,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #chfg  ,,in ,,the ,,house ,,of  
,,representatives  ,september #bh1      
#bjag,mr4 ,mullin 7for himself1 ,mr4    
,holding1 ,mr4 ,butterfield1 and ,ms4   
,snchez7 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     
amend title ,,xviii of the ,social      
,security ,act to create care management
 demonstration programs for chronic     
kidney disease under the ,medicare      
program1 and for other purposes4  #a4   
,care management demonstration programs 
for chronic kidney disease ,title       
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie et seq47 is amended
 by inserting after section #ahff;,e the
 following new section3  #ahff;,f4 ,care

 management demonstration programs for  
chronic kidney disease  7a7             
,demonstration program for earlier and  
improved detection and treatment of     
chronic kidney disease  7#a7 ,in general
 ,not later than #ah months after the   
enactment of this section1 the          
,secretary shall establish a            
demonstration program 7referred to in   
this section as the ,,ckd early         
detection and treatment demonstration   
program7 of the use of the payment      
system described in paragraph 7#b7 that1
 with respect to an enrolled ,,ckd-,,edt
 individual 7as defined in paragraph    
7#h77;,d771 provides to a ,,ckd-,,edt   
practitioner 7as defined in paragraph   
7#h77;,a77 a single monthly care        
management payment for all ,,ckd-,,edt  
services 7as defined in paragraph       
7#h77;,b77 furnished to such individual 
by such practitioner in a month4  7#b7  
,payment system described ,the payment  
system described in this paragraph is a 
payment system that1 with respect to all

 ,,ckd-,,edt services furnished in a    
month by a ,,ckd-,,edt practitioner to  
an enrolled ,,ckd-,,edt individual1     
provides a care management payment to   
such practitioner in an amount that--   
7,a7 is greater than the amount of      
payment that such practitioner otherwise
 would receive pursuant to this title   
for furnishing such services to such    
individual if the practitioner had not  
elected to participate in the ,,ckd     
early detection and treatment           
demonstration program 7to be calculated 
in a manner that includes1 as part of   
such amount that the practitioner       
otherwise would so receive1 any amounts 
that the practitioner would receive as  
cost-sharing amounts from the           
individual72  7,b7 with respect to a    
fiscal year that is after the first     
fiscal year in which the ,,ckd-,,edt    
practitioner participates in the ,,ckd  
early detection and treatment           
demonstration program1 is1 to the extent
 feasible1 adjusted based on the        

performance of the practitioner during  
the prior fiscal year with respect to   
the measures developed by the ,secretary
 pursuant to paragraph 7#c72 and  7,c7  
is determined through the use of a      
computation that is developed in        
consultation with-- 7i7 chronic kidney  
disease patient advocates2  7ii7        
clinicians in the primary care          
community2 and  7iii7 such other        
entities as the ,secretary determines   
appropriate4  ,for purposes of applying 
subparagraph 7,a7 with respect to       
,,ckd-,,edt services that are furnished 
via a telecommunications system by a    
,,ckd-,,edt practitioner to an enrolled 
,,ckd-,,edt individual1 the ,secretary  
shall calculate the amount that the     
practitioner otherwise would so receive 
with respect to such services in a      
manner that makes such amount equal the 
amount that such practitioner otherwise 
would so receive for such services if   
such services had been furnished without
 the use of a telecommunications system4

  7#c7 ,measures  7,a7 ,in general ,for 
purposes of paragraph 7#b77;,b71 the    
,secretary1 in conjunction with         
stakeholders 7including chronic kidney  
care patient advocates1 clinicians in   
the primary care community1 and experts 
in the development or use of            
evidence-based guidelines for the       
detection1 diagnosis1 and management of 
chronic kidney care71 shall specify     
measures of performance with respect to 
the tasks described in subparagraph     
7,b74 ,such measures shall be in        
accordance with clinical guidelines in  
existence with respect to chronic kidney
 disease at the time of such            
specification4  7,b7 ,tasks described   
,the tasks described in this            
subparagraph1 with respect to a         
,,ckd-,,edt practitioner1 are the       
following3  7i7 ,administering1 as      
appropriate1 an annual serum creatinine 
and urine albumin testing in accordance 
with published chronic kidney care      
practice guidelines to individuals for  

