,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #chfg  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,septemb] #bh1        
#bjag,mr4 ,mull9 7= himself1 ,mr4       
,hold+1 ,mr4 ,butt]field1 & ,ms4 ,sn*ez7
 introduc$ ! foll[+ bill2 :i* 0 ref]r$  
to ! ,committee on ,en]gy & ,comm]ce1 & 
9 addition to ! ,committee on ,ways &   
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to create c>e    
managem5t demon/ration programs = *ronic
 kidney disease "u ! ,m$ic>e program1 & 
= o!r purposes4  #a4 ,c>e managem5t     
demon/ration programs = *ronic kidney   
disease ,title ,,xviii ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 is am5d$ by ins]t+ aft] section   
#ahff;,e ! foll[+ new section3          
#ahff;,f4 ,c>e managem5t demon/ration   
programs = *ronic kidney disease  7a7   
,demon/ration program = e>li] & improv$ 

detection & treatm5t ( *ronic kidney    
disease  7#a7 ,9 g5]al ,n lat] ?an #ah  
mon?s aft] ! enactm5t ( ?is section1 !  
,secret>y %all e/abli% a demon/ration   
program 7ref]r$ to 9 ?is section z !    
,,ckd e>ly detection & treatm5t         
demon/ration program7 ( ! use ( ! paym5t
 sy/em describ$ 9 p>agraph 7#b7 t1 )    
respect to an enroll$ ,,ckd-,,edt       
individual 7z def9$ 9 p>agraph          
7#h77;,d771 provides to a ,,ckd-,,edt   
practition] 7z def9$ 9 p>agraph         
7#h77;,a77 a s+le mon?ly c>e managem5t  
paym5t = all ,,ckd-,,edt s]vices 7z     
def9$ 9 p>agraph 7#h77;,b77 furni%$ to  
su* individual by su* practition] 9 a   
mon?4  7#b7 ,paym5t sy/em describ$ ,!   
paym5t sy/em describ$ 9 ?is p>agraph is 
a paym5t sy/em t1 ) respect to all      
,,ckd-,,edt s]vices furni%$ 9 a mon? by 
a ,,ckd-,,edt practition] to an enroll$ 
,,ckd-,,edt individual1 provides a c>e  
managem5t paym5t to su* practition] 9 an
 am\nt t--  7,a7 is great] ?an ! am\nt (
 paym5t t su* practition] o!rwise w\ld  

receive pursuant to ?is title = furni%+ 
su* s]vices to su* individual if !      
practition] _h n elect$ to p>ticipate 9 
! ,,ckd e>ly detection & treatm5t       
demon/ration program 7to be calculat$ 9 
a mann] t includes1 z "p ( su* am\nt t !
 practition] o!rwise w\ld s receive1 any
 am\nts t ! practition] w\ld receive z  
co/-%>+ am\nts f ! individual72  7,b7 ) 
respect to a fiscal ye> t is aft] ! fir/
 fiscal ye> 9 :i* ! ,,ckd-,,edt         
practition] p>ticipates 9 ! ,,ckd e>ly  
detection & treatm5t demon/ration       
program1 is1 to ! ext5t feasible1 adju/$
 bas$ on ! p]=mance ( ! practition] dur+
 ! prior fiscal ye> ) respect to !      
measures develop$ by ! ,secret>y        
pursuant to p>agraph 7#c72 &  7,c7 is   
det]m9$ ?r\gh ! use ( a computation t is
 develop$ 9 consultation )-- 7i7 *ronic 
kidney disease pati5t advocates2  7ii7  
cl9icians 9 ! prim>y c>e community2 &   
7iii7 su* o!r entities z ! ,secret>y    
det]m9es appropriate4  ,= purposes (    
apply+ subp>agraph 7,a7 ) respect to    

,,ckd-,,edt s]vices t are furni%$ via a 
telecommunications sy/em by a           
,,ckd-,,edt practition] to an enroll$   
,,ckd-,,edt individual1 ! ,secret>y %all
 calculate ! am\nt t ! practition]      
o!rwise w\ld s receive ) respect to su* 
s]vices 9 a mann] t makes su* am\nt     
equal ! am\nt t su* practition] o!rwise 
w\ld s receive = su* s]vices if su*     
s]vices _h be5 furni%$ )\t ! use ( a    
telecommunications sy/em4  7#c7         
,measures  7,a7 ,9 g5]al ,= purposes (  
p>agraph 7#b77;,b71 ! ,secret>y1 9      
conjunction ) /akehold]s 7includ+ *ronic
 kidney c>e pati5t advocates1 cl9icians 
9 ! prim>y c>e community1 & exp]ts 9 !  
developm5t or use ( evid5ce-bas$        
guidel9es = ! detection1 diagnosis1 &   
managem5t ( *ronic kidney c>e71 %all    
specify measures ( p]=mance ) respect to
 ! tasks describ$ 9 subp>agraph 7,b74   
,su* measures %all be 9 accordance )    
cl9ical guidel9es 9 exi/5ce ) respect to
 *ronic kidney disease at ! "t ( su*    
specification4  7,b7 ,tasks describ$ ,! 

