,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #ccec  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #bg1 #bjbj,mr4
 ,cassidy 7= himself1 ,mr4 ,durb91 ,ms4 
,ern/1 ,mrs4 ,%ahe51 ,mr4 ,:iteh\se1 &  
,mr4 ,"y7 introduc$ ! foll[+ bill2 :i* 0
 read twice & ref]r$ to ! ,committee on 
,f9ance  ,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 ( #bjbj4  #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 ^:      
entitlem5t to insurance b5efits "u "p ,a
 ends 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 cov]age is available  7,a7 ,9 g5]al 
,an individual describ$ 9 p>agraph 7#a7 
%all n be eligible = enrollm5t 9 !      

program = purposes ( cov]age describ$ 9 
su* p>agraph ) respect to any p]iod 9   
:i* ! individual1 z det]m9$ 9 accordance
 ) subp>agraph 7,b7-- 7i7 is enroll$ 9 a
 gr\p heal? plan or gr\p or individual  
heal? insurance cov]age1 z su* t]ms are 
def9$ 9 section #bgia ( ! ,public ,heal?
 ,s]vice ,act2  7ii7 is enroll$ =       
cov]age "u ! ,,tric>e = ,life program "u
 section #ajhf7;d7 ( title #aj1 ,unit$  
,/ates ,code2 or  7iii7 7,i7 is enroll$ 
9 ! pati5t enrollm5t sy/em ( ! ,dep>tm5t
 ( ,vet]ans ,affairs e/abli%$ & op]at$  
"u section #agje ( title #ch1 ,unit$    
,/ates ,code2  7,,ii7 is n requir$ to   
enroll "u section #agje ( su* title to  
receive immunosuppressive drugs describ$
 9 ?is subsection2 or  7,,iii7 is       
o!rwise eligible "u a provision ( title 
#ch1 ,unit$ ,/ates ,code1 o!r ?an       
section #agaj ( su* title to receive    
immunosuppressive drugs describ$ 9 ?is  
subsection4  7,b7 ,eligibility          
det]m9ations  7i7 ,9 g5]al ,! ,secret>y1
 9 consultation ) ! ,commission] (      

,social ,security1 %all e/abli% a       
process = det]m9+ :e!r an individual    
describ$ 9 p>agraph 7#a7 :o is to be    
enroll$ or deem$ to be enroll$ 9 !      
insurance program describ$ 9 su*        
p>agraph meets ! requirem5ts = su*      
enrollm5t "u ?is subsection1 includ+ !  
requirem5t t ! individual n be enroll$ 9
 o!r cov]age z describ$ 9 subp>agraph   
7,a74  7ii7 ,atte/ation reg>d+ o!r      
cov]age ,! process e/abli%$ "u clause   
7i7 %all include1 at a m9imum1 a        
requirem5t t-- 7,i7 ! individual provide
 to ! ,commission] an atte/ation t !    
individual is n enroll$ 9 su* o!r       
cov]age2 &  7,,ii7 ! individual notify !
 ,secret>y )9 #fj days ( any *ange 9 !  
insurance cov]age ( ! individual4  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;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 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 re5rolls1 if applicable7 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 #bjbb1 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  #c4  
,,gao /udy & report  7a7 ,/udy ,!       
,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 
?is section ref]r$ to z ! ,comptroll]   
,g5]al7 %all conduct a /udy on !        
implem5tation ( cov]age (               
immunosuppressive drugs = kidney        
transplant pati5ts "u ! ,m$ic>e program 
pursuant to ! provisions (1 & am5dm5ts  
made by ?is ,act4 ,su* /udy %all include
 ! id5tification1 aft] implem5tation (  
su* cov]age1 ( any leakage 9 !          
eligibility1 enrollm5t1 & cov]age       
processes relat+ to su* cov]age 9 ord]  
to address program integrity issues4    
7b7 ,report ,n lat] ?an ,janu>y #a1     
#bjbd1 ! ,comptroll] ,g5]al %all submit 
to ,congress a report on ! /udy conduct$
 "u subsection 7a71 toge!r )            
recomm5dations = su* legislation &      
adm9i/rative action z ! ,comptroll]     
,g5]al det]m9es appropriate4