[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2706 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 2706
To prohibit discrimination on the basis of mental or physical
disability in cases of organ transplants.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 19, 2023
Mrs. Cammack (for herself, Mrs. Dingell, Mr. Sessions, Ms. Wasserman
Schultz, and Mr. Issa) introduced the following bill; which was
referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To prohibit discrimination on the basis of mental or physical
disability in cases of organ transplants.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Charlotte Woodward Organ Transplant
Discrimination Prevention Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The Americans with Disabilities Act of 1990, section
504 of the Rehabilitation Act of 1973, and section 1557 of the
Patient Protection and Affordable Care Act prohibit
discrimination against individuals with disabilities in organ
transplantation and the allocation of organs.
(2) Despite those prohibitions, there are findings and
cases that show, as is documented by the National Council on
Disability and others, that individuals with disabilities are
being denied organ transplants and related services based
solely on the fact that those individuals have a disability.
(3) 34 States have crafted State-level policy to prohibit
organ transplant discrimination against individuals with
disabilities. Federal action, however, is required to protect
individuals with disabilities and to enforce existing law
regardless of the State in which they live.
(4) The current situation, with continuing cases of
discrimination against individuals with disabilities, calls for
further clarity by Congress about which actions constitute
discrimination under current law, which entities are covered,
and the remedies available to individuals experiencing
potential discrimination.
(5) Licensed providers of health care services that provide
organ transplants and related services in exchange for medical
fees are engaging in an economic transaction with patients that
occurs in or substantially impacts interstate commerce.
(6) In the national administration of organ allocation in
the United States, organs are transported across State lines
for transplantation procedures.
(7) Discrimination in organ transplantation limits
individuals with disabilities from participating in health care
transactions in a manner that allows equal access to interstate
commerce.
(8) The existence of discrimination against individuals
with disabilities in the provision of organ transplantation and
related services burdens the flow of organs through legal
channels of interstate commerce.
SEC. 3. DEFINITIONS.
In this Act:
(1) Auxiliary aids and services.--The term ``auxiliary aids
and services'' includes--
(A) qualified interpreters or other effective
methods of making aurally delivered materials available
to individuals with a hearing impairment;
(B) qualified readers, taped texts, or other
effective methods of making visually delivered
materials available to individuals with a visual
impairment;
(C) information in a format that is accessible for
individuals with a cognitive, neurological,
developmental, or intellectual disability;
(D) supported decision-making services; and
(E) acquisition or modification of equipment or
devices.
(2) Covered entity.--The term ``covered entity'' means any
licensed provider of health care services (including licensed
health care practitioners, hospitals, nursing facilities,
laboratories, intermediate care facilities, psychiatric
residential treatment facilities, institutions for individuals
with intellectual or developmental disabilities, and prison
health centers), and any transplant hospital (as defined in
section 121.2 of title 42, Code of Federal Regulations or a
successor regulation), that--
(A) is in interstate commerce; or
(B) provides health care services in a manner
that--
(i) substantially affects or has a
substantial relation to interstate commerce; or
(ii) includes use of an instrument
(including an instrument of transportation or
communication) of interstate commerce.
(3) Disability.--The term ``disability'' has the meaning
given the term in section 3 of the Americans with Disabilities
Act of 1990 (42 U.S.C. 12102).
(4) Human organ.--The term ``human organ'' has the meaning
given the term in section 301(c) of the National Organ
Transplant Act (42 U.S.C. 274e(c)).
(5) Matching entity.--The term ``matching entity'' means an
entity described in section 4.
(6) Organ transplant.--The term ``organ transplant'' means
the transplantation or transfusion of a donated human organ
into the body of another human for the purpose of treating a
medical condition.
(7) Qualified individual.--The term ``qualified
individual'' means an individual who, with or without a support
network, provision of auxiliary aids and services, or
reasonable modifications to policies or practices, meets
eligibility requirements for the receipt of a human organ.
(8) Reasonable modifications to policies or practices.--The
term ``reasonable modifications to policies or practices''
includes--
(A) communication with persons responsible for
supporting a qualified individual with postsurgical or
other care following an organ transplant or related
services, including support with medication; and
(B) consideration, in determining whether a
qualified individual will be able to comply with health
requirements following an organ transplant or receipt
of related services, of support networks available to
the qualified individual, including family, friends,
and providers of home and community-based services,
including home and community-based services funded
through the Medicare or Medicaid program under title
XVIII or XIX, respectively, of the Social Security Act
(42 U.S.C. 1395 et seq., 1396 et seq.), another health
plan in which the qualified individual is enrolled, or
any program or source of funding available to the
qualified individual.
(9) Related services.--The term ``related services'' means
services related to an organ transplant that consist of--
(A) evaluation;
(B) counseling;
(C) treatment, including postoperative treatment,
and care;
(D) provision of information; and
(E) any other service recommended or required by a
physician.
(10) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(11) Supported decision making.--The term ``supported
decision making'' means the use of a support person to assist a
qualified individual in making health care decisions,
communicate information to the qualified individual, or
ascertain a qualified individual's wishes. Such term includes--
(A) the inclusion of the individual's attorney-in-
fact or health care proxy, or any person of the
individual's choice, in communications about the
individual's health care;
(B) permitting the individual to designate a person
of the individual's choice for the purposes of
supporting that individual in communicating, processing
information, or making health care decisions;
(C) providing auxiliary aids and services described
in subparagraph (A), (B), (C), or (E) of paragraph (1)
to facilitate the individual's ability to communicate
and process health-related information, including
providing use of assistive communication technology;
(D) providing health information to persons
designated by the individual, consistent with the
regulations promulgated under section 264(c) of the
Health Insurance Portability and Accountability Act of
1996 (42 U.S.C. 1320d-2 note) and other applicable laws
and regulations governing disclosure of health
information;
(E) providing health information in a format that
is readily understandable by the individual; and
(F) working with a court-appointed guardian or
other person responsible for making health care
decisions on behalf of the individual, to ensure that
the individual is included in decisions involving the
health care of the individual and that health care
decisions are in accordance with the individual's own
expressed interests.