tasks describ$ 9 ?is subp>agraph1 )     
respect to a ,,ckd-,,edt practition]1   
are ! foll[+3  7i7 ,adm9i/]+1 z         
appropriate1 an annual s]um creat99e &  
ur9e album9 te/+ 9 accordance ) publi%$ 
*ronic kidney c>e practice guidel9es to 
individuals = :om ! practition] is !    
prim>y c>e practition] & t ei!r are     
,,ckd-,,edt individuals or are at !     
highe/ risk = *ronic kidney disease4    
7ii7 ,ensur+ t1 :5 appropriate1         
individuals t are enroll$ ,,ckd-,,edt   
individuals ) respect to ! practition]  
receive timely consultations1 9         
accordance ) publi%$ *ronic kidney c>e  
practice guidel9es1 ) nephrologi/s      
locat$ 9 ! geographic area 9 :i* !      
individual resides4  7,c7 ,flexibility 9
 measure specification ,= purposes (    
subp>agraph 7,a71 ! ,secret>y may       
specify measures t ! ,secret>y develops 
= purposes ( su* subp>agraph or t !     
,secret>y did n develop = su* purposes4 
7#d7 ,waiv+ ( co/-%>+ ,a ,,ckd-,,edt    
practition] t p>ticipates 9 ! ,,ckd e>ly

 detection & treatm5t demon/ration      
program %all1 ) respect to any          
,,ckd-,,edt s]vices = :i* paym5t is made
 "u ! paym5t sy/em describ$ 9 p>agraph  
7#b71 accept any paym5t made "u su*     
p>agraph = su* s]vices z paym5t 9 full =
 su* s]vices1 & may n collect any am\nt 
( co/-%>+ 7includ+ any am\nt (          
d$uctible1 co9surance1 or copaym5t7 f an
 enroll$ ,,ckd-,,edt individual = !     
furni%+ ( su* s]vices to su* individual4
  7#e7 ,geographic di/ribution (        
provid]s ,to ! ext5t practicable1 !     
,secret>y %all ensure 7includ+ ?r\gh    
t>get$ outrea* to physicians1 nurse     
practition]s1 & physician assi/ants t   
are prim>y c>e practition]s ) respect to
 enroll$ ,,ckd-,,edt individuals7 t !   
individuals :o receive ,,ckd-,,edt      
s]vices = :i* paym5t is provid$ "u !    
,,ckd e>ly detection & treatm5t         
demon/ration program are ev5ly          
di/ribut$--  7,a7 9 diff]5t regions ( ! 
,unit$ ,/ates2  7,b7 9 urban & rural    
areas2 &  7,c7 among appropriate        

facilities1 includ+-- 7i7 f$]ally       
qualifi$ heal? c5t]s2 &  7ii7 community 
heal? c5t]s t receive assi/ance "u      
section #ccj ( ! ,public ,heal? ,s]vice 
,act4  7#f7 ,duration & scope (         
demon/ration  7,a7 ,?ree-ye> m9imum     
,subject to subp>agraph 7,c71 !         
,secret>y %all conduct ! ,,ckd e>ly     
detection & treatm5t demon/ration       
program = a p]iod ( ?ree ye>s4  7,b7    
,scope ,subject to subp>agraph 7,c71 !  
,secret>y %all enroll1 subject to       
p>agraph 7#aj71 n m ?an #e1jjj          
,,ckd-,,edt individuals = p>ticipation 9
 ! demon/ration program4 ,su* an        
individual may p>ticipate 9 !           
demon/ration program on a volunt>y basis
 & may t]m9ate p>ticipation at any "t4  
7,c7 ,option to ext5d ,! ,secret>y may1 
?r\gh rulemak+1 exp& 7includ+           
implem5tation on a nationwide basis7 !  
duration & ! scope ( ! ,,ckd e>ly       
detection & treatm5t demon/ration       
program1 to ! ext5t det]m9$ appropriate 
by ! ,secret>y1 if--  7i7 ! ,secret>y   

