Clarification and preservation of prohibition under the Medicare program

Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended— (1) by striking clause (ii) and inserting the following: (ii) may not on any basis (including the diagnosis of end-stage renal disease or the need for renal dialysis) or in any manner— (I) differentiate (or have the effect of differentiating) in the benefits it provides between individuals having end stage renal disease and other individuals covered by such plan; or (II) apply a limitation on benefits (including on network composition) under the plan that will disparately affect individuals having end-stage renal disease;; and (2) by adding at the end of the matter following clause (ii) the following: Nothing in this subsection shall be construed as requiring a group health plan to include a particular renal dialysis provider or a particular number of renal dialysis providers as part of the provider network the group health plan elects to offer its enrollees. The Secretary shall enforce this subparagraph consistent with the nonconformance determination requirements described in part 411 of title 42, Code of Federal Regulations (or any successor regulation)..