,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #ciab  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bc1 #bjai,mr4  
,lewis 7= himself & ,mr4 ,bu*anan7      
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 increase      
aw>5ess1 exp& prev5tative s]vices1 &    
improve c>e = individuals ) end-/age    
r5al disease1 & = o!r purposes4  #a4    
,%ort title ,?is ,act may be cit$ z !   
,*ronic ,kidney ,disease ,improvem5t 9  
,rese>* & ,treatm5t ,act4  ,i ,increas+ 
,aw>5ess1 ,exp&+ ,prev5tative ,s]vices1 
& ,improv+ ,c>e ,coord9ation  #aja4     
,increas+ access to m$ic>e kidney       
disease education b5efit  7a7 ,9 g5]al  
,section #ahfa7;ggg7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           

#aciex7ggg77 is am5d$--  7#a7 9 p>agraph
 7#a7-- 7,a7 9 subp>agraph 7,a71 by     
ins]t+ or /age ,v aft] /age ,,iv2 &     
7,b7 9 subp>agraph 7,b71 by ins]t+ or ( 
a physician assi/ant1 nurse practition]1
 or cl9ical nurse speciali/ 7z def9$ 9  
section #ahfa7;aa77#e77 assi/+ 9 !      
treatm5t ( ! individual's kidney        
condition aft] kidney condition2 &  7#b7
 9 p>agraph 7#b7-- 7,a7 by /rik+        
subp>agraph 7,b72 &  7,b7 9 subp>agraph 
7,a7-- 7i7 by /rik+ 7,a7 aft] 7#b72     
7ii7 by /rik+ & at ! end ( clause 7i72  
7iii7 by /rik+ ! p]iod at ! end ( clause
 7ii7 & ins]t+ 2 &2  7iv7 by r$esignat+ 
clauses 7i7 & 7ii7 z subp>agraphs 7,a7 &
 7,b71 respectively2 &  7v7 by add+ at !
 end ! foll[+3  7,c7 a r5al dialysis    
facility subject to ! requirem5ts (     
section #ahha7;b77#a7 ) p]sonnel :o--   
7i7 provide ! s]vices describ$ 9        
p>agraph 7#a72 &  7ii7 is a physician 7z
 def9$ 9 subsection 7r77#a77 or a       
physician assi/ant1 nurse practition]1  
or cl9ical nurse speciali/ 7z def9$ 9   

subsection 7aa77#e774  4  7b7 ,paym5t to
 r5al dialysis facilities ,section      
#ahha7;b7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acierr7b77 is am5d$ by  
add+ at ! end ! foll[+ new p>agraph3    
7#ae7 ,= purposes ( p>agraph 7#ad71 !   
s+le paym5t = r5al dialysis s]vices "u  
su* p>agraph %all n take into acc\nt !  
am\nt ( paym5t = kidney disease         
education s]vices 7z def9$ 9 section    
#ahfa7;ggg774 ,in/ead1 paym5t = su*     
s]vices %all be made to ! r5al dialysis 
facility on an assignm5t-relat$ basis "u
 section #ahdh4  4  7c7 ,effective date 
,! am5dm5ts made by ?is section apply to
 kidney disease education s]vices       
furni%$ on or aft] ,janu>y #a1 #bjbj4   
#ajb4 ,und]/&+ curr5t utilization (     
palliative c>e s]vices  7a7 ,/udy  7#a7 
,9 g5]al ,! ,comptroll] ,g5]al ( !      
,unit$ ,/ates 79 ?is section ref]r$ to z
 ! ,comptroll] ,g5]al7 %all conduct a   
/udy on ! utilization ( palliative c>e 9
 treat+ individuals ) advanc$ kidney    
disease1 f /age #d ?r\gh /age #e1       