det]m9es t su* expansion is expect$ to--
 7,i7 r$uce sp5d+ "u ?is title )\t r$uc+
 ! quality ( c>e2 or  7,,ii7 improve !  
quality ( pati5t c>e )\t increas+ sp5d+ 
"u ?is title2  7ii7 ! ,*ief ,actu>y ( ! 
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices     
c]tifies t su* expansion w\ld r$uce 7or 
w\ld n result 9 any increase 97 net     
program sp5d+ "u ?is title2 &  7iii7 !  
,secret>y det]m9es t su* expansion w\ld 
n d5y or limit ! cov]age or provision ( 
b5efits "u ?is title = applicable       
individuals4  7#g7 ,consultation )      
/akehold]s  7,a7 ,9 g5]al ,! ,secret>y  
%all consult ) /akehold]s reg>d+ !      
e/abli%m5t & implem5tation ( ! ,,ckd    
e>ly detection & treatm5t demon/ration  
program4  7,b7 ,tim+ ( consultation ,!  
,secret>y %all beg9 to consult )        
/akehold]s pursuant to subp>agraph 7,a7 
n lat] ?an six mon?s aft] ! date ( !    
enactm5t ( ?is section4  7#h7           
,def9itions ,= purposes ( ?is section1 !
 foll[+ def9itions apply3 7,a7          
,,ckd-,,edt practition] ,subject to     

p>agraph 7#i71 ! t]m ,,ckd-,,edt        
practition] means1 ) respect to an      
enroll$ ,,ckd-,,edt individual1 a       
physician1 nurse practition]1 or        
physician assi/ant :o--  7i7 is ! prim>y
 c>e practition] = su* individual2  7ii7
 agrees1 ) respect to ea* fiscal ye> 9  
:i* ! practition] p>ticipates 9 ! ,,ckd 
e>ly detection & treatm5t demon/ration  
program1 to--  7,i7 assess ! at-risk    
pati5t populations ( su* physician1     
nurse practition]1 or physician assi/ant
 7z applicable7 = *ronic kidney disease 
pursuant to publi%$ cl9ical practice    
guidel9es ) respect to *ronic kidney    
disease2 &  7,,ii7 submit to ! ,secret>y
 ! results ( ! assessm5ts describ$ 9    
subclause 7,i72  7iii7 uses c]tifi$     
,,ehr te*nology 7z def9$ 9 section      
#ahcc7o77#d772  7iv7 elects to          
p>ticipate 9 ! ,,ckd e>ly detection &   
treatm5t demon/ration program ) respect 
to all enroll$ ,,ckd-,,edt individuals =
 :om su* physician1 nurse practition]1  
or physician assi/ant 7z applicable7 is 

! prim>y c>e practition]2  7v7 agrees1 )
 respect to ea* fiscal ye> 9 :i* !      
practition] p>ticipates 9 ! demon/ration
 program1 to assess annually 7pursuant  
to e/abli%$ cl9ical guidel9es ) respect 
to ! monitor+ ( ! progression ( *ronic  
kidney disease7 all enroll$ ,,ckd-,,edt 
individuals = :om su* physician1 nurse  
practition]1 or physician assi/ant 7z   
applicable7 is ! prim>y c>e practition] 
& t are ei!r--  7,i7 confirm$ to h      
*ronic kidney disease2 or  7,,ii7 at !  
highe/ risk ( becom+ an individual )    
confirm$ *ronic kidney disease2  7vi7   
agrees to provide to ea* enroll$        
,,ckd-,,edt individual = :om su*        
physician1 nurse practition]1 or        
physician assi/ant 7z applicable7 is !  
prim>y c>e practition]--  7,i7          
educational mat]ials t provide backgr\nd
 in=mation ab\t *ronic kidney disease & 
t are develop$ by cr$ible organizations1
 z specifi$ by ! ,secret>y1 ) exp]tise 9
 ! developm5t ( cl9ical guidel9es &     
pati5t educational mat]ials ) respect to

 *ronic kidney disease2 &  7,,ii7 a     
notification ( ! pot5tial b5efits t !   
individual may receive z a result ( !   
practition] p>ticipat+ 9 ! ,,ckd e>ly   
detection & treatm5t demon/ration       
program2 &  7vii7 agrees to comply ) !  
requirem5ts ( p>agraph 7#aj74  7,b7     
,,ckd-,,edt s]vices  7i7 ,9 g5]al ,! t]m
 ,,ckd-,,edt s]vices means adm9i/ration 
& evaluation ( su* s]vices z ! ,secret>y
 may specify t are scre5+ s]vices & c>e 
managem5t s]vices = *ronic kidney       
disease & = :i*1 subject to clause 7iv71
 paym5t may o!rwise be made "u ?is      
title4  7ii7 ,consultation requir$ ,9   
det]m9+ :i* s]vices to specify =        
purposes ( clause 7i71 ! ,secret>y %all 
consult )--  7,i7 *ronic kidney disease 
pati5t advocates2  7,,ii7 cl9icians 9 ! 
prim>y c>e nephrologi/ community2 &     
7,,iii7 exp]ts 9 ! developm5t (         
evid5ce-bas$ guidel9es = ! detection1   
diagnosis1 & managem5t ( *ronic kidney  
disease4  7iii7 ,consid]$ s]vices ,9    
specify+ s]vices = purposes ( clause    

