,i #aacth ,,congress #b;d ,session ,h4 ,r4 #dhad ,,in ,,the ,,house ,,of ,,representatives ,june #i1 #bjad ,mr4 ,marino 7for himself and ,mr4 ,lewis7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to improve the understanding of1 and promote access to treatment for1 chronic kidney disease1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,chronic ,kidney ,disease ,improvement in ,research and ,treatment ,act of #bjad4 #b4 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title4 ,sec4 #b4 ,table of contents4 ,title ,i--,improving ,understanding of ,chronic ,kidney ,disease through ,expanded ,research and ,coordination ,sec4 #aja4 ,identifying gaps in chronic kidney disease research4 ,sec4 #ajb4 ,coordinating research on chronic kidney disease4 ,sec4 #ajc4 ,understanding the progression of kidney disease and treatment of kidney failure in minority populations4 ,title ,,ii--,promoting ,access to ,chronic ,kidney ,disease ,treatments ,sec4 #bja4 ,increasing access to ,medicare kidney disease education benefit4 ,sec4 #bjb4 ,improving access to chronic kidney disease treatment in underserved rural and urban areas4 ,sec4 #bjc4 ,promoting access to home dialysis treatments4 ,sec4 #bjd4 ,expand access for patients with acute kidney injury4 ,title ,,iii--,creating ,economic ,stability for ,providers ,caring for ,individuals with ,chronic ,kidney ,disease ,sec4 #cja4 ,stabilizing ,medicare payments for services provided to beneficiaries with stage ,v chronic kidney disease receiving dialysis services4 ,sec4 #cjb4 ,allowing individuals with kidney failure to retain access to private insurance4 ,sec4 #cjc4 ,providing individuals with kidney failure access to managed care and coordinated care programs4 ,i ,improving ,understanding of ,chronic ,kidney ,disease through ,expanded ,research and ,coordination #aja4 ,identifying gaps in chronic kidney disease research 7a7 ,report ,not later than one year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall develop and submit to the ,congress a comprehensive report assessing the adequacy of ,federal expenditures in chronic kidney disease research relative to ,federal expenditures for chronic kidney disease care4 7b7 ,contents ,the report required by this section shall-- 7#a7 analyze the current chronic kidney disease research projects being funded by ,federal agencies2 7#b7 identify1 including by surveying the kidney care community1 areas of chronic kidney disease knowledge gaps that are not part of current ,federal research efforts2 7#c7 report on the level of ,federal expenditures on kidney research as compared to the amount of ,federal expenditures on treating individuals with chronic kidney disease2 and 7#d7 identify areas of kidney failure knowledge gaps in research to assess treatment patterns associated with providing care to minority populations that are disproportionately affected by kidney failure4 #ajb4 ,coordinating research on chronic kidney disease 7a7 ,interagency committee ,the ,secretary of ,health and ,human ,services shall establish and maintain an interagency committee for the purpose of improving the coordination of chronic kidney disease research4 7b7 ,reports ,for the purpose described in subsection 7a71 the interagency committee established under such subsection shall issue public reports that-- 7#a7 include a strategic plan1 including recommendations for-- 7,a7 improving communication and coordination among ,federal agencies2 7,b7 procedures for monitoring ,federal chronic kidney disease research activities2 and 7,c7 ways to maximize the efficiency of the ,federal chronic kidney disease research investment and minimize the potential for unnecessary duplication2 7#b7 include a portfolio analysis that provides information on chronic kidney disease research projects1 organized by the strategic plan objectives2 and 7#c7 address such other topics as the interagency committee determines appropriate4 7c7 ,meetings ,the interagency committee established under subsection 7a7 shall meet not less than semi-annually4 #ajc4 ,understanding the progression of kidney disease and treatment of kidney failure in minority populations ,not later than one year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 complete a study on-- 7,a7 the social1 behavioral1 and biological factors leading to kidney disease2 7,b7 efforts to slow the progression of kidney disease in minority populations that are disproportionately affected by such disease2 and 7,c7 treatment patterns associated with providing care1 under the ,medicare program under title ,,xviii of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 and through private health insurance1 to minority populations that are disproportionately affected by kidney failure2 and 7#b7 submit a report to the ,congress on the results of such study4 ,,ii ,promoting ,access to ,chronic ,kidney ,disease ,treatments #bja4 ,increasing access to ,medicare kidney disease education benefit 7a7 ,in general ,section #ahfa7;ggg7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ggg77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,a71 by inserting or stage ,v after stage ,,iv2 7,b7 in subparagraph 7,b71 by inserting or of a physician assistant1 nurse practitioner1 or clinical nurse specialist 7as defined in section #ahfa7;aa77#e77 assisting in the treatment of the individual's kidney condition after kidney