includ+ individuals ) kidney failure on 
dialysis ?r\gh any progression ( !      
disease4 ,su* /udy %all include an      
analysis (--  7,a7 h[ palliative c>e c  
be utiliz$ to improve ! quality ( life (
 ^? ) kidney disease & facilitate c>e   
tailor$ to _! individual goals & values2
  7,b7 ! successful use ( palliative c>e
 9 ! c>e ( pati5ts ) o!r *ronic diseases
 & s]i\s illnesses2  7,c7 ! utilization 
( palliative c>e at any po9t 9 an       
illness1 includ+ :5 us$ at ! same "t z  
curative treatm5t2 &  7,d7 o!r areas    
det]m9$ appropriate by ! ,comptroll]    
,g5]al4  7#b7 ,def9ition ( palliative   
c>e ,9 ?is section1 ! t]m palliative c>e
 means pati5t & family c5t]$ c>e t      
optimizes quality ( life by anticipat+1 
prev5t+1 & treat+ suff]+4 ,su* t]m      
includes c>e t is furni%$ ?r\gh\t !     
cont9uum ( ! illness t addresses        
physical1 intellectual1 emotional1      
social1 & spiritual ne$s & t facilitates
 pati5t autonomy1 access to in=mation & 
*oice4  7b7 ,report ,n lat] ?an #a ye>  

aft] ! date ( ! enactm5t ( ?is ,act1 !  
,comptroll] ,g5]al %all submit to !     
,congress a report on ! /udy conduct$ "u
 subsection 7a71 toge!r ) su*           
recomm5dations z ! ,comptroll] ,g5]al   
det]m9es to be appropriate4  #ajc4      
,improv+ access 9 und]s]v$ areas  7a7   
,def9ition ( prim>y c>e s]vices ,section
 #cca7;a77#c77;,d7 ( ! ,public ,heal?   
,s]vice ,act 7#db ,u4,s4,c4             
#bed;d7a77#c77;,d77 is am5d$ by ins]t+ &
 includes r5al dialysis s]vices be=e !  
p]iod at ! end4  7b7 ,national heal?    
s]vice corps s*ol>%ip program ,section  
#cch;,a7a77#b7 ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4             
#bedl7a77#b77 is am5d$ by ins]t+ 1      
includ+ nephrology heal? pr(essionals   
be=e ! p]iod at ! end4  7c7 ,national   
heal? s]vice corps loan repaym5t program
 ,section #cch;,b7a77#b7 ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bedl-#a7;a77#b77 is am5d$ by ins]t+ 1  
includ+ nephrology heal? pr(essionals   
be=e ! p]iod at ! end4  #ajd4 ,improv+  

c>e coord9ation = dialysis pati5ts  7a7 
,hospitals requir$ ,to provide in=mation
 ,section #ahha ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acierr7 is am5d$ by
 add+ at ! end ! foll[+ new subsection3 
7i7 ,hospitals requir$ ,to provide      
in=mation  7#a7 ,9 g5]al ,! ,secret>y   
%all e/abli% a process "u :i* a hospital
 or a critical access hospital %all     
provide a r5al dialysis facility ) heal?
 & treatm5t in=mation ) respect to an   
individual :o is dis*>g$ f ! hospital or
 critical access hospital & :o          
subsequ5tly receives treatm5t at        
facility4  7#b7 ,elem5ts ,"u ! process  
e/abli%$ "u p>agraph 7#a7-- 7,a7 !      
reque/ = ! heal? in=mation may be       
initiat$ by ! individual prior to       
dis*>ge or ^u reque/ by ! r5al dialysis 
facility aft] ! pati5t is dis*>g$2 &    
7,b7 ! in=mation mu/ be provid$ to !    
facility )9 #g days ( ! reque/ be+ made4
  4  ,,ii ,inc5tiviz+ ,innovation =     
,truly ,innovative ,new ,drugs1         
,biologicals1 ,devices1 & ,o!r          

,te*nologies4  #bja4 ,ma9ta9 an         
economically /able dialysis             
infra/ructure  7a7 ,9 g5]al ,section    
#ahha7;b77#ad7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acierr7b77#ad77 is 
am5d$--  7#a7 9 subp>agraph 7,d71 9 !   
matt] prec$+ clause 7i71 by /rik+ ,su*  
sy/em & ins]t+ ,subject to subp>agraph  
7,j71 su* sy/em2 &  7#b7 by add+ at !   
end ! foll[+ new subp>agraph3  7,j7 ,=  
paym5t = r5al dialysis s]vices furni%$  
on or aft] ,janu>y #a1 #bjbj1 "u ! sy/em
 "u ?is p>agraph--  7i7 ! paym5t        
adju/m5t describ$ 9 clause 7i7 (        
subp>agraph 7,d7-- 7,i7 %all n take into
 acc\nt comorbidities2 &  7,,ii7 %all   
only take into acc\nt age = purposes (  
di/+ui%+ betwe5 individuals :o are "u   
#ah ye>s ( age & ^? :o are #ah ye>s (   
age & old] b %all n include any o!r     
adju/m5t = age2  7ii7 ! ,secret>y %all  
reassess any adju/m5ts relat$ to pati5t 
weight "u su* clause2  7iii7 ! paym5t   
adju/m5t describ$ 9 clause 7ii7 ( su*   
subp>agraph %all n be includ$2  7iv7 !  