7i71 ! ,secret>y may1 9 addition to     
consid]+ o!r s]vices & pati5t b5efits1  
consid] ! foll[+ s]vices ) respect to ! 
scre5+1 c>e1 & managem5t ( *ronic kidney
 disease3  7,i7 ,blood pressure         
managem5t4  7,,ii7 ,lipid managem5t4    
7,,iii7 ,assessm5t = bone & m9]al       
metabolism abnormalities1 anemia1       
nutritional ne$s1 m5tal heal?1 &        
availability ( family & o!r social      
support networks4  7,,iv7 ,deliv]y (    
pati5t education on self-managem5t      
/rategies = *ronic kidney disease4  7,v7
 ,developm5t ( c>e plans ) respect to   
*ronic kidney disease4  7,,vi7          
,m$ication reconciliation & dosage      
adju/m5ts4  7,,vii7 ,review ( laboratory
 te/s4  7,,viii7 ,m$ical nutrition      
!rapy4  7iv7 ,p]missible inclusion (    
teleheal? s]vices ,! t]m ,,ckd-,,edt    
s]vices may include s]vices t are       
furni%$ via a telecommunications sy/em  
by a ,,ckd-,,edt practition] to an      
enroll$ ,,ckd-,,edt individual & t w\ld 
h be5 ,,ckd-,,edt s]vices "u clause 7i7 

if su* s]vices _h be5 furni%$ )\t ! use 
( a telecommunications sy/em4  7,c7     
,,ckd-,,edt individual ,! t]m           
,,ckd-,,edt individual means an         
individual :o-- 7i7 is n "u ! c>e ( a   
nephrologi/ or nephrology practition]2  
7ii7 is an individual ) confirm$ *ronic 
kidney disease at a /age equal to1 or   
great] ?an1 /age #c2 &  7iii7 is entitl$
 to b5efits "u "p ,a & enroll$ "u "p ,b4
  7,d7 ,enroll$ ,,ckd-,,edt individual  
,! t]m enroll$ ,,ckd-,,edt individual   
means a ,,ckd-,,edt individual :o is    
enroll$ to p>ticipate 9 ! demon/ration  
program "u p>agraph 7#f74  7#i7         
,integrat$ c>e /rategy  7,a7 ,9 g5]al   
,"u ! demon/ration1 a ,,ckd-,,edt       
practition]1 ) respect to enroll$       
,,ckd-,,edt individuals1 %all develop & 
submit = ! ,secret>y's approval1 subject
 to subp>agraphs 7,b7 & 7,c71 a         
,,ckd-,,edt integrat$ c>e /rategy4  7,b7
 ,integrat$ c>e /rategy ,9 assess+ a    
,,ckd-,,edt integrat$ c>e /rategy1 !    
,secret>y %all consid] ! ext5t to :i* ! 

/rategy includes elem5ts1 su* z !       
foll[+3  7i7 ,int]discipl9>y c>e teams  
l$ by at lea/ "o nephrologi/1 & compris$
 ( regi/]$ nurses1 social work]s1 & o!r 
repres5tatives f alt]native sett+s      
describ$ 9 clause 7vi74  7ii7 ,heal?    
risk & o!r assessm5ts to det]m9e !      
physical1 psy*osocial1 nutrition1       
language1 cultural1 & o!r ne$s ( enroll$
 ,,ckd-,,edt individuals involv$4  7iii7
 ,developm5t & at lea/ annual updat+ (  
individualiz$ c>e plans t incorporate at
 lea/ ! m$ical1 social1 & functional    
ne$s1 pref]5ces1 & c>e goals ( enroll$  
,,ckd-,,edt individuals4  7iv7          
,coord9ation & deliv]y ( non-cl9ical    
s]vices1 su* z transportation1 aim$ at  
improv+ ! adh]5ce ( enroll$ ,,ckd-,,edt 
individuals ) c>e recomm5dations4  7v7  
,s]vices1 su* z transplant evaluation & 
vascul> access c>e4  7vi7 ,9 ! case ( an
 individual :o1 :ile enroll$ 9 !        
demon/ration1 receives confirmation t a 
kidney transplant is imm95t1 ! provision
 by an int]discipl9>y c>e team describ$ 