condition2 and 7#b7 in paragraph 7#b7-- 7,a7 by striking subparagraph 7,b72 and 7,b7 in subparagraph 7,a7-- 7i7 by striking 7,a7 after 7#b72 7ii7 by striking and at the end of clause 7i72 7iii7 by striking the period at the end of clause 7ii7 and inserting 2 and2 7iv7 by redesignating clauses 7i7 and 7ii7 as subparagraphs 7,a7 and 7,b71 respectively2 and 7v7 by adding at the end the following3 7,c7 a renal dialysis facility subject to the requirements of section #ahha7;b77#a7 with personnel who-- 7i7 provide the services described in paragraph 7#a72 and 7ii7 is a physician 7as defined in subsection 7r77#a77 or a physician assistant1 nurse practitioner1 or clinical nurse specialist 7as defined in subsection 7aa77#e774 4 7b7 ,payment to renal dialysis facilities ,section #ahha7;b7 of such ,act 7#db ,u4,s4,c4 #acierr7b77 is amended by adding at the end the following new paragraph3 7#ae7 ,for purposes of paragraph 7#ad71 the single payment for renal dialysis services under such paragraph shall not take into account the amount of payment for kidney disease education services 7as defined in section #ahfa7;ggg774 ,instead1 payment for such services shall be made to the renal dialysis facility on an assignment-related basis under section #ahdh4 4 7c7 ,effective date ,the amendments made by this section apply to kidney disease education services furnished on or after ,january #a1 #bjae4 #bjb4 ,improving access to chronic kidney disease treatment in underserved rural and urban areas 7a7 ,definition of primary care services ,section #cca7;a77#c77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;d7a77#c77;,d77 is amended by inserting and includes renal dialysis services before the period at the end4 7b7 ,national ,health ,service ,corps ,scholarship ,program ,section #cch;,a7a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl7a77#b77 is amended by inserting 1 including nephrologists and non-physician practitioners providing renal dialysis services before the period at the end4 7c7 ,national ,health ,service ,corps ,loan ,repayment ,program ,section #cch;,b7a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl-#a7;a77#b77 is amended by inserting 1 including nephrologists and non-physician practitioners providing renal dialysis services before the period at the end4 #bjc4 ,promoting access to home dialysis treatments 7a7 ,monthly capitation payments ,notwithstanding any other provision of law1 with respect to dialysis services furnished on or after ,january #a1 #bjae1 the ,secretary of ,health and ,human ,services shall apply with respect to visits by a physician provided within a month to an end stage renal disease patient receiving dialysis services at home1 the alternative ,medicare billing procedures1 as described in the final rule promulgated by the ,secretary in the ,federal ,register on ,november #g1 #bjjc 7#fh ,fed4 ,reg4 #fcbaf71 for physicians managing patients on dialysis1 with respect to visits by such a physician provided within a month to an end stage renal disease patient who is hospitalized during the month4 7b7 ,telehealth ,section #ahcd7m77#d77;,c77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77ii77 is amended by adding at the end the following new subclause3 7,,ix7 ,a renal dialysis facility 7as defined in section #ahha74 4 #bjd4 ,expand access for patients with acute kidney injury ,section #ahha7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77 is amended-- 7#a7 in paragraph 7#a71 by inserting or acute kidney injury after individuals who have been determined to have end stage renal disease2 7#b7 in paragraph 7#b77;,a71 by inserting or acute kidney injury after end stage renal disease2 7#c7 in paragraph 7#b77;,b71 by inserting or acute kidney injury after end stage renal disease2 7#d7 in paragraph 7#c71 in the matter preceding subparagraph 7,a71 by inserting or acute kidney injury after end stage renal disease2 7#e7 in paragraph 7#aa77;,a71 by inserting or acute kidney injury after end stage renal disease2 7#f7 in paragraph 7#aa77;,b71 by inserting or acute kidney injury after end stage renal disease2 7#g7 in paragraph 7#ad77;,b7-- 7,a7 in clause 7ii71 by inserting or acute kidney injury after end stage renal disease2 7,b7 in clause 7iii71 by inserting or acute kidney injury after end stage renal disease2 and 7,c7 in clause 7iv71 by inserting or acute kidney injury after end stage renal disease2 and 7#h7 in paragraph 7#ad77;,h77i71 by inserting or acute kidney injury after end stage renal disease4 ,,iii ,creating ,economic ,stability for ,providers ,caring for ,individuals with ,chronic ,kidney ,disease #cja4 ,stabilizing ,medicare payments for services provided to beneficiaries with stage ,v chronic kidney disease receiving dialysis services ,section #ahha7;b77#ad7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77 is amended-- 7#a7 in subparagraph 7,d71 in the matter preceding clause 7i71 by striking ,such system and inserting ,subject to subparagraph 7,j71 such system2 and 7#b7 by adding at the end the following new subparagraph3 7,j7 7i7 ,for payment for renal dialysis services furnished on or after ,january #a1 #bjae1 under the system under this paragraph-- 7,i7 the payment adjustment described in clause 7i7 of subparagraph 7,d7 shall not take into account comorbidities2 7,,ii7 the payment adjustment described in clause 7ii7 of such subparagraph shall not be