/&>dization factor describ$ 9 ! f9al    
rule publi%$ 9 ! ,f$]al ,regi/] on      
,novemb] #h1 #bjab 7#gg ,f$4 ,reg4      
#fgdgj71 %all be e/abli%$ us+ ! mo/     
curr5tly available data 7& n hi/orical  
data7 & adju/$ on an annual basis1 bas$ 
on su* available data1 to acc\nt = any  
*ange 9 utilization ( drugs & any       
modification 9 adju/ors appli$ "u ?is   
p>agraph2 &  7v7 take into acc\nt       
reasonable co/s = det]m9+ ! paym5t rate 
consi/5t ) p>agraph 7#b77;,b74  4  7b7  
,inclusion ( network fee z an all[able  
co/ ,section #ahha7;b77#ad7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acierr7b77#ad771 z am5d$ by subsection 
7a71 is am5d$ by add+ at ! end ! foll[+ 
new subp>agraph3  7,k7 ,n lat] ?an      
,janu>y #a1 #bjbj1 ! ,secret>y %all am5d
 ! ,,esrd facility co/ report to include
 ! p] treatm5t network fee 7z describ$ 9
 p>agraph 7#g77 z an all[able co/ or    
(fset to rev5ue4  4  7c7 ,affirmation ( 
availability ( bad debt reimbursem5t =  
non-,composite rate s]vices  7#a7       

,repeal ( ,,mippa bad debt rule (       
contruction ,section #aec7;b77#d7 ( !   
,m$ic>e ,improvem5ts = ,pati5ts &       
,provid]s ,act 7#db ,u4,s4,c4 #acierr   
note7 is repeal$4  7#b7 ,bad debt       
paym5ts ,section #ahha7;b77#ad7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acierr7b771 z am5d$ by subsections 7a7 
& 7b71 is fur!r am5d$ by add+ at ! end !
 foll[+ new subp>agraphs3  7,l7 ,not)/&+
 any o!r provision ( ?is title1 !       
,secret>y %all provide paym5ts = any    
unrecov]$ am\nt = any bad debt          
attributable to d$uctible & co9surance =
 any item or s]vice reimburs$ "u ! sy/em
 "u ?is p>agraph or bad debt describ$ 9 
section #aec7;b77#d7 ( ! ,m$ic>e        
,improvem5ts = ,pati5ts & ,provid]s ,act
 ( #bjjh4 ,su* paym5ts = any unrecov]$  
am\nt %all be made 9 addition to paym5ts
 made "u su* sy/em & su* drug           
designation process4  7,m7 ,! additional
 paym5ts made "u subp>agraph 7,l7-- 7i7 
%all n be consid]$ an adju/m5t "u       
subp>agraph 7,d72 &  7ii7 %all n be     

implem5t$ 9 a budget neutral mann]4  4  
7#c7 ,effective date ,p>agraph 7#a7 & ! 
am5dm5ts made by p>agraph 7#b7 %all     
apply to paym5ts beg9n+ on ,janu>y #a1  
#bjbj4  7d7 ,productivity adju/m5t      
,section #ahhf7;b77#c77;,b77xi7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7b77#c77;,b77xi77 is am5d$-- 7#a7
 9 subclause 7,i71 by /rik+ ,= #bjab &  
ins]t+ ,subject to subclause 7,,iv71 =  
#bjab2 &  7#b7 by add+ at ! end1 !      
foll[+ new subclause3  7,,iv7 ,= #bjbj  
?r\gh #bjbd1 ! productivity adju/m5t    
describ$ 9 subclause 7,,ii7 %all be z]o 
= a paym5t sy/em = any ye> 9 :i* !      
,m$ic>e ,paym5t ,advisory ,commission   
e/abli%$ "u section #ahje e/imates t    
paym5ts provid$ "u su* paym5t sy/em1 on 
an aggregate national basis1 exce$ co/s1
 on an aggregate national basis1 by #c4j
 p]c5t or less4  4  7e7 ,paym5t = new & 
innovative drugs & biologicals t are    
r5al dialysis s]vices ,section          
#ahha7;b77#ad7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acieww7b77#ad771 z 