9 clause 7i7 ( c\nsel+ s]vices to su*   
individual on prep>ation = & pot5tial   
*all5ges surr\nd+ su* transplant4  7vii7
 ,deliv]y ( b5efits & s]vices 9         
alt]native sett+s1 su* z ! home ( !     
enroll$ ,,ckd-,,edt individuals1 9      
coord9ation ) ! provid] or o!r          
appropriate /akehold] involv$ 9 su*     
deliv]y s]v+ on an int]discipl9>y c>e   
team describ$ 9 clause 7i74  7viii7 ,use
 ( pati5t rem9d] sy/ems4  7ix7          
,education programs = pati5ts1 families1
 & c>egiv]s4  7x7 ,use ( heal? c>e      
advice res\rces1 su* z nurse advice     
l9es4  7xi7 ,use ( team-bas$ heal? c>e  
deliv]y models t provide compreh5sive & 
cont9u\s m$ical c>e1 su* z m$ical homes4
  7xii7 ,co-location ( provid]s &       
s]vices4  7xiii7 ,use ( a demon/rat$    
capacity to %>e electronic heal? record 
in=mation across sites ( c>e4  7xiv7    
,use ( programs to promote bett] adh]5ce
 to recomm5d$ treatm5t regim5s by       
individuals1 includ+ by address+ b>ri]s 
to access to c>e by su* individuals4    

7xv7 ,o!r s]vices1 /rategies1 &         
approa*es id5tifi$ by ! ,,ckd-,,edt     
practition] to improve c>e coord9ation &
 deliv]y4  7,c7 ,requirem5ts ,!         
,secret>y may n approve a ,,ckd-,,edt   
integrat$ c>e /rategy ( a ,,ckd-,,edt   
practition] unless "u su* /rategy !     
pracition]--  7i7 provides s]vices to   
enroll$ ,,ckd-,,edt individuals ?r\gh a 
compreh5sive1 multidiscipl9>y heal? &   
social s]vices deliv]y sy/em :i*        
integrates acute & long-t]m c>e s]vices 
pursuant to regulations2 &  7ii7        
specifies ! cov]$ items & s]vices t w n 
be provid$ directly by ! practition]1 & 
to arrange = deliv]y ( ^? items &       
s]vices ?r\gh contracts meet+ !         
requirem5ts ( regulations4  7#aj7       
,b5efici>y protections  7,a7            
,antidiscrim9ation ,9 ! case ( a        
,,ckd-,,edt practition] t p>ticipates 9 
! ,,ckd e>ly detection & treatm5t       
demon/ration program t is treat+ a      
,,ckd-,,edt individual & su* individual 
elects = ! practition] n to s p>ticipate

 9 su* demon/ration program ) respect to
 su* individual1 su* practition] may n  
p>ticipate 9 su* demon/ration program ) 
respect to su* individual 7b may s      
p>ticipate ) respect to o!r ,,ckd-,,edt 
individuals74  7,b7 ,no impact on       
quality ( c>e ,a ,,ckd-,,edt practition]
 t p>ticipates 9 ! ,,ckd e>ly detection 
& treatm5t demon/ration program may n   
all[ ! p>ticipation ( su* practition] 9 
su* program to affect ! quality (       
s]vices furni%$ "u ?is title to an      
individual1 reg>dless ( :e!r !          
practition] p>ticipates 9 su*           
demon/ration program ) respect to su*   
individual4  7,c7 ,quality assurance2   
pati5t safegu>ds ,! ,secret>y %all      
require t ea* ,,ckd-,,edt practition] t 
p>ticipates 9 ! ,,ckd e>ly detection &  
treatm5t demon/ration program has 9     
effect--  7i7 a writt5 plan ( quality   
assurance & improvem5t ) respect to     
,,ckd-,,edt s]vices = :i* paym5t is made
 "u su* demon/ration program1 &         
proc$ures implem5t+ su* plan1 9         

accordance ) regulations2 &  7ii7 writt5
 safegu>ds ( ! rights ( enroll$         
,,ckd-,,edt individuals = :om su*       
practition] is ! prim>y c>e practition] 
7includ+ a pati5t bill ( rights &       
proc$ures = grievances & appeals7 9     
accordance ) regulations & ) o!r        
requirem5ts ( ?is title & ,f$]al & ,/ate
 law t are design$ = ! protection (     
pati5ts4  7b7 ,demon/ration program =   
advanc$ *ronic kidney disease  7#a7 ,9  
g5]al ,n lat] ?an #ah mon?s aft] !      
enactm5t ( ?is section1 ! ,secret>y %all
 e/abli% a demon/ration program 7ref]r$ 
to 9 ?is section z ! advanc$ ,,ckd      
demon/ration program7 ( ! use ( ! paym5t
 sy/em describ$ 9 p>agraph 7#b7 t1 )    
respect to an individual entitl$ to     
b5efits "u "p ,a or enroll$ "u "p ,b )  
confirm$ *ronic kidney disease at a /age
 equal to1 or great] ?an1 /age #d 7z    
confirm$ by te/+ s]um creat99e & ur9e   
album9 9 alignm5t ) evid5ce-bas$ *ronic 
kidney disease cl9ical guidel9es71      
provides to an advanc$ ,,ckd practition]