(12) Support network.--The term ``support network'' means,
with respect to a qualified individual, one or more people who
are--
(A) selected by the qualified individual or by the
qualified individual and the guardian of the qualified
individual, to provide assistance to the qualified
individual or guidance to that qualified individual in
understanding issues, making plans for the future, or
making complex decisions; and
(B) who may include the family members, friends,
unpaid supporters, members of the religious
congregation, and appropriate personnel at a community
center, of or serving the qualified individual.
SEC. 4. PROHIBITION OF DISCRIMINATORY POLICY.
An entity who receives a contract under section 372 of the Public
Health Service Act (42 U.S.C. 274) to match human organs and
individuals, and otherwise carry out the functions described in
subsection (b) of that section, shall not issue policies,
recommendations, or other memoranda that would prohibit, or otherwise
hinder, a qualified individual's access to an organ transplant solely
on the basis of that individual's disability.
SEC. 5. PROHIBITION OF DISCRIMINATION.
(a) In General.--Subject to subsection (b), a covered entity may
not, solely on the basis of a qualified individual's disability--
(1) determine that the individual is ineligible to receive
an organ transplant or related services;
(2) deny the individual an organ transplant or related
services;
(3) refuse to refer the individual to an organ transplant
center or other related specialist for the purpose of receipt
of an organ transplant or other related services; or
(4) refuse to place the individual on an organ transplant
waiting list.
(b) Exception.--
(1) In general.--
(A) Medically significant disabilities.--
Notwithstanding subsection (a), a covered entity may
take a qualified individual's disability into account
when making a health care treatment or coverage
recommendation or decision, solely to the extent that
the disability has been found by a physician, following
an individualized evaluation of the potential
recipient, to be medically significant to the receipt
of the organ transplant or related services, as the
case may be.
(B) Construction.--Subparagraph (A) shall not be
construed to require a referral or recommendation for,
or the performance of, a medically inappropriate organ
transplant or medically inappropriate related services.
(2) Clarification.--If a qualified individual has the
necessary support network to provide a reasonable assurance
that the qualified individual will be able to comply with
health requirements following an organ transplant or receipt of
related services, as the case may be, the qualified
individual's inability to independently comply with those
requirements may not be construed to be medically significant
for purposes of paragraph (1).
(c) Reasonable Modifications.--A covered entity shall make
reasonable modifications to policies or practices (including
procedures) of such entity if such modifications are necessary to make
an organ transplant or related services available to qualified
individuals with disabilities, unless the entity can demonstrate that
making such modifications would fundamentally alter the nature of such
policies or practices.
(d) Clarifications.--
(1) No denial of services because of absence of auxiliary
aids and services.--For purposes of this section, a covered
entity shall take such steps as may be necessary to ensure that
a qualified individual with a disability is not denied a
procedure associated with the receipt of an organ transplant or
related services, because of the absence of auxiliary aids and
services, unless the covered entity can demonstrate that taking
such steps would fundamentally alter the nature of the
procedure being offered or would result in an undue burden on
the entity.
(2) Compliance with other law.--Nothing in this section
shall be construed--
(A) to prevent a covered entity from providing
organ transplants or related services at a level that
is greater than the level that is required by this
section; or
(B) to limit the rights of an individual with a
disability under, or to replace or limit the scope of
obligations imposed by, the Americans with Disabilities
Act of 1990 (42 U.S.C. 12101 et seq.) including the
provisions added to such Act by the ADA Amendments Act
of 2008, section 504 of the Rehabilitation Act of 1973
(29 U.S.C. 794), section 1557 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18116), or any other
applicable law.
(e) Enforcement.--
(1) In general.--Any individual who alleges that a
qualified individual was subject to a violation of this section
by a covered entity--
(A) may bring a claim regarding the allegation to
the Office for Civil Rights of the Department of Health
and Human Services, for expedited resolution; and
(B) whether or not such a claim is brought under
subparagraph (A) or a violation is found pursuant to
subparagraph (A), may bring a civil action in a
district court of the United States for injunctive or
other equitable relief, including the relief described
in paragraph (2), against such covered entity to obtain
compliance of such covered entity with this section.
(2) Relief available.--The injunctive and equitable relief
available in a civil action brought under paragraph (1)(B),
with respect to a covered entity, includes--
(A) requiring auxiliary aids and services to be
made available by the entity involved;
(B) requiring reasonable modifications to policies
or practices (including procedures) of such entity; or
(C) requiring that a facility of such entity be
made readily accessible and usable.
(3) Expedited review.--In the case of a civil action
brought under paragraph (1)(B), with respect to a covered
entity, the district court in which such action is brought
shall advance on its docket and expedite review and disposition
of such action.
(4) Rule of construction.--Nothing in this subsection is
intended to limit or replace available remedies under the
Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et
seq.) or any other applicable law.
SEC. 6. APPLICATION TO EACH PART OF PROCESS.
The provisions of this Act--
(1) that apply to an organ transplant, also apply to the
evaluation and listing of a qualified individual, and to the
organ transplant and post-organ-transplant treatment of such an
individual; and
(2) that apply to related services, also apply to the
process for receipt of related services by such an individual.
SEC. 7. EFFECT ON OTHER LAWS.
Nothing in this Act shall be construed to supersede any provision
of any State or local law that provides greater rights to qualified
individuals with respect to organ transplants than the rights
established under this Act.
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