whom the practitioner is the primary    
care practitioner and that either are   
,,ckd-,,edt individuals or are at the   
highest risk for chronic kidney disease4
  7ii7 ,ensuring that1 when appropriate1
 individuals that are enrolled          
,,ckd-,,edt individuals with respect to 
the practitioner receive timely         
consultations1 in accordance with       
published chronic kidney care practice  
guidelines1 with nephrologists located  
in the geographic area in which the     
individual resides4  7,c7 ,flexibility  
in measure specification ,for purposes  
of subparagraph 7,a71 the ,secretary may
 specify measures that the ,secretary   
develops for purposes of such           
subparagraph or that the ,secretary did 
not develop for such purposes4  7#d7    
,waiving of cost-sharing ,a ,,ckd-,,edt 
practitioner that participates in the   
,,ckd early detection and treatment     
demonstration program shall1 with       
respect to any ,,ckd-,,edt services for 
which payment is made under the payment 

system described in paragraph 7#b71     
accept any payment made under such      
paragraph for such services as payment  
in full for such services1 and may not  
collect any amount of cost-sharing      
7including any amount of deductible1    
coinsurance1 or copayment7 from an      
enrolled ,,ckd-,,edt individual for the 
furnishing of such services to such     
individual4  7#e7 ,geographic           
distribution of providers ,to the extent
 practicable1 the ,secretary shall      
ensure 7including through targeted      
outreach to physicians1 nurse           
practitioners1 and physician assistants 
that are primary care practitioners with
 respect to enrolled ,,ckd-,,edt        
individuals7 that the individuals who   
receive ,,ckd-,,edt services for which  
payment is provided under the ,,ckd     
early detection and treatment           
demonstration program are evenly        
distributed--  7,a7 in different regions
 of the ,united ,states2  7,b7 in urban 
and rural areas2 and  7,c7 among        

appropriate facilities1 including-- 7i7 
federally qualified health centers2 and 
7ii7 community health centers that      
receive assistance under section #ccj of
 the ,public ,health ,service ,act4     
7#f7 ,duration and scope of             
demonstration  7,a7 ,three-year minimum 
,subject to subparagraph 7,c71 the      
,secretary shall conduct the ,,ckd early
 detection and treatment demonstration  
program for a period of three years4    
7,b7 ,scope ,subject to subparagraph    
7,c71 the ,secretary shall enroll1      
subject to paragraph 7#aj71 not more    
than #e1jjj ,,ckd-,,edt individuals for 
participation in the demonstration      
program4 ,such an individual may        
participate in the demonstration program
 on a voluntary basis and may terminate 
participation at any time4  7,c7 ,option
 to extend ,the ,secretary may1 through 
rulemaking1 expand 7including           
implementation on a nationwide basis7   
the duration and the scope of the ,,ckd 
early detection and treatment           

demonstration program1 to the extent    
determined appropriate by the           
,secretary1 if--  7i7 the ,secretary    
determines that such expansion is       
expected to-- 7,i7 reduce spending under
 this title without reducing the quality
 of care2 or  7,,ii7 improve the quality
 of patient care without increasing     
spending under this title2  7ii7 the    
,chief ,actuary of the ,centers for     
,medicare  ,medicaid ,services certifies
 that such expansion would reduce 7or   
would not result in any increase in7 net
 program spending under this title2 and 
7iii7 the ,secretary determines that    
such expansion would not deny or limit  
the coverage or provision of benefits   
under this title for applicable         
individuals4  7#g7 ,consultation with   
stakeholders  7,a7 ,in general ,the     
,secretary shall consult with           
stakeholders regarding the establishment
 and implementation of the ,,ckd early  
detection and treatment demonstration   
program4  7,b7 ,timing of consultation  

,the ,secretary shall begin to consult  
with stakeholders pursuant to           
subparagraph 7,a7 not later than six    
months after the date of the enactment  
of this section4  7#h7 ,definitions ,for
 purposes of this section1 the following
 definitions apply3 7,a7 ,,ckd-,,edt    
practitioner ,subject to paragraph 7#i71
 the term ,,ckd-,,edt practitioner      
means1 with respect to an enrolled      
,,ckd-,,edt individual1 a physician1    
nurse practitioner1 or physician        
assistant who--  7i7 is the primary care
 practitioner for such individual2  7ii7
 agrees1 with respect to each fiscal    
year in which the practitioner          
participates in the ,,ckd early         
detection and treatment demonstration   
program1 to--  7,i7 assess the at-risk  
patient populations of such physician1  
nurse practitioner1 or physician        
assistant 7as applicable7 for chronic   
kidney disease pursuant to published    
clinical practice guidelines with       
respect to chronic kidney disease2 and  

