate4