The Kidney Disease Program is a program in the Department for the purpose of providing funding of kidney disease treatment for qualified individuals who elect to enroll in the Program and agree to pay fees which are described in this subtitle.

In this subtitle the following words have the meanings indicated. “Commission” means the State Commission on Kidney Disease. “Department” means the department responsible for administering the Kidney Disease Program. “Liquid assets” includes cash, bank accounts, and investments such as stocks and bonds that can be readily converted to cash. “Liquid assets” does not include an individual’s: Principal residence; or Principal car. “Program” means the Kidney Disease Program. “Recipient” means an individual with chronic kidney disease who has been certified to receive benefits under the Kidney Disease Program.

The General Assembly finds that: One of the most serious and tragic problems facing the public health and welfare is the death of hundreds of people in this State each year from chronic kidney disease, when the present state of medical art and technology could return these individuals to a socially productive life; Advances and discoveries in the treatment of patients who have chronic kidney disease allow not mere survival, but rehabilitation to normal occupations and activities; Treatment for persons with kidney disease is very expensive and continues throughout a person’s life; Private insurance coverage for kidney disease treatment is difficult to obtain; and Individuals who receive State benefits for kidney disease treatment should be responsible for bearing some of the cost of that care taking into account their ability to pay. This State recognizes its responsibilities: To allow its citizens to keep their health without being made paupers; and To use its resources and organization to aid in gathering and giving out information on the treatment of chronic kidney disease. The General Assembly seeks to meet these responsibilities by making the treatment of chronic kidney disease easily available through the education, treatment, and reimbursement programs under this subtitle, thus, lowering the cost of this treatment.

There is a State Commission on Kidney Disease.

The Commission consists of 12 members appointed by the Governor. Of the 12 Commission members: 1 shall be an individual from the Renal Administrators Association; 3 shall be individuals who are laypersons to the field of medicine; 3 shall be individuals appointed at the discretion of the Governor who: Are medical specialists or other patient care providers in nephrology or kidney transplants; and Do not have direct ownership of more than 30% in renal dialysis or kidney transplant centers that do business in the State; 4 shall be individuals appointed as provided in paragraph (3) of this subsection; and 1 shall be a renal social worker nominated by the Maryland Chapter of the Council of Nephrology Social Workers or the National Capital Area Chapter of the Council of Nephrology Social Workers. Except as provided in subparagraph (iv) of this paragraph, the Governor shall appoint 1 member from a list of individuals submitted to the Governor by each of the following organizations: The Kidney Foundation of Maryland; The faculty of the University of Maryland School of Medicine; The faculty of the Johns Hopkins University School of Medicine; and The Medical and Chirurgical Faculty of the State of Maryland. The number of names on a list shall be at least 2. An organization shall submit its list at least 3 months before the expiration of the term of the member who represents the organization. If a list is not submitted to the Governor as required under subparagraph (iii) of this paragraph or if a vacancy occurs for a reason other than expiration of the term, the Governor may appoint any individual without the list. The term of a member is 4 years. The terms of the members are staggered as required by the terms provided for members of the Commission on July 1, 1982. The terms of one fourth of those members end each year. At the end of a term, a member continues to serve until a successor is appointed and qualifies. A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies. A member who serves 2 consecutive full 4–year terms may not be reappointed for 4 years after completion of those terms. If a vacancy occurs, the Governor promptly shall appoint a successor who will serve until the term expires. The successor may be reappointed for a full term.

The members present at a meeting are a quorum to do business. The Commission shall meet at least twice a year, at the times and places that it determines. A member of the Commission: May not receive compensation; but Is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget. The Secretary shall designate the staff necessary to carry out this subtitle.

The Commission: Shall institute and supervise education programs for health providers and the public on the prevention and treatment of chronic kidney disease; and May use existing programs and groups for this purpose. The Commission shall: Evaluate annually the Kidney Disease Program under this subtitle; and Submit an annual report of the evaluation to the Governor.

Subject to the limitations provided in this section, the Commission may adopt rules and regulations to carry out the provisions of this subtitle. The Commission shall adopt physical and medical standards for the operation of dialysis and transplant centers. The Commission shall adopt reasonable medical standards for acceptance of an individual for treatment. The Commission may not adopt any standard that prevents an individual from receiving federal medical or financial aid. The Commission may adopt rules and regulations for: Coverage of treatment that is given outside this State; and Approval or disapproval, for purposes of State payment under this subtitle, of a dialysis or transplant center that is outside this State. The Department, in consultation with the Commission, shall adopt rules and regulations under this subtitle governing: Nonmedical eligibility criteria for recipients; and Reimbursement of providers and recovery of Program expenditures from recipients and third parties.

The Secretary: Is responsible for the operation of the Kidney Disease Program under this subtitle within the rules, regulations, and standards that the Commission and the Department adopt; Shall disburse and collect any funds under this subtitle; and Shall keep the Commission informed of: The progress of the Kidney Disease Program; and Any need for a change in its rules, regulations, or standards.