included2 7,,iii7 the standardization factor described in the final rule published in the ,federal ,register on ,november #h1 #bjab 7#gg ,fed4 ,reg4 #fgdgj71 shall be established using the most currently available data 7and not historical data7 and adjusted on an annual basis1 based on such available data1 to account for any change in utilization of drugs and any modification in adjustors applied under this paragraph2 and 7,,iv7 the ,secretary shall take into account reasonable costs consistent with paragraph 7#b77;,b7 when calculating such payments4 7ii7 ,not later than ,january #a1 #bjae1 the ,secretary shall amend the ,,esrd facility cost report to-- 7,i7 include the per treatment network fee 7as described in paragraph 7#g77 as an allowable cost2 and 7,,ii7 eliminate the limitation for reporting medical director fees on such reports in order to take into account the wages of a board-certified nephrologist4 4 #cjb4 ,allowing individuals with kidney failure to retain access to private insurance 7a7 ,in general ,section #ahfb7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4#aciey7b77#a77;,c7 is amended-- 7#a7 in the last sentence1 by inserting and before ,january #a1 #bjae after prior to such date2 and 7#b7 by adding at the end the following new sentence3 ,effective for items and services furnished on or after ,january #a1 #bjae 7with respect to periods beginning on or after the date that is #db months prior to such date71 clauses 7i7 and 7ii7 shall be applied by substituting #db-month for #ab-month each place it appears44 7b7 ,effective date ,the amendments made by this subsection shall take effect on the date of enactment of this ,act4 ,for purposes of determining an individual's status under section #ahfb7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c771 as amended by subsection 7a71 an individual who is within the coordinating period as of the date of enactment of this ,act shall have that period extended to the full #db months described in the last sentence of such section1 as added by the amendment made by subsection 7a77#b74 #cjc4 ,providing individuals with kidney failure access to managed care and coordinated care programs 7a7 ,expanding access to ,medicare ,advantage 7#a7 ,eligibility under ,medicare ,advantage 7,a7 ,in general ,section #ahea7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;a77#c77 is amended-- 7i7 by striking subparagraph 7,b72 and 7ii7 by striking eligible individual4-- and all that follows through ,in this title and inserting eligible individual4--,in this title4 7,b7 ,conforming amendment ,section #aheb7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;b77#a77 is amended-- 7i7 by striking subparagraph 7,b72 and 7ii7 by striking ,beneficiaries4-- and all that follows through ,a ,medicare,choice organization and inserting ,beneficiaries4--,a ,medicare ,advantage organization4 7,c7 ,effective date ,the amendments made by this paragraph shall apply with respect to plan years beginning on or after ,january #a1 #bjae4 7#b7 ,education ,section #ahea7;d77#b77;,a77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;d77#b77;,a77iii77 is amended by inserting before the period at the end the following 1 including any additional information that individuals determined to have end stage renal disease may need to make informed decisions with respect to such an election4 7#c7 ,quality metrics ,section #aheb7;e77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;e77#c77;,a77 is amended by adding at the end the following new clause3 7v7 ,requirements with respect to individuals with ,,esrd ,in addition to the data required to be collected1 analyzed1 and reported under clause 7i7 and notwithstanding the limitations under subparagraph 7,b71 as part of the quality improvement program under paragraph 7#a71 each ,,ma organization shall provide for the collection1 analysis1 and reporting of data1 determined in consultation with the kidney care community1 that permits the measurement of health outcomes and other indices of quality with respect to individuals determined to have end stage renal disease4 4 7b7 ,permanent extension of ,medicare ,advantage ,,esrd ,special ,needs ,plans authority ,section #ahei7;f77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#a77 is amended by inserting 1 in the case of a specialized ,,ma plan for special needs individuals who have not been determined to have end stage renal disease1 before for periods before ,january #a1 #bjag4 7c7 ,voluntary ,,esrd coordinated care gainsharing program 7#a7 ,in general ,section #ahha7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77 is amended by adding at the end the following new paragraph3 7#ae7 7,a7 ,not later than ,january #a1 #bjaf1 the ,secretary shall1 in accordance with this paragraph1 establish an ,,esrd ,care ,coordination gainsharing program for nephrologists1 renal dialysis facilities1 and providers of services that develop coordinated care organizations to provide a full range of clinical and supportive services 7as described in subparagraph 7,d77 to individuals determined to have end stage renal disease4 7,b7 ,under such program1 subject to subparagraph 7,c71 the payment amounts renal dialysis facilities and providers of services described in subparagraph 7,a7 would otherwise receive under paragraph 7#ad7 and nephrologists described in subparagraph 7,a7 would otherwise