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

This section states the purposes of the Act: (1) to restore the Medicare Secondary Payer Act's (MSPA) protections for end-stage renal disease (ESRD) patients by ensuring private health plans do not discriminate against such patients or adversely classify dialysis compared to other covered medical services; (2) to prohibit health insurance plans from shifting primary responsibility for ESRD patients' health care costs to Medicare; and (3) to affirm congressional intent that singling out dialysis for disfavored coverage limitations compared to other services constitutes inappropriate differentiation of ESRD benefits, without altering plans' ability to limit renal dialysis providers in their networks.

This section revises the Medicare Secondary Payer prohibition on employer group health plans (i.e., plans offered by employers with 20 or more employees) denying or limiting coverage to Medicare-eligible individuals with end-stage renal disease (ESRD). Specifically, it (1) replaces clause (ii) to prohibit such plans from differentiating (or having the effect of differentiating) in benefits provided between ESRD individuals and others or from applying any benefit limitation—including on network composition—that disparately affects ESRD individuals, on any basis (including ESRD diagnosis or need for dialysis) or in any manner; and (2) adds clarifying language stating that the prohibition does not require a plan to include a particular renal dialysis provider or a specific number of such providers in its network and directing the Secretary to enforce the provision consistent with the existing nonconformance determination process in 42 CFR part 411. (Thus, the changes preserve and expand antidiscrimination protections during the 30-month period when such plans must serve as primary payers for ESRD beneficiaries.)