H.R. 2199: Restore Protections for Dialysis Patients Act

This bill, titled the Restore Protections for Dialysis Patients Act, aims to strengthen the protections for patients with end-stage renal disease (ESRD) under the Medicare program. The main objectives of the bill are as follows:

Key Purposes

• Protect ESRD Patients: The bill seeks to ensure that private health insurance plans cannot discriminate against dialysis patients or treat dialysis services less favorably than other medical services.
• Prevent Cost Shifting: It aims to stop health insurance plans from passing the primary responsibility for covering healthcare services for ESRD patients onto the Medicare program.
• Clarify Coverage Limitations: The bill clarifies that it is inappropriate for health plans to single out dialysis services for different treatment or coverage limitations compared to other services, while still allowing plans to choose which dialysis providers are included in their networks.

Prohibition Clarifications

The bill proposes amendments to the Social Security Act, specifically regarding the Medicare program, to include the following:

• Health insurance plans are prohibited from differentiating benefits between individuals with ESRD and other insured individuals based on the diagnosis of ESRD or the need for dialysis.
• The bill prevents plans from implementing limitations on benefits that would disproportionately impact individuals with ESRD.
• It reaffirms that while plans cannot discriminate in the benefits provided, they are not required to include specific dialysis providers or a certain number of providers in their network.

Enforcement

The Secretary of Health and Human Services would be tasked with enforcing these provisions in line with existing federal regulations concerning health insurance plans.

Relevant Companies

• DVA (DaVita Inc.): A major provider of dialysis services in the United States that could be positively affected by regulations that protect patient access to dialysis services.
• CMI (Cantel Medical Corp.): A company that provides infection prevention and minimally invasive products, including some related to dialysis that may be impacted by increased demand from ESRD patients.