7,,ii7 submit to the ,secretary the     
results of the assessments described in 
subclause 7,i72  7iii7 uses certified   
,,ehr technology 7as defined in section 
#ahcc7o77#d772  7iv7 elects to          
participate in the ,,ckd early detection
 and treatment demonstration program    
with respect to all enrolled ,,ckd-,,edt
 individuals for whom such physician1   
nurse practitioner1 or physician        
assistant 7as applicable7 is the primary
 care practitioner2  7v7 agrees1 with   
respect to each fiscal year in which the
 practitioner participates in the       
demonstration program1 to assess        
annually 7pursuant to established       
clinical guidelines with respect to the 
monitoring of the progression of chronic
 kidney disease7 all enrolled           
,,ckd-,,edt individuals for whom such   
physician1 nurse practitioner1 or       
physician assistant 7as applicable7 is  
the primary care practitioner and that  
are either--  7,i7 confirmed to have    
chronic kidney disease2 or  7,,ii7 at   

the highest risk of becoming an         
individual with confirmed chronic kidney
 disease2  7vi7 agrees to provide to    
each enrolled ,,ckd-,,edt individual for
 whom such physician1 nurse             
practitioner1 or physician assistant 7as
 applicable7 is the primary care        
practitioner--  7,i7 educational        
materials that provide background       
information about chronic kidney disease
 and that are developed by credible     
organizations1 as specified by the      
,secretary1 with expertise in the       
development of clinical guidelines and  
patient educational materials with      
respect to chronic kidney disease2 and  
7,,ii7 a notification of the potential  
benefits that the individual may receive
 as a result of the practitioner        
participating in the ,,ckd early        
detection and treatment demonstration   
program2 and  7vii7 agrees to comply    
with the requirements of paragraph      
7#aj74  7,b7 ,,ckd-,,edt services  7i7  
,in general ,the term ,,ckd-,,edt       

services means administration and       
evaluation of such services as the      
,secretary may specify that are         
screening services and care management  
services for chronic kidney disease and 
for which1 subject to clause 7iv71      
payment may otherwise be made under this
 title4  7ii7 ,consultation required ,in
 determining which services to specify  
for purposes of clause 7i71 the         
,secretary shall consult with--  7,i7   
chronic kidney disease patient          
advocates2  7,,ii7 clinicians in the    
primary care nephrologist community2 and
  7,,iii7 experts in the development of 
evidence-based guidelines for the       
detection1 diagnosis1 and management of 
chronic kidney disease4  7iii7          
,considered services ,in specifying     
services for purposes of clause 7i71 the
 ,secretary may1 in addition to         
considering other services and patient  
benefits1 consider the following        
services with respect to the screening1 
care1 and management of chronic kidney  

disease3  7,i7 ,blood pressure          
management4  7,,ii7 ,lipid management4  
7,,iii7 ,assessment for bone and mineral
 metabolism abnormalities1 anemia1      
nutritional needs1 mental health1 and   
availability of family and other social 
support networks4  7,,iv7 ,delivery of  
patient education on self-management    
strategies for chronic kidney disease4  
7,v7 ,development of care plans with    
respect to chronic kidney disease4      
7,,vi7 ,medication reconciliation and   
dosage adjustments4  7,,vii7 ,review of 
laboratory tests4  7,,viii7 ,medical    
nutrition therapy4  7iv7 ,permissible   
inclusion of telehealth services ,the   
term ,,ckd-,,edt services may include   
services that are furnished via a       
telecommunications system by a          
,,ckd-,,edt practitioner to an enrolled 
,,ckd-,,edt individual and that would   
have been ,,ckd-,,edt services under    
clause 7i7 if such services had been    
furnished without the use of a          
telecommunications system4  7,c7        