 7z def9$ 9 p>agraph 7#e77;,a77 a s+le  
c>e managem5t paym5t = all advanc$ ,,ckd
 s]vices 7z def9$ 9 p>agraph 7#e77;,b77 
furni%$ to su* individual by su*        
practition] 9 a mon?4  7#b7 ,paym5t     
sy/em describ$ ,! paym5t sy/em describ$ 
9 ?is p>agraph is a paym5t sy/em t1 )   
respect to all advanc$ ,,ckd s]vices    
furni%$ 9 a mon? by an advanc$ ,,ckd    
practition] to an individual describ$ 9 
p>agraph 7#a71 provides a c>e managem5t 
paym5t to su* practition] 9 an am\nt t--
  7,a7 is great] ?an ! am\nt ( paym5t t 
su* practition] o!rwise w\ld receive    
pursuant to title ,,xviii = furni%+ su* 
s]vices to su* individual if !          
practition] _h n elect$ to p>ticipate 9 
! advanc$ ,,ckd demon/ration program 7to
 be calculat$ 9 a mann] t includes1 z "p
 ( su* am\nt t ! practition] o!rwise    
w\ld s receive1 any am\nts t !          
practition] w\ld receive z co/-%>+      
am\nts f ! individual72  7,b7 ) respect 
to a fiscal ye> t is aft] ! fir/ fiscal 
ye> 9 :i* ! advanc$ ,,ckd practition]   

p>ticipates 9 ! advanc$ ,,ckd           
demon/ration program1 is adju/$ bas$ on 
! p]=mance ( ! practition] dur+ ! prior 
fiscal ye> ) respect to ! measures      
develop$ by ! ,secret>y pursuant to     
p>agraph 7#c72  7,c7 is det]m9$ ?r\gh ! 
use ( a computation t is develop$ 9     
consultation )-- 7i7 *ronic kidney      
disease pati5t advocates2  7ii7         
cl9icians 9 ! nephrology community2     
7iii7 exp]ts 9 ! developm5t (           
evid5ce-bas$ guidel9es = ! detection1   
diagnosis1 & managem5t ( *ronic kidney  
disease2 &  7iv7 su* o!r entities z !   
,secret>y det]m9es appropriate4  ,=     
purposes ( apply+ subp>agraph 7,a77i7 ) 
respect to advanc$ ,,ckd s]vices t are  
furni%$ via a telecommunications sy/em  
by an advanc$ ,,ckd practition] to an   
individual describ$ 9 p>agraph 7#a71 !  
,secret>y %all calculate ! am\nt t !    
practition] o!rwise w\ld s receive )    
respect to su* s]vices 9 a mann] t makes
 su* am\nt equal ! am\nt t su*          
practition] o!rwise w\ld s receive = su*

 s]vices if su* s]vices _h be5 furni%$  
)\t ! use ( a telecommunications sy/em4 
7#c7 ,measures  7,a7 ,9 g5]al ,=        
purposes ( p>agraph 7#b77;,b71 !        
,secret>y1 9 conjunction ) /akehold]s   
7includ+ *ronic kidney c>e pati5t       
advocates1 cl9icians 9 ! nephrology     
community1 exp]ts 9 ! developm5t (      
evid5ce-bas$ guidel9es = ! detection1   
diagnosis1 & managem5t ( *ronic kidney  
c>e1 & su* o!r entities z ! ,secret>y   
det]m9es appropriate71 %all specify     
measures ( p]=mance ) respect to ! tasks
 describ$ 9 subp>agraph 7,b74 ,su*      
measures %all be 9 accordance ) cl9ical 
guidel9es 9 exi/5ce ) respect to *ronic 
kidney disease at ! "t ( su*            
specification4  7,b7 ,tasks describ$ ,! 
tasks describ$ 9 ?is subp>agraph are !  
foll[+3 7i7 ,r$uc+ co/s associat$ )     
hospitalizations ( individuals describ$ 
9 p>agraph 7#a7 t are furni%$           
,,ckd-,,edt s]vices by su* practition]4 
7ii7 ,provid+ education to su*          
individuals reg>d+ ! importance (       

