Restore Protections for Dialysis Patients Act
- Bill Number
- H.R. 2199
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-03-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-06-30T08:06:36Z
AI-Generated Summary
Restore Protections for Dialysis Patients Act (H.R. 2199)
Purpose
This bill aims to strengthen protections under the Medicare Secondary Payer Act (MSPA) for patients with end-stage renal disease (ESRD), a severe kidney condition requiring dialysis or transplant. It seeks to prevent private health insurance plans from treating these patients unfairly compared to others, stop plans from pushing costs onto Medicare, and clarify that limiting dialysis coverage in ways that single it out for worse treatment is not allowed—while still permitting plans to choose their network of dialysis providers.
Key Provisions
- Prohibition on Discrimination: Private group health plans cannot differentiate in benefits (or create effects that differentiate) between ESRD patients and other covered individuals, based on ESRD diagnosis or need for renal dialysis.
- Ban on Disparate Limitations: Plans cannot impose benefit limits (including network composition) that unfairly impact ESRD patients more than others.
- Network Flexibility Preserved: Plans are not required to include specific renal dialysis providers or a certain number in their networks.
- Enforcement: The Secretary of Health and Human Services must enforce these rules using existing regulations on determining plan noncompliance (found in federal code at 42 CFR Part 411).
Significant Changes to Existing Law
- Amends Section 1862(b)(1)(C) of the Social Security Act, which governs MSPA rules.
- Replaces the previous clause (ii) with stronger language explicitly barring any basis or manner of differentiation or disparate effects on ESRD patients due to dialysis needs.
- Adds clarifying sentences to ensure the law does not mandate specific provider inclusions in networks and ties enforcement to current regulatory processes.
- These changes broaden and clarify the MSPA's anti-discrimination scope without altering plans' ability to design networks, addressing potential loopholes where dialysis was treated less favorably.
Potential Impacts
- On Government Agencies: The Department of Health and Human Services (via the Centers for Medicare & Medicaid Services) will handle enforcement under existing rules, potentially increasing oversight of private plans but without new administrative burdens.
- On Citizens: ESRD patients (about 800,000 in the U.S., many on dialysis) gain stronger safeguards against coverage gaps or higher costs from private plans, ensuring more equitable access to dialysis services and reducing financial strain when Medicare acts as secondary payer.
- On International Relations: No direct impacts, as this is a domestic health policy focused on U.S. insurance and Medicare systems.
Main Stakeholders Affected
- ESRD Patients: Primary beneficiaries, protected from discriminatory practices in private insurance.
- Private Health Insurance Plans: Must adjust policies to avoid differentiating dialysis benefits; group health plans (e.g., employer-sponsored) face compliance requirements.
- Medicare Program: Benefits from reduced cost-shifting, preserving resources for secondary payer role in ESRD cases.
- Dialysis Providers: Indirectly affected, as plans retain network control but cannot impose blanket limits that harm ESRD access.
- Bipartisan Sponsors: Representatives from both parties, indicating broad support in Congress.
Notable Legal, Constitutional, or Political Implications
- Legal: Reinforces MSPA's original intent by closing interpretive gaps on "inappropriate differentiations," potentially leading to more consistent court rulings on insurance disputes; relies on administrative enforcement rather than new litigation tools.
- Constitutional: Aligns with equal protection principles under the U.S. Constitution by promoting nondiscriminatory treatment in federally influenced health benefits, without raising federalism concerns as it targets private plans.
- Political: Bipartisan introduction signals consensus on protecting vulnerable patients, could influence future health reforms by affirming Medicare's role; may face opposition from insurers concerned about compliance costs, but preserves plan flexibility to mitigate pushback.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (72)
Rep. Clarke, Yvette D. [D-NY-9], Rep. Dunn, Neal P. [R-FL-2], Rep. Davis, Danny K. [D-IL-7], Rep. Joyce, John [R-PA-13], Rep. Ruiz, Raul [D-CA-25], Rep. Van Duyne, Beth [R-TX-24], Rep. Pettersen, Brittany [D-CO-7], Rep. Crow, Jason [D-CO-6], Rep. Cherfilus-McCormick, Sheila [D-FL-20], Rep. Soto, Darren [D-FL-9], Rep. Cohen, Steve [D-TN-9], Rep. Johnson, Julie [D-TX-32], Rep. Tonko, Paul [D-NY-20], Rep. Panetta, Jimmy [D-CA-19], Rep. McIver, LaMonica [D-NJ-10], Rep. McBride, Sarah [D-DE-At Large], Rep. Conaway, Herbert C. [D-NJ-3], Rep. Davis, Donald G. [D-NC-1], Rep. Landsman, Greg [D-OH-1], Rep. Wasserman Schultz, Debbie [D-FL-25], Rep. Thompson, Glenn [R-PA-15], Rep. Malliotakis, Nicole [R-NY-11], Rep. Wilson, Joe [R-SC-2], Rep. Balderson, Troy [R-OH-12], Rep. Pfluger, August [R-TX-11], Rep. Craig, Angie [D-MN-2], Rep. Neguse, Joe [D-CO-2], Rep. Mann, Tracey [R-KS-1], Rep. Tenney, Claudia [R-NY-24], Rep. Trahan, Lori [D-MA-3], Rep. Vasquez, Gabe [D-NM-2], Rep. Tlaib, Rashida [D-MI-12], Rep. Thanedar, Shri [D-MI-13], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Carter, Earl L. "Buddy" [R-GA-1], Rep. Moran, Nathaniel [R-TX-1], Rep. Fong, Vince [R-CA-20], Rep. Sewell, Terri A. [D-AL-7], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Valadao, David G. [R-CA-22], Rep. Hinson, Ashley [R-IA-2], Rep. Bresnahan, Robert P. [R-PA-8], Rep. LaHood, Darin [R-IL-16], Rep. Carey, Mike [R-OH-15], Rep. Bynum, Janelle S. [D-OR-5], Rep. Bean, Aaron [R-FL-4], Rep. Dean, Madeleine [D-PA-4], Rep. Gonzalez, Vicente [D-TX-34], Rep. Rutherford, John H. [R-FL-5] and 22 more
Recent Actions
- 2025-03-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-03-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-03-18: Introduced in House
- 2025-03-18: Introduced in House
Bill Versions
- Restore Protections for Dialysis Patients Act — issued 2025-03-18 — PDF (4 pages)