,,ckd-,,edt individual ,the term        
,,ckd-,,edt individual means an         
individual who-- 7i7 is not under the   
care of a nephrologist or nephrology    
practitioner2  7ii7 is an individual    
with confirmed chronic kidney disease at
 a stage equal to1 or greater than1     
stage #c2 and  7iii7 is entitled to     
benefits under part ,a and enrolled     
under part ,b4  7,d7 ,enrolled          
,,ckd-,,edt individual ,the term        
enrolled ,,ckd-,,edt individual means a 
,,ckd-,,edt individual who is enrolled  
to participate in the demonstration     
program under paragraph 7#f74  7#i7     
,integrated care strategy  7,a7 ,in     
general ,under the demonstration1 a     
,,ckd-,,edt practitioner1 with respect  
to enrolled ,,ckd-,,edt individuals1    
shall develop and submit for the        
,secretary's approval1 subject to       
subparagraphs 7,b7 and 7,c71 a          
,,ckd-,,edt integrated care strategy4   
7,b7 ,integrated care strategy ,in      
assessing a ,,ckd-,,edt integrated care 

strategy1 the ,secretary shall consider 
the extent to which the strategy        
includes elements1 such as the          
following3  7i7 ,interdisciplinary care 
teams led by at least one nephrologist1 
and comprised of registered nurses1     
social workers1 and other               
representatives from alternative        
settings described in clause 7vi74  7ii7
 ,health risk and other assessments to  
determine the physical1 psychosocial1   
nutrition1 language1 cultural1 and other
 needs of enrolled ,,ckd-,,edt          
individuals involved4  7iii7            
,development and at least annual        
updating of individualized care plans   
that incorporate at least the medical1  
social1 and functional needs1           
preferences1 and care goals of enrolled 
,,ckd-,,edt individuals4  7iv7          
,coordination and delivery of           
non-clinical services1 such as          
transportation1 aimed at improving the  
adherence of enrolled ,,ckd-,,edt       
individuals with care recommendations4  

7v7 ,services1 such as transplant       
evaluation and vascular access care4    
7vi7 ,in the case of an individual who1 
while enrolled in the demonstration1    
receives confirmation that a kidney     
transplant is imminent1 the provision by
 an interdisciplinary care team         
described in clause 7i7 of counseling   
services to such individual on          
preparation for and potential challenges
 surrounding such transplant4  7vii7    
,delivery of benefits and services in   
alternative settings1 such as the home  
of the enrolled ,,ckd-,,edt individuals1
 in coordination with the provider or   
other appropriate stakeholder involved  
in such delivery serving on an          
interdisciplinary care team described in
 clause 7i74  7viii7 ,use of patient    
reminder systems4  7ix7 ,education      
programs for patients1 families1 and    
caregivers4  7x7 ,use of health care    
advice resources1 such as nurse advice  
lines4  7xi7 ,use of team-based health  
care delivery models that provide       

comprehensive and continuous medical    
care1 such as medical homes4  7xii7     
,co-location of providers and services4 
7xiii7 ,use of a demonstrated capacity  
to share electronic health record       
information across sites of care4  7xiv7
 ,use of programs to promote better     
adherence to recommended treatment      
regimens by individuals1 including by   
addressing barriers to access to care by
 such individuals4  7xv7 ,other         
services1 strategies1 and approaches    
identified by the ,,ckd-,,edt           
practitioner to improve care            
coordination and delivery4  7,c7        
,requirements ,the ,secretary may not   
approve a ,,ckd-,,edt integrated care   
strategy of a ,,ckd-,,edt practitioner  
unless under such strategy the          
pracitioner--  7i7 provides services to 
enrolled ,,ckd-,,edt individuals through
 a comprehensive1 multidisciplinary     
health and social services delivery     
system which integrates acute and       
long-term care services pursuant to     

regulations2 and  7ii7 specifies the    
covered items and services that will not
 be provided directly by the            
practitioner1 and to arrange for        
delivery of those items and services    
through contracts meeting the           
requirements of regulations4  7#aj7     
,beneficiary protections  7,a7          
,antidiscrimination ,in the case of a   
,,ckd-,,edt practitioner that           
participates in the ,,ckd early         
detection and treatment demonstration   
program that is treating a ,,ckd-,,edt  
individual and such individual elects   
for the practitioner not to so          
participate in such demonstration       
program with respect to such individual1
 such practitioner may not participate  
in such demonstration program with      
respect to such individual 7but may so  
participate with respect to other       
,,ckd-,,edt individuals74  7,b7 ,no     
impact on quality of care ,a ,,ckd-,,edt
 practitioner that participates in the  
,,ckd early detection and treatment     