avoidance ( non-/]oidal                 
anti-inflammatory drugs = pati5ts )     
confirm$ *ronic kidney disease4  7iii7  
,provid+ appropriate prescription (     
kidney-protective blood pressure        
m$ications to su* individuals = su*     
*ronic kidney disease 7unless           
contra-indicat$ = individuals ) confirm$
 *ronic kidney disease71 elevat$ ur9e   
album91 & elevat$ blood pressure 9      
alignm5t ) evid5ce-bas$ guidel9es4  7iv7
 ,provid+ su* individuals1 z            
appropriate1 ) plann$ />ts ( r5al       
replacem5t !rapy ?r\gh ! receipt by su* 
individuals ( preemptive kidney         
transplants1 ! initiation ( home        
dialysis1 ! initiation ( outpati5t      
9-c5t] hemodialysis ?r\gh art]iov5u\s   
fi/ula or art]iov5\s graft1 or          
supportive c>e4  7,c7 ,flexibility 9    
measure specification ,= purposes (     
subp>agraph 7,a71 ! ,secret>y may       
specify measures t ! ,secret>y develops 
= purposes ( su* subp>agraph or t !     
,secret>y did n develop = su* purposes4 

7#d7 ,application ( e>ly detection &    
treatm5t demon/ration program provisions
 ,! ,secret>y %all1 "u ?is subsection1  
apply ! provisions ( p>agraphs 7#d71    
7#e71 7#f71 7#g71 & 7#aj7 ( subsection  
7a7 to ! advanc$ ,,ckd demon/ration     
program1 advanc$ ,,ckd practition]s1    
advanc$ ,,ckd s]vices1 & individuals    
describ$ 9 p>agraph 7#a7 to ! same ext5t
 t su* provisions apply "u subsection   
7a7 to ! ,,ckd e>ly detection & treatm5t
 demon/ration program1 ,,ckd-,,edt      
practition]s1 ,,ckd-,,edt s]vices1 &    
enroll$ ,,ckd-,,edt individuals1        
respectively4  7#e7 ,def9itions ,=      
purposes ( ?is section1 ! foll[+        
def9itions apply3 7,a7 ,advanc$ ,,ckd   
practition] ,subject to p>agraph 7#f71 !
 t]m advanc$ ,,ckd practition] means1 ) 
respect to an individual describ$ 9     
p>agraph 7#a71 a nephrologi/ :o--  7i7  
p>ticipates 9 ! ,m$ic>e program "u ?is  
title2  7ii7 subject to subsection      
7a77#aj77;,a7 z appli$ pursuant to      
p>agraph 7#d71 elects to p>ticipate 9 ! 

advanc$ ,,ckd demon/ration program )    
respect to all individuals describ$ 9   
p>agraph 7#a7 :o receive c>e f !        
nephrologi/2  7iii7 agrees to provide to
 ea* individual describ$ 9 p>agraph 7#a7
 :o receives c>e f ! nephrologi/--  7,i7
 educational mat]ials t provide         
backgr\nd in=mation ab\t *ronic kidney  
disease & t are develop$ by cr$ible     
organizations ) exp]tise 9 ! developm5t 
( cl9ical guidel9es & pati5t educational
 mat]ials ) respect to *ronic kidney    
disease2 &  7,,ii7 a notification ( !   
pot5tial b5efits t ! individual may     
receive z a result ( ! practition]      
p>ticipat+ 9 ! advanc$ ,,ckd            
demon/ration program2 &  7iv7 agrees to 
comply ) ! requirem5ts ( subsection     
7a77#aj71 z appli$ pursuant to p>agraph 
7#d74  7,b7 ,advanc$ ,,ckd s]vices  7i7 
,9 g5]al ,! t]m advanc$ ,,ckd s]vices   
means1 ) respect to individuals describ$
 9 p>agraph 7#a71 su* s]vices z !       
,secret>y may specify t are c>e &       
managem5t s]vices = *ronic kidney       

disease & t1 subject to clause 7iv71 are
 s]vices = :i* paym5t may o!rwise be    
made "u ?is title4  7ii7 ,consultation  
requir$ ,9 det]m9+ :i* s]vices to       
specify = purposes ( clause 7i71 !      
,secret>y %all consult )--  7,i7 *ronic 
kidney disease pati5t advocates2  7,,ii7
 cl9icians 9 ! nephrology community2    
7,,iii7 exp]ts 9 ! developm5t (         
evid5ce-bas$ guidel9es = ! detection1   
diagnosis1 & managem5t ( *ronic kidney  
disease2 &  7,,iv7 su* o!r entities z ! 
,secret>y det]m9es appropriate4  7iii7  
,consid]$ s]vices ,9 specify+ s]vices = 
purposes ( clause 7i71 ! ,secret>y may1 
9 addition to consid]+ o!r s]vices1     
consid] ! foll[+ s]vices ) respect to ! 
c>e & managem5t ( *ronic kidney disease3
  7,i7 ,kidney disease education b5efit 
sessions4  7,,ii7 ,pati5t c>e plann+    
7includ+ pati5t *oice ( r5al replacem5t 
!rapy or palliative or advanc$ c>e      
plann+74  7,,iii7 ,comorbidities        
assessm5t & managem5t 7) respect to     
conditions su* z anemia1 bone & m9]al   

