S. 1173 — Restore Protections for Dialysis Patients Act

This section states the purposes of the Act: (1) restoring protections under Medicare Secondary Payer provisions for individuals with end-stage renal disease (ESRD) by ensuring private health plans do not discriminate against such individuals or adversely classify dialysis compared to other covered medical services; (2) prohibiting health insurance plans from shifting primary responsibility for ESRD health care costs to Medicare; and (3) affirming congressional intent that singling out dialysis services for disfavored coverage limitations compared to other health services constitutes inappropriate differentiation of benefits for ESRD individuals, without affecting a plan's ability to limit its renal dialysis provider network.

This section revises the prohibition in Medicare law on employer group health plans (as primary payers during the 30-month coordination period for individuals with end-stage renal disease (ESRD)) from discriminating against such individuals. (1) It replaces clause (ii) to prohibit 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 (e.g., ESRD diagnosis or need for dialysis); and (2) clarifies that the prohibition does not require plans to include a particular renal dialysis provider or number of such providers in their networks and directs the Secretary to enforce it consistent with 42 CFR part 411 (or successor regulations).