,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #afgf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #bc 7legislative  
day1 ,may #bb71 #bjai,mr4 ,c>d9 7=      
himself & ,mr4 ,blunt7 introduc$ !      
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to improve ! und]/&+ (1 & promote      
access to treatm5t =1 *ronic kidney     
disease1 & = o!r purposes4  #a4 ,%ort   
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,*ronic       
,kidney ,disease ,improvem5t 9 ,rese>* &
 ,treatm5t ,act ( #bjai4  7b7 ,table (  
cont5ts ,! table ( cont5ts = ?is ,act is
 z foll[s3 ,sec4 #a4 ,%ort title2 table 
( cont5ts4,title ,i--,increas+ ,aw>5ess1
 ,exp&+ ,prev5tive ,s]vices1 & ,improv+ 
,c>e ,coordination,sec4 #aja4 ,increas+ 
access to ,m$ic>e kidney disease        
education b5efit4,sec4 #ajb4 ,improv+   
pati5t lives & quality ( c>e ?r\gh      
rese>* & innovation4,sec4 #ajc4 ,und]/&+
 curr5t utilization ( palliative c>e    
s]vices4,sec4 #ajd4 ,und]/&+ !          

progression ( kidney disease & treatm5t 
( kidney failure 9 m9ority              
populations4,sec4 #aje4 ,improv+ access 
9 und]s]v$ areas4,sec4 #ajf4 ,improv+   
c>e coord9ation = dialysis pati5ts by   
requir+ hospitals to provide            
in=mation4,title ,,ii--,inc5tiviz+      
,innovation = ,truly ,innovative ,new   
,drugs1 ,biologicals1 ,devices1 & ,o!r  
,technologies,sec4 #bja4 ,ma9ta9+ an    
economically /able dialysis             
infra/ructure4,title ,,iii--,improv+ !  
,accuracy & ,transp>5cy ( ,end ,/age    
,r5al ,disease ,quality ,programs,sec4  
#cja4 ,improv+ pati5t decision mak+ &   
transp>5cy by consolidat+ & mod]niz+    
quality programs4,title ,,iv--,emp[]+   
,patients,sec4 #dja4 ,m$igap cov]age =  
b5efici>ies ) end-/age r5al disease4  ,i
 ,increas+ ,aw>5ess1 ,exp&+ ,prev5tive  
,s]vices1 & ,improv+ ,c>e ,coord9ation  
#aja4 ,increas+ access to ,m$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 ,improv+ pati5t lives & quality ( 
c>e ?r\gh rese>* & innovation  7a7 ,/udy
 ,! ,secret>y ( ,heal? & ,human ,s]vices
 79 ?is section ref]r$ to z ! ,secret>y7
 %all conduct a /udy on increas+ kidney 
transplantation rates4 ,su* /udy %all   
include an analysis ( ea* ( ! foll[+3   
7#a7 ,any dis9c5tives 9 ! paym5t sy/ems 

"u ! ,m$ic>e program "u title ,,xviii ( 
! ,social ,security ,act t create b>ri]s
 to kidney transplants & po/-transplant 
c>e = b5efici>ies ) end-/age r5al       
disease4  7#b7 ,! practices us$ by      
,/ates ) high] ?an av]age donation rates
 & :e!r ^? practices & policies c\ld be 
successfully utiliz$ 9 o!r ,/ates4  7#c7
 ,practices & policies t c\ld increase  
deceas$ donation rates ( m9ority        
populations4  7#d7 ,:e!r cultural &     
policy b>ri]s exi/ to increas+ liv+     
donation rates1 includ+ an exam9ation ( 
h[ to bett] facilitate *a9$ donations4  
7#e7 ,o!r areas det]m9$ appropriate by !
 ,secret>y4  7b7 ,report ,n lat] ?an #ah
 mon?s aft] ! date ( ! enactm5t ( ?is   
,act1 ! ,secret>y %all submit to        
,congress a report on ! /udy conduct$ "u
 subsection 7a71 toge!r ) su*           
recomm5dations z ! ,secret>y det]m9es to
 be appropriate4  #ajc4 ,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 ,,iv     
?r\gh /age ,v1 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      
#ajd4 ,und]/&+ ! progression ( kidney   
disease & treatm5t ( kidney failure 9   
m9ority populations  7a7 ,/udy ,!       
,secret>y ( ,heal? & ,human ,s]vices 79 
?is section ref]r$ to z ! ,secret>y7    
%all conduct a /udy on-- 7#a7 ! social1 
behavioral1 & biological factors lead+  
to kidney disease2  7#b7 ef=ts to sl[ ! 
progression ( kidney disease 9 m9ority  
populations t are disproportionately    
affect$ by su* disease2 &  7#c7 treatm5t
 patt]ns associat$ ) provid+ c>e1 "u !  
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act1 ! ,m$icaid      
program "u title ,,xix ( su* ,act1 &    