demonstration program may not allow the 
participation of such practitioner in   
such program to affect the quality of   
services furnished under this title to  
an individual1 regardless of whether the
 practitioner participates in such      
demonstration program with respect to   
such individual4  7,c7 ,quality         
assurance2 patient safeguards ,the      
,secretary shall require that each      
,,ckd-,,edt practitioner that           
participates in the ,,ckd early         
detection and treatment demonstration   
program has in effect--  7i7 a written  
plan of quality assurance and           
improvement with respect to ,,ckd-,,edt 
services for which payment is made under
 such demonstration program1 and        
procedures implementing such plan1 in   
accordance with regulations2 and  7ii7  
written safeguards of the rights of     
enrolled ,,ckd-,,edt individuals for    
whom such practitioner is the primary   
care practitioner 7including a patient  
bill of rights and procedures for       

grievances and appeals7 in accordance   
with regulations and with other         
requirements of this title and ,federal 
and ,state law that are designed for the
 protection of patients4  7b7           
,demonstration program for advanced     
chronic kidney disease  7#a7 ,in general
 ,not later than #ah months after the   
enactment of this section1 the          
,secretary shall establish a            
demonstration program 7referred to in   
this section as the advanced ,,ckd      
demonstration program7 of the use of the
 payment system described in paragraph  
7#b7 that1 with respect to an individual
 entitled to benefits under part ,a or  
enrolled under part ,b with confirmed   
chronic kidney disease at a stage equal 
to1 or greater than1 stage #d 7as       
confirmed by testing serum creatinine   
and urine albumin in alignment with     
evidence-based chronic kidney disease   
clinical guidelines71 provides to an    
advanced ,,ckd practitioner 7as defined 
in paragraph 7#e77;,a77 a single care   

management payment for all advanced     
,,ckd services 7as defined in paragraph 
7#e77;,b77 furnished to such individual 
by such practitioner in a month4  7#b7  
,payment system described ,the payment  
system described in this paragraph is a 
payment system that1 with respect to all
 advanced ,,ckd services furnished in a 
month by an advanced ,,ckd practitioner 
to an individual described in paragraph 
7#a71 provides a care management payment
 to such practitioner in an amount      
that--  7,a7 is greater than the amount 
of payment that such practitioner       
otherwise would receive pursuant to     
title ,,xviii for furnishing such       
services to such individual if the      
practitioner had not elected to         
participate in the advanced ,,ckd       
demonstration program 7to be calculated 
in a manner that includes1 as part of   
such amount that the practitioner       
otherwise would so receive1 any amounts 
that the practitioner would receive as  
cost-sharing amounts from the           

individual72  7,b7 with respect to a    
fiscal year that is after the first     
fiscal year in which the advanced ,,ckd 
practitioner participates in the        
advanced ,,ckd demonstration program1 is
 adjusted based on the performance of   
the practitioner during the prior fiscal
 year with respect to the measures      
developed by the ,secretary pursuant to 
paragraph 7#c72  7,c7 is determined     
through the use of a computation that is
 developed in consultation with-- 7i7   
chronic kidney disease patient          
advocates2  7ii7 clinicians in the      
nephrology community2  7iii7 experts in 
the development of evidence-based       
guidelines for the detection1 diagnosis1
 and management of chronic kidney       
disease2 and  7iv7 such other entities  
as the ,secretary determines            
appropriate4  ,for purposes of applying 
subparagraph 7,a77i7 with respect to    
advanced ,,ckd services that are        
furnished via a telecommunications      
system by an advanced ,,ckd practitioner