am5d$ by subsections 7a71 7b71 & 7c71 is
 fur!r am5d$ by add+ ! foll[+ new       
subp>agraph3  7,n7 ,paym5t = new &      
innovative drugs1 biologicals1 & devices
 t are r5al dialysis s]vices  7i7 ,9    
g5]al ,= drugs or biologicals det]m9$ to
 be )9 a functional category1 !         
,secret>y1 9 consultation ) /akehold]s1 
%all ensure t ! s+le paym5t am\nt is    
adequate to cov] ! co/ ( new innovative 
drugs or biologicals & increase ! s+le  
paym5t am\nt if x is n4 ,! ,secret>y    
%all use ! co/ & utilization data       
collect$ dur+ ! two-ye> transitional    
p]iod1 z set =? 9 ! f9al regulation     
entitl$ ,m$ic>e ,program2 ,end-,/age    
,r5al ,disease ,prospective ,paym5t     
,sy/em1 ,paym5t = ,r5al ,dialysis       
,s]vices ,furni%$ to ,individuals ,)    
,acute ,kidney ,injury1 ,end-,/age ,r5al
 ,disease ,quality ,inc5tive ,program1  
,durable ,m$ical ,equipm5t1 ,pro/hetics1
 ,or?otics & ,supplies 7,,dmepos7       
,competitive ,bidd+ ,program 7,,cbp7 &  
,fee ,s*$ule ,am\nts1 & ,te*nical       

,am5dm5ts ,to ,correct ,exi/+           
,regulations ,relat$ to ! ,,cbp = ,c]ta9
 ,,dmepos publi%$ on ,novemb] #ad1 #bjah
 7#hc ,f$4 ,reg4 #efibb et seq474  7ii7 
,money to foll[ ! pati5t ,! ,secret>y   
?r\gh notice & comm5t rulemak+ %all     
implem5t a policy = any drug or         
biological t is n provid$ to ! av]age   
pati5t t results 9 ! am\nt by :i* ! s+le
 paym5t am\nt is increas$ pursuant to   
?is clause %all be paid only :5 a       
provid] or r5al dialysis facility has   
demon/rat$ t x has adm9i/]$ ! drug or   
biological to a pati5t4  4  7f7 ,new    
devices & o!r te*nologies ,z "p ( !     
promulgation ( ! annual rule = ! ,m$ic>e
 end-/age r5al disease prospective      
paym5t sy/em "u section #ahha7;b77#ad7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acierr7b77#ad77 = cal5d> ye> #bjba & 9
 consultation ) /akehold]s1 ! ,secret>y 
( ,heal? & ,human ,s]vices %all e/abli% 
a process = id5tify+ & det]m9+          
appropriate paym5t am\nts = incorporat+ 
new devices & te*nologies into ! bundl$ 

paym5t "u su* sy/em4  ,,iii ,improv+ !  
,accuracy & ,transp>5cy ( ,end-,/age    
,r5al ,disease ,quality ,programs  #cja4
 ,improve pati5t decision mak+ &        
transp>5cy by consolidat+ & mod]niz+    
quality programs  7a7 ,measures ,section
 #ahha7;h77#b7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acierr7h77#b77 is  
am5d$-- 7#a7 by /rik+ subp>agraph 7,a7 &
 ins]t+ ! foll[+3  7,a7 ,9 g5]al ,!     
measures specifi$ "u ?is p>agraph )     
respect to ! ye> involv$ %all be select$
 9 consultation ) /akehold]s to promote 
improvem5t 9 b5efici>y outcomes & %>$   
decision-mak+ ) b5efici>ies & _!        
c>egiv]s4 ,:5 select+ measures specifi$ 
"u ?is p>agraph1 ! ,secret>y %all take  
into acc\nt cl9ical gaps 9 c>e1         
und]utilization t may lead to b5efici>y 
h>m1 pati5t safety1 & outcomes4  4  7#b7
 by add+ at ! end ! foll[+ new          
subp>agraphs3  7,f7 ,weight+ limitation 
,no s+le measure specifi$ by ! ,secret>y
 or individual measure )9 a composite   
measure s specifi$ may be weight$ less  