?r\gh private heal? insurance1 to       
m9ority populations t are               
disproportionately affect$ by kidney    
failure4  7b7 ,report ,n lat] ?an #a ye>
 aft] ! date ( ! enactm5t ( ?is ,act1 ! 
,secret>y %all submit to ,congress a    
report on ! /udy conduct$ "u subsection 
7a71 toge!r ) su* recomm5dations z !    
,secret>y det]m9es to be appropriate4   
#aje4 ,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+  
r5al dialysis1 aft] d5ti/ry14  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 :i* may include 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  
:i* may include nephrology heal?        
pr(essionals be=e ! p]iod at ! end4     
#ajf4 ,improv+ c>e coord9ation =        
dialysis pati5ts by requir+ hospitals 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? & 
treatm5t in=mation may be initiat$ by ! 
individual prior to dis*>ge or ^u reque/
 by ! r5al dialysis facility aft] !     
individual is dis*>g$2 &  7,b7 !        
in=mation reque/$ mu/ be provid$ to !   

facility )9 #g days ( ! reque/ be+ made4
  4  ,,ii ,inc5tiviz+ ,innovation =     
,truly ,innovative ,new ,drugs1         
,biologicals1 ,devices1 & ,o!r          
,te*nologies  #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 ,det]m9ation ( productivity      
adju/m5t ,section #ahhf7;b77#c77;,b77xi7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acieww7b77#c77;,b77xi77 is   
am5d$-- 7#a7 9 subclause 7,i71 by /rik+ 
,= #bjab & ins]t+ ,subject to subclause 
7,,iv71 = #bjab2 &  7#b7 by add+ at !   
end1 ! foll[+ new subclause3  7,,iv7 ,= 
ea* ( #bjbj ?r\gh #bjbd1 ! productivity 
adju/m5t describ$ 9 subclause 7,,ii7    
%all be z]o = a paym5t sy/em 9 any ye> 9
 :i* ! ,m$ic>e ,paym5t ,advisory        
,commission e/imates t paym5ts "u ?is   
title pursuant to su* paym5t sy/em1 on  
an aggregate national basis1 exce$ co/s1
 on an aggregate national basis1 by #c4j
 p]c5t or less4  4  7d7 ,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 7a7 & 7b71 is am5d$
 by add+ ! foll[+ new subp>agraph--     
7,l7 ,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 ! ,secret>y det]m9es su* paym5t
 am\nt is n adequate to cov] su* co/4 ,9
 c>ry+ out ! prec$+ s5t5ce1 ! ,secret>y 
%all use ! co/ & utilization data       
collect$ dur+ ! two-ye> transitional    
paym5t p]iod1 z describ$ 9 ! f9al       
regulation publi%$ on ,novemb] #ad1     
#bjah 7#hc ,f$4 ,reg4 #efibb et seq474  
7ii7 ,money to foll[ ! pati5t ,!        
,secret>y1 ?r\gh notice & comm5t        
rulemak+1 %all implem5t a policy = any  
drug or biological t is n provid$ to !  
av]age pati5t t results 9 ! am\nt by :i*
 ! s+le paym5t am\nt is increas$        
pursuant to ?is subp>agraph %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   
7e7 ,new devices & o!r te*nologies ,z "p
 ( ! promulgation ( ! annual rule = !   
,m$ic>e end /age r5al disease           
prospective paym5t sy/em "u section     
#ahha7;b77#ad7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acierr7b77#ad77 =  
cal5d> ye> #bjba1 & 9 consultation )    
/akehold]s1 ! ,secret>y %all e/abli% a  
process = id5tify+ & det]m9+ appropriate
 paym5t am\nts = incorporat+ new devices
 & te*nologies into ! bundl$ paym5t "u  
su* sy/em4  ,,iii ,improv+ ! ,accuracy &
 ,transp>5cy ( ,end ,/age ,r5al ,disease
 ,quality ,programs  #cja4 ,improv+     
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$-- 7#a7 by /rik+
 subp>agraph 7,a7 & ins]t+ ! foll[+3    
7,a7 ,! measures specifi$ "u ?is        
p>agraph ) respect to ! ye> involv$ %all
 be select$ by ! ,secret>y 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  2  7#b7
 9 subp>agraph 7,b77i71 by /rik+        
subp>agraph 7,a77iv7 & ins]t+           
subp>agraph 7,a72  7#c7 by /rik+        
subp>agraph 7,e72 &  7#d7 by add+ at !  
end ! foll[+ new subp>agraphs3  7,e7    
,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,f7   
,/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-- 7i7 %all assign />s us+ !
 same me?odology & total p]=mance score 
results f ! quality inc5tive program "u 
?is subsection2  7ii7 %all det]m9e ! />s
 us+ ! same me?odology us$ "u su*       

quality inc5tive program2 &  7iii7 %all 
n use a =c$ bell curve :5 det]m9+ ! />s 
or rebasel9+ ! />s4  4  7d7 ,inc5tive   
paym5ts ,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  7e7 ,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$-- 7,a7 9
 p>agraph 7#b7-- 7i7 9 subp>agraph 7,a71
 by /rik+ is #fe & all t foll[s ?r\gh ! 
p]iod & ins]t+ ! foll[+3 8is--  7i7 #fe 
ye>s ( age or old] & is enroll$ =       
b5efits "u "p ,b2 or  7ii7 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 subp>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-a72  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