 to an individual described in paragraph
 7#a71 the ,secretary shall calculate   
the amount that the practitioner        
otherwise would so receive with respect 
to such services in a manner that makes 
such amount equal the amount that such  
practitioner otherwise would so receive 
for such services if such services had  
been furnished without the use of a     
telecommunications system4  7#c7        
,measures  7,a7 ,in general ,for        
purposes of paragraph 7#b77;,b71 the    
,secretary1 in conjunction with         
stakeholders 7including chronic kidney  
care patient advocates1 clinicians in   
the nephrology community1 experts in the
 development of evidence-based          
guidelines for the detection1 diagnosis1
 and management of chronic kidney care1 
and such other entities as the          
,secretary determines appropriate71     
shall specify measures of performance   
with respect to the tasks described in  
subparagraph 7,b74 ,such measures shall 
be in accordance with clinical          

guidelines in existence with respect to 
chronic kidney disease at the time of   
such specification4  7,b7 ,tasks        
described ,the tasks described in this  
subparagraph are the following3 7i7     
,reducing costs associated with         
hospitalizations of individuals         
described in paragraph 7#a7 that are    
furnished ,,ckd-,,edt services by such  
practitioner4  7ii7 ,providing education
 to such individuals regarding the      
importance of avoidance of non-steroidal
 anti-inflammatory drugs for patients   
with confirmed chronic kidney disease4  
7iii7 ,providing appropriate            
prescription of kidney-protective blood 
pressure medications to such individuals
 for such chronic kidney disease 7unless
 contra-indicated for individuals with  
confirmed chronic kidney disease71      
elevated urine albumin1 and elevated    
blood pressure in alignment with        
evidence-based guidelines4  7iv7        
,providing such individuals1 as         
appropriate1 with planned starts of     

renal replacement therapy through the   
receipt by such individuals of          
preemptive kidney transplants1 the      
initiation of home dialysis1 the        
initiation of outpatient in-center      
hemodialysis through arteriovenuous     
fistula or arteriovenous graft1 or      
supportive care4  7,c7 ,flexibility in  
measure specification ,for purposes of  
subparagraph 7,a71 the ,secretary may   
specify measures that the ,secretary    
develops for purposes of such           
subparagraph or that the ,secretary did 
not develop for such purposes4  7#d7    
,application of early detection and     
treatment demonstration program         
provisions ,the ,secretary shall1 under 
this subsection1 apply the provisions of
 paragraphs 7#d71 7#e71 7#f71 7#g71 and 
7#aj7 of subsection 7a7 to the advanced 
,,ckd demonstration program1 advanced   
,,ckd practitioners1 advanced ,,ckd     
services1 and individuals described in  
paragraph 7#a7 to the same extent that  
such provisions apply under subsection  

7a7 to the ,,ckd early detection and    
treatment demonstration program1        
,,ckd-,,edt practitioners1 ,,ckd-,,edt  
services1 and enrolled ,,ckd-,,edt      
individuals1 respectively4  7#e7        
,definitions ,for purposes of this      
section1 the following definitions      
apply3 7,a7 ,advanced ,,ckd practitioner
 ,subject to paragraph 7#f71 the term   
advanced ,,ckd practitioner means1 with 
respect to an individual described in   
paragraph 7#a71 a nephrologist who--    
7i7 participates in the ,medicare       
program under this title2  7ii7 subject 
to subsection 7a77#aj77;,a7 as applied  
pursuant to paragraph 7#d71 elects to   
participate in the advanced ,,ckd       
demonstration program with respect to   
all individuals described in paragraph  
7#a7 who receive care from the          
nephrologist2  7iii7 agrees to provide  
to each individual described in         
paragraph 7#a7 who receives care from   
the nephrologist--  7,i7 educational    
materials that provide background       

information about chronic kidney disease
 and that are developed by credible     
organizations with expertise in the     
development of clinical guidelines and  
patient educational materials with      
respect to chronic kidney disease2 and  
7,,ii7 a notification of the potential  
benefits that the individual may receive
 as a result of the practitioner        
participating in the advanced ,,ckd     
demonstration program2 and  7iv7 agrees 
to comply with the requirements of      
subsection 7a77#aj71 as applied pursuant
 to paragraph 7#d74  7,b7 ,advanced     
,,ckd services  7i7 ,in general ,the    
term advanced ,,ckd services means1 with
 respect to individuals described in    
paragraph 7#a71 such services as the    
,secretary may specify that are care and
 management services for chronic kidney 
disease and that1 subject to clause     
7iv71 are services for which payment may
 otherwise be made under this title4    
7ii7 ,consultation required ,in         
determining which services to specify   