?an #aj p]c5t ( ! total p]=mance score4 
7,g7 ,/ati/ically valid & reliable ,9   
specify+ measures "u subp>agraph 7,a71 !
 ,secret>y %all only specify measures t 
h be5 %[n to be /ati/ically valid &     
reliable ?r\gh te/+4  4  7b7 ,endorsem5t
 ,section #ahha7;h77#b77;,b7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acierr7h77#b77;,b77 is am5d$-- 7#a7 9  
clause 7ii71 by add+ at ! end ! foll[+  
new s5t5ce3 ,! exception "u ! prec$+    
s5t5ce %all n apply to a measure t !    
entity ) a contract "u section #ahij7;a7
 7or a simil> entity7 consid]$ b fail$  
to endorse42 &  7#b7 by add+ at ! end ! 
foll[+ new clause3  7iii7 ,composite    
measures ,clauses 7i7 & 7ii7 %all apply 
to composite measures 9 ! same mann] z  
su* clauses apply to individual         
measures4  4  7c7 ,requirem5ts =        
dialysis facility comp>e /> rat+ program
 ,section #ahha7;h77#f7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acierr7h77#f77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph3  7,e7     

,requirem5ts = any dialysis facility    
comp>e /> rat+ program ,to ! ext5t t !  
,secret>y ma9ta9s a dialysis facility   
comp>e /> rat+ program1 "u su* a program
 ! ,secret>y %all--  7i7 assign />s us+ 
! same me?odology & total p]=mance score
 results f ! quality inc5tive program "u
 ?is subsection2  7ii7 det]m9e ! />s us+
 ! same me?odology us$ "u su* quality   
inc5tive program2 &  7iii7 n use a =c$  
bell curve :5 det]m9+ ! />s or rebasel9+
 ! />s4  4  7d7 ,inc5tive paym5ts  7#a7 
,9 g5]al ,section #ahha7;h77#a7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acierr7h77#a77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph3  7,d7     
,inc5tive paym5ts  7i7 ,9 g5]al ,9 !    
case ( a provid] ( s]vices or a r5al    
dialysis facility t ! ,secret>y det]m9es
 exce$s ! atta9m5t p]=mance /&>ds "u    
p>agraph 7#d7 ) respect to a ye>1 !     
,secret>y may make a bonus paym5t to !  
provid] or facility 7pursuant to a      
process e/abli%$ by ! ,secret>y74  7ii7 
,fund+ ,! total am\nt ( bonus paym5ts "u

 clause 7i7 9 a ye> %all be equal to !  
total am\nt ( r$uc$ paym5ts 9 a ye> "u  
subp>agraph 7,a74  7iii7 ,no effect 9   
subsequ5t ye>s ,! provisions (          
subp>agraph 7,c7 %all apply to a bonus  
paym5t "u ?is subp>agraph 9 ! same mann]
 subp>agraph 7,c7 applies to a r$uction 
"u su* subp>agraph4  4  7#b7 ,effective 
date ,! am5dm5ts made by ?is section    
%all apply to items & s]vices furni%$ on
 or aft] ,janu>y #a1 #bjbj4  ,,iv       
,emp[]+ ,pati5ts  #dja4 ,m$igap cov]age 
= b5efici>ies ) end-/age r5al disease   
7a7 ,gu>ante$ availability ( ,m$igap    
policies to all ,,esrd m$ic>e           
b5efici>ies  7#a7 ,9 g5]al ,section     
#ahhb7s7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciess7s77 is am5d$-- 7,a7 9
 p>agraph 7#b7--  7i7 9 subp>agraph     
7,a71 by /rik+ is #fe & all t foll[s    
?r\gh ! p]iod at ! end & ins]t+ !       
foll[+3 is-- 7i7 #fe ye>s ( age or old] 
& is enroll$ = b5efits "u "p ,b2 or     
7ii7 is entitl$ to b5efits "u #bbf;,a7b7
 & is enroll$ = b5efits "u "p ,b4  2 &  

