H.R. 5659, Expanding Seniors Receiving Dialysis (ESRD) Choice Act of 2016

H.R. 5659

Expanding Seniors Receiving Dialysis (ESRD) Choice Act of 2016

Committee
Ways and Means

Date
September 20, 2016 (114th Congress, 2nd Session)

Staff Contact
John Huston

Floor Situation

On­­­­ Tuesday, September 20, 2016, the House will consider H.R. 5659, the ESRD Choice Act of 2016, under suspension of the rules. H.R. 5659 was introduced on July 7, 2016, by Rep. Jason Smith (R-MO) and was referred to the Committee on Ways and Means, and in addition, the Committee on Energy and Commerce. The Committee on Ways and Means ordered the bill reported by voice vote on July 13, 2016.

Bill Summary

H.R. 5659 would enable Medicare beneficiaries who develop End-Stage Renal Disease (ESRD)[1] or kidney failure to be edible to enroll in Medicare Advantage (MA) plans beginning in 2020.

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[1] End-Stage Renal Disease is a medical condition in which a person’s kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life.

Background

Under current law, beneficiaries who develop End-Stage Renal Disease (ESRD) or kidney failure while enrolled in a Medicare Advantage (MA) plan may remain in that plan. However, Medicare beneficiaries are prohibited from enrolling in an MA plan after they have developed ESRD, and must stay in the fee-for-service portion of the Medicare program. H.R. 5659 would eliminate that prohibition, beginning in January 2020.[1]

For beneficiaries with ESRD, Medicare currently pays MA plans an amount equal to the statewide average cost of treating such beneficiaries in the fee-for-service portion of Medicare, and would continue to do so under H.R. 5659. That methodology is designed to pay similar amounts regardless of whether beneficiaries are in fee-for-service or an MA plan.

According to the bill sponsor, “For too long, patients suffering from ESRD have been denied access to certain care and coverage options that they need the most. There are over 640,000 Americans, […] diagnosed with ESRD that are in need of affordable and flexible high-quality care. [This] legislation will remove this unnecessary federal restriction and finally allow these patients to choose in the care options they want and deserve.”[2]

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[1] See CBO Cost Estimate, H.R. 5659, Expanding Seniors Receiving Dialysis Choice Act of 2016
[2] See Rep. Jason Smith Press Release, “U.S. Rep. Jason Smith’s Expanding Seniors Receiving Dialysis’ Choice Act Advanced by the Ways and Means Committee,” July 13, 2016.

Cost

The Congressional Budget Office (CBO) estimates would affect direct spending, pay-as-you-go procedures apply; however CBO estimates that effects would be negligible over the 2017-2026 period. CBO estimates that enacting H.R. 5659 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027.

Additional Information

For questions or further information please contact John Huston with the House Republican Policy Committee by email or at 6-5539.