for purposes of clause 7i71 the         
,secretary shall consult with--  7,i7   
chronic kidney disease patient          
advocates2  7,,ii7 clinicians in the    
nephrology community2  7,,iii7 experts  
in the development of evidence-based    
guidelines for the detection1 diagnosis1
 and management of chronic kidney       
disease2 and  7,,iv7 such other entities
 as the ,secretary determines           
appropriate4  7iii7 ,considered services
 ,in specifying services for purposes of
 clause 7i71 the ,secretary may1 in     
addition to considering other services1 
consider the following services with    
respect to the care and management of   
chronic kidney disease3  7,i7 ,kidney   
disease education benefit sessions4     
7,,ii7 ,patient care planning 7including
 patient choice of renal replacement    
therapy or palliative or advanced care  
planning74  7,,iii7 ,comorbidities      
assessment and management 7with respect 
to conditions such as anemia1 bone and  
mineral abnormalities1 and              

cardiovascular disease74  7,,iv7 ,mental
 health assessment and referral4  7,v7  
,practitioner consultation and          
coordination with cardiologists1        
endocrinologists1 mental health         
specialists1 primary care practitioners1
 and other appropriate health care      
providers and suppliers4  7,,vi7        
,vascular or peritoneal dialysis access 
assessments and coordinations with      
surgeons4  7,,vii7 ,referrals and       
coordinations with transplant centers4  
7,,viii7 ,medication reconciliations and
 coordinations with pharmacists4  7,,ix7
 ,medical nutrition therapy administered
 by dieticians4  7iv7 ,permissible      
inclusion of telehealth services ,the   
term advanced ,,ckd services may include
 services that are furnished via a      
telecommunications system by an advanced
 ,,ckd practitioner to an individual    
described in paragraph 7#a7 and that    
would have been advanced ,,ckd services 
under clause 7i7 if such services had   
been furnished without the use of a     

telecommunications system4  7#f7        
,participation of care teams  7,a7 ,in  
general ,with respect to an individual  
described in paragraph 7#a71 a          
nephrologist for such individual may    
participate in a care team described in 
subparagraph 7,b7 that1 with respect to 
the furnishing of advanced ,,ckd        
services to such individual1            
participates in the advanced ,,ckd      
demonstration program as an advanced    
,,ckd practitioner4 ,in applying this   
subsection1 such group shall be treated 
as such an advanced ,,ckd practitioner4 
7,b7 ,care team described ,a care team  
described in this subparagraph1 with    
respect to an individual described in   
paragraph 7#a71 is1 subject to          
subparagraph 7,c71 a group of           
providers--  7i7 each of which          
participates in the ,medicare program   
under this title2  7ii7 each of which   
elects to participate in the advanced   
,,ckd demonstration program with respect
 to all individuals described in        

paragraph 7#a7 for whom the nephrologist
 described in subparagraph 7,a7 is the  
nephrologist2 and  7iii7 that agrees to 
provide to each individual described in 
paragraph 7#a7 for whom the nephrologist
 described in subparagraph 7,a7 is the  
nephrologist--  7,i7 educational        
materials that provide background       
information about chronic kidney disease
 and that are developed by credible     
organizations with expertise in the     
development of clinical guidelines and  
patient educational materials with      
respect to chronic kidney disease2 and  
7,,ii7 a notification of the potential  
benefits that the individual may receive
 as a result of the practitioner        
participating in the advanced ,,ckd     
demonstration program4  7,c7            
,permissible assembly and administration
 by third party-administrator           
organizations  7i7 ,in general ,a care  
team described in subparagraph 7,b7 may 
be assembled and administered by a third
 party-administrator organization4  7ii7

 ,third party-administrator organization
 ,for purposes of this paragraph1 the   
term third party-administrator          
organization means the following3 7,i7  
,a ,medicare ,advantage plan described  
in section #ahea7;a77#b7 or a ,medicare 
,advantage organization offering such a 
plan4  7,,ii7 ,a prescription drug plan 
7as defined in section                  
#ahfj;,d-#da7;a77#ad774  7,,iii7 ,a     
medicaid managed care organization 7as  
defined in section #aijc7m774  4