The Department shall certify a dialysis or transplant center that meets the standards that the Commission adopts under this subtitle.

In this section, “Fund” means the Kidney Disease Fund. There is a Kidney Disease Fund. Subject to the provisions of paragraphs (2) and (3) of this subsection, the Commission shall set by regulation reasonable fees to be paid by all certified kidney dialysis and transplant centers as an additional requirement for annual certification. The provisions of this section do not apply to: State–owned facilities; or Hospital services under the jurisdiction of the Health Services Cost Review Commission. The fee set by the Commission may not exceed $1500 per year. The Department shall collect the fee set by the Commission under subsection (c) of this section and transfer the fee into the Fund. The Fund is a continuing, nonlapsing fund, not subject to § 7–302 of the State Finance and Procurement Article. The Fund shall be used exclusively to offset and partially cover the actual documented direct costs of fulfilling the statutory and regulatory duties of the Commission as described in this subtitle. The Department shall pay the indirect costs the Commission incurs in fulfilling the statutory and regulatory duties of the Commission as described in this subtitle. Any unspent portions of the Fund may not be transferred or revert to the General Fund of the State, but shall remain in the Fund to be used for the purposes specified in paragraph (2)(i) of this subsection. The Chairman of the Commission or the designee of the Chairman shall administer the Fund. Money in the Fund may be expended only for the purposes specified in subsection (e)(2)(i) of this section. The Legislative Auditor shall audit the accounts and transactions of the Fund as provided in § 2–1220 of the State Government Article.

The Department shall certify an individual as eligible for benefits under the Program if the Department determines that: The individual has chronic kidney disease as defined in the Commission’s regulations; and The individual meets the residency, citizenship, and other nonmedical eligibility requirements established by the Department. The certification of an individual under this section shall be for a period of 1 year. The certification is renewable after each 1-year period if the individual meets the requirements of subsection (a) of this section.

Except as provided in subsection (b) of this section, the Department shall require Program recipients to apply for eligibility in the Maryland Medical Assistance Program, the Medicare Part B Program, and the Medicare Part D Program within 60 days of notification to do so by the Department. The Department may not require Program recipients to apply for eligibility in the Medicare Part B Program or the Medicare Part D Program if the Department determines the Program recipient has comparable insurance coverage.

Prior to receiving Program benefits, each recipient whose family income exceeds 175 percent of the federal poverty income guidelines shall be required to pay an annual fee equal to the sum of: 5 percent of the amount by which the sum of the recipient’s adjusted gross income as defined in the Internal Revenue Code for federal income tax purposes plus Social Security benefits and tier 1 railroad retirement benefits not otherwise included in the recipient’s gross income under § 86 of the Internal Revenue Code exceeds 175 percent of the federal poverty guidelines adjusted for family size; and 5 percent of the value of the recipient’s liquid assets above 200 percent of the federal poverty guidelines adjusted for family size. The annual fee required under paragraph (1) of this subsection shall be collected quarterly by the Department. A recipient is required to submit copies of the most recent tax returns of the recipient and of persons in the recipient’s family. The Department shall provide recipients with a grace period after the deadline for a fee payment. A recipient who has not paid overdue fees by the end of the grace period shall be terminated from the Program. The Department shall extend the grace period in an appropriate hardship case.

This State shall pay the incurred cost of all treatment related to kidney disease that a certified patient is given, for any cause, on or after the date of certification of that patient, if the treatment is given in: A certified dialysis or transplant center that is in this State; A dialysis or transplant center that is in a contiguous state and is approved by that contiguous state and the Commission; or A home dialysis program that is approved by the Commission. The State shall pay the incurred cost of all approved hospital services provided in any Maryland hospital, other than routine chronic maintenance dialysis, which a certified patient may require as a direct result of end stage renal disease. The State shall pay the incurred costs of all prescription drugs and other pharmaceutical products that are determined to be medically necessary by the recipient’s physician for treatment related to kidney disease in accordance with rates established by the Department. The Secretary may not pay for any treatment that an individual receives at a facility or program that is not certified or otherwise approved. Except for an invoice submitted to a Medicare intermediary or any other insurance provider, the Secretary may not make any payment for an invoice that the Secretary receives more than 6 months after the dates of the services given. An invoice shall be submitted to the Secretary within 3 months after payment or rejection by the Medicare intermediary or other insurance providers. A provider who fails to submit an invoice within the required time may not recover the amount later from either the patient or the Secretary.

The Program shall be the payor of last resort. The Department is authorized to require providers to seek all available third party reimbursement prior to billing the Program. If it is determined to be in the Department’s best interest, the Department may pay the health insurance premiums of recipients, including Part B premiums, to insurance carriers or employers under the Program.

The Department shall specifically request the Governor to appropriate and identify in a separate line item in the annual budget the money necessary to carry out this subtitle.