receive under section #ahdh with respect to dialysis services furnished by such a facility1 provider1 or nephrologist during a year1 shall be increased by a portion of the amount 7as determined by the ,secretary7 of actual reductions in expenditure under this title attributable to the coordinated care organization developed by such facility1 provider1 or nephrologist involved1 taking into account non-dialysis expenditures under parts ,a and ,b1 during the preceding calendar year4 ,the payment amount under this subparagraph shall be provided to a nephrologist1 renal dialysis facility1 and provider of services that developed the coordinated care organization no later than ,march #ca of the year after the year during which such services are provided by such nephrologist1 facility1 or provider4 7,c7 ,the aggregate incentive payment amounts provided under such program for a year may not exceed the amount equal to #b percent less than the estimated total amount of non-dialysis expenditures under parts ,a and ,b for #bjaf for items and services that are not related to dialysis or transplant services4 7,d7 ,for purposes of subparagraph 7,a71 the full range of clinical and supportive services includes at least the following3 7i7 ,primary care and other preventative services4 7ii7 ,specialty care for co-morbidities or non-renal acute conditions1 including at least podiatry1 cardiology1 and orthopedics4 7iii7 ,vascular access4 7iv7 ,laboratory testing and diagnostic imaging4 7v7 ,pharmacy care management4 7vi7 ,patient1 family1 and caregiver education4 7vii7 ,psychiatric1 behavioral therapy1 and counseling services4 7,e7 ,in providing payment incentive amounts under such program1 the ,secretary shall apply a risk adjustment methodology that-- 7i7 uses risk adjuster factors applied under part ,c2 and 7ii7 adjusts such payments to exclude the top #b percent of outliers4 7,f7 ,in establishing such program1 the ,secretary shall ensure that each of the following is satisfied3 7i7 ,the program allows for all types and sizes of renal dialysis facilities and providers of services described in subparagraph 7,a71 including profit and not-for-profit1 urban and rural1 as well as all other types and sizes of such facilities and providers1 to participate4 7ii7 ,the program rewards high quality1 efficient facilities and providers through gain-sharing4 7iii7 ,for purposes of determining the actual reductions in expenditures under this title attributable to a coordinated care organization described in subparagraph 7,a71 the program includes a market-based benchmark system that will not be rebased against which such expenditures shall be compared4 7iv7 ,the program results in reductions of expenditures under parts ,a and ,b for services that are not dialysis-related services4 7v7 ,the program allows new applicants to participate in the program after the initial implementation period4 7vi7 ,the program establishes clear quality metrics in consultation with the kidney care community4 7vii7 ,the program provides for waivers of ,federal laws or requirements1 in consultation with interested stakeholders4 7viii7 ,under such program the ,secretary attributes individuals described in subparagraph 7,a7 who receive treatment through a care coordination organization described in such subparagraph to such organization rather than to any other payment model that requires beneficiary attribution4 7ix7 ,under such program the ,secretary provides quarterly ,medicare parts ,a and ,b claims data to facilities and providers described in subparagraph 7,a7 participating in such program4 7,g7 ,not later than three years after the date of the implementation of the ,,esrd ,care ,coordination gainsharing program1 the ,secretary shall submit to the ,congress a report on the waivers granted under subparagraph 7,f77vii7 and the effectiveness of such waivers in allowing the coordination of care4 4 7#b7 ,conforming amendments 7,a7 ,section #ahha ,section #ahha7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77 is amended-- 7i7 in each of paragraphs 7#ab77;,a7 and 7#ac77;,a71 by striking paragraph 7#ad7 and inserting paragraphs 7#ad7 and 7#ae72 and 7ii7 in paragraph 7#ad77;,a77i71 by inserting and paragraph 7#ae7 after ,subject to subparagraph 7,e74 7,b7 ,section #ahdh ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended by adding at the end the following new subsection3 7q7 ,voluntary ,,esrd coordinated care program ,for provisions related to incentive payment amounts to nephrologists under the ,,esrd ,care ,coordination gainsharing program1 see section #ahha7;b77#ae74 4 7d7 ,patient information requirement ,the ,secretary of ,health and ,human ,services shall require hospitals that furnish items and services to individuals entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act or eligible for benefits under part ,b of such title and who subsequently receive dialysis services at a renal dialysis facility 7as defined in section #ahha of such ,act 7#db ,u4,s4,c4 #acierr77 to provide to such facility health information with respect to such individual1 including a discharge summary and co-morbidity information1 upon request of the facility1 not later than #g days after notification by the hospital of the provision of such services to such individual or of the determination that such individual has end stage renal disease1 as applicable4