abnormalities1 & c>diovascul> disease74 
7,,iv7 ,m5tal heal? assessm5t & ref]ral4
  7,v7 ,practition] consultation &      
coord9ation ) c>diologi/s1              
endocr9ologi/s1 m5tal heal? speciali/s1 
prim>y c>e practition]s1 & o!r          
appropriate heal? c>e provid]s &        
suppli]s4  7,,vi7 ,vascul> or p]itoneal 
dialysis access assessm5ts &            
coord9ations ) surgeons4  7,,vii7       
,ref]rals & coord9ations ) transplant   
c5t]s4  7,,viii7 ,m$ication             
reconciliations & coord9ations )        
ph>maci/s4  7,,ix7 ,m$ical nutrition    
!rapy adm9i/]$ by dieticians4  7iv7     
,p]missible inclusion ( teleheal?       
s]vices ,! t]m advanc$ ,,ckd s]vices may
 include s]vices t are furni%$ via a    
telecommunications sy/em by an advanc$  
,,ckd practition] to an individual      
describ$ 9 p>agraph 7#a7 & t w\ld h be5 
advanc$ ,,ckd s]vices "u clause 7i7 if  
su* s]vices _h be5 furni%$ )\t ! use ( a
 telecommunications sy/em4  7#f7        
,p>ticipation ( c>e teams  7,a7 ,9 g5]al

 ,) respect to an individual describ$ 9 
p>agraph 7#a71 a nephrologi/ = su*      
individual may p>ticipate 9 a c>e team  
describ$ 9 subp>agraph 7,b7 t1 ) respect
 to ! furni%+ ( advanc$ ,,ckd s]vices to
 su* individual1 p>ticipates 9 ! advanc$
 ,,ckd demon/ration program z an advanc$
 ,,ckd practition]4 ,9 apply+ ?is       
subsection1 su* gr\p %all be treat$ z   
su* an advanc$ ,,ckd practition]4  7,b7 
,c>e team describ$ ,a c>e team describ$ 
9 ?is subp>agraph1 ) respect to an      
individual describ$ 9 p>agraph 7#a71 is1
 subject to subp>agraph 7,c71 a gr\p (  
provid]s--  7i7 ea* ( :i* p>ticipates 9 
! ,m$ic>e program "u ?is title2  7ii7   
ea* ( :i* elects to p>ticipate 9 !      
advanc$ ,,ckd demon/ration program )    
respect to all individuals describ$ 9   
p>agraph 7#a7 = :om ! nephrologi/       
describ$ 9 subp>agraph 7,a7 is !        
nephrologi/2 &  7iii7 t agrees to       
provide to ea* individual describ$ 9    
p>agraph 7#a7 = :om ! nephrologi/       
describ$ 9 subp>agraph 7,a7 is !        

nephrologi/--  7,i7 educational mat]ials
 t provide backgr\nd in=mation ab\t     
*ronic kidney disease & t are develop$  
by cr$ible organizations ) exp]tise 9 ! 
developm5t ( cl9ical guidel9es & pati5t 
educational mat]ials ) respect to *ronic
 kidney disease2 &  7,,ii7 a            
notification ( ! pot5tial b5efits t !   
individual may receive z a result ( !   
practition] p>ticipat+ 9 ! advanc$ ,,ckd
 demon/ration program4  7,c7 ,p]missible
 assembly & adm9i/ration by ?ird        
p>ty-adm9i/rator organizations  7i7 ,9  
g5]al ,a c>e team describ$ 9 subp>agraph
 7,b7 may be assembl$ & adm9i/]$ by a   
?ird p>ty-adm9i/rator organization4     
7ii7 ,?ird p>ty-adm9i/rator organization
 ,= purposes ( ?is p>agraph1 ! t]m ?ird 
p>ty-adm9i/rator organization means !   
foll[+3 7,i7 ,a ,m$ic>e ,advantage plan 
describ$ 9 section #ahea7;a77#b7 or a   
,m$ic>e ,advantage organization (f]+ su*
 a plan4  7,,ii7 ,a prescription drug   
plan 7z def9$ 9 section                 
#ahfj;,d-#da7;a77#ad774  7,,iii7 ,a     

m$icaid manag$ c>e organization 7z def9$
 9 section #aijc7m774  4