7ii7 9 subp>agraph 7,d71 9 ! matt]      
prec$+ clause 7i71 by ins]t+ 7or is     
entitl$ to b5efits "u #bbf;,a7b77 aft]  
is #fe ye>s ( age or old]2 &  7,b7 9    
p>agraph 7#c77;,b7--  7i7 9 clause 7ii71
 by ins]t+ 7or is entitl$ to b5efits "u 
#bbf;,a7b77 aft] is #fe ye>s ( age or   
old]2 &  7ii7 9 clause 7vi71 by ins]t+  
7or "u #bbf;,a7b77 aft] at age #fe4     
7#b7 ,effective date ,! am5dm5ts made by
 p>agraph 7#a7 %all apply to ,m$ic>e    
supplem5tal policies effective on or    
aft] ,janu>y #a1 #bjba4  7b7 ,additional
 enrollm5t p]iod = c]ta9 individuals    
7#a7 ,"o-"t enrollm5t p]iod  7,a7 ,9    
g5]al ,9 ! case ( an individual describ$
 9 p>agraph 7#b71 ! ,secret>y ( ,heal? &
 ,human ,s]vices %all e/abli% a "o-"t   
enrollm5t p]iod dur+ :i* su* an         
individual may enroll 9 any ,m$ic>e     
supplem5tal policy "u section #ahhb ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciess7 ( ! individual's *oos+4  7,b7  
,enrollm5t p]iod ,! enrollm5t p]iod     
e/abli%$ "u subp>agraph 7,a7 %all beg9  

on ,janu>y #a1 #bjba1 & %all end ,june  
#cj1 #bjba4  7#b7 ,individual describ$  
,an individual describ$ 9 ?is p>agraph  
is an individual :o-- 7,a7 is entitl$ to
 hospital insurance b5efits "u "p ,a (  
title ,,xviii ( ! ,social ,security ,act
 "u section #bbf;,a7b7 ( su* ,act 7#db  
,u4,s4,c4 #dbf-a7;b772  7,b7 is enroll$ 
= b5efits "u "p ,b ( su* title ,,xviii2 
&  7,c7 w\ld n1 b = ! provisions (1 &   
am5dm5ts made by1 subsection 7a7 be     
eligible = ! gu>ante$ issue ( a ,m$ic>e 
supplem5tal policy "u p>agraph 7#b7 or  
7#c7 ( section #ahhb7s7 ( su* ,act 7#db 
,u4,s4,c4 #aciess7s774  #djb4 ,all[+    
individuals ) kidney failure to reta9   
access to private insurance  7a7 ,9     
g5]al ,section #ahfb7;b77#a77;,c7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciey7b77#a77;,c77 is am5d$-- 7#a7 9 ! 
la/ s5t5ce1 by ins]t+ & be=e ,janu>y #a1
 #bjbj aft] prior to su* date2 &  7#b7  
by add+ at ! end ! foll[+ new s5t5ce3   
,effective = items & s]vices furni%$ on 
or aft] ,janu>y #a1 #bjbj 7) respect to 

p]iods beg9n+ on or aft] ! date t is #db
 mon?s prior to su* date71 clauses 7i7 &
 7ii7 %all be appli$ by sub/itut+       
#db-mon? = #ab-mon? ea* place x appe>s44
  7b7 ,effective date ,! am5dm5ts made  
by ?is subsection %all take effect on ! 
date ( enactm5t ( ?is ,act4 ,= purposes 
( det]m9+ an individual's /atus "u      
section #ahfb7;b77#a77;,c7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciey7b77#a77;,c771 z am5d$ by         
subsection 7a71 an individual :o is )9 !
 coord9at+ p]iod z ( ! date ( enactm5t (
 ?is ,act %all h t p]iod ext5d$ to !    
full #db mon?s describ$ 9 ! la/ s5t5ce (
 su* section1 z add$ by ! am5dm5t made  
by subsection 7a77#b74