Restore Protections for Dialysis Patients Act

This legislation, known as the Restore Protections for Dialysis Patients Act , seeks to reinforce and clarify the protections afforded to individuals with End-Stage Renal Disease (ESRD) under the Medicare Secondary Payer Act (MSPA). Its primary purposes are to prevent private health plans from discriminating against ESRD patients and to prohibit these plans from shifting the primary financial responsibility for their care to the Medicare program. The bill explicitly affirms Congress's intent that singling out dialysis services for disfavored treatment, such as through coverage limitations compared to other medical services, constitutes inappropriate differentiation. To achieve these goals, the Act amends Section 1862(b)(1)(C) of the Social Security Act. The amendment specifies that health plans "may not on any basis" differentiate in benefits between individuals with ESRD and other covered individuals, nor apply limitations that would "disparately affect" those with ESRD, including limitations on network composition. However, it clarifies that this does not compel a group health plan to include a particular renal dialysis provider or a specific number of providers in its network, as long as the overall benefit structure is non-discriminatory. The Secretary is directed to enforce these provisions consistent with existing nonconformance determination requirements.