,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #hjge  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #ah1 #bjbd,mrs4
 ,mill] ( ,we/ ,virg9ia 7= h]self1 ,mrs4
 ,mill]-,meeks1 ,ms4 ,/rickl&1 & ,mr4   
,blum5au]7 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   
provide = ,m$ic>e cov]age ( /aff-assi/$ 
home dialysis = c]ta9 hemodialysis &    
p]itoneal dialysis pati5ts & to ensure  
all pati5ts are educat$ on modality     
options & receive ! res\rces1 in=mation1
 & support to succe$ on ! modality ( _! 
*oice1 & = o!r purposes4  #a4 ,%ort     
title ,?is ,act may be cit$ z ! ,improv+
 ,access to ,home ,dialysis ,act (      
#bjbd4  #b4 ,provid+ = /aff-assi/$ home 
dialysis = c]ta9 hemodialysis &         

p]itoneal dialysis pati5ts  7a7 ,9 g5]al
 ,section #ahha7;b77#ad7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acierr7b77#ad77 is am5d$ by add+ at !  
end ! foll[+ new subp>agraph3  7,j7 7i7 
,) respect to /aff-assi/$ home dialysis 
7z def9$ 9 clause 7iv77,,iv77 furni%$ on
 or aft] ! date t is #a ye> aft] ! date 
( ! enactm5t ( ?is subp>agraph1 subject 
to ! succe$+ provisions ( ?is           
subp>agraph1 ! ,secret>y %all increase !
 s+le paym5t t w\ld o!rwise apply "u ?is
 p>agraph = r5al dialysis s]vices by !  
add-on paym5t am\nt e/abli%$ pursuant to
 clause 7iii74  7ii7 7,i7 ,subject to   
subclause 7,,ii71 /aff-assi/$ home      
dialysis may only be furni%$-- 7aa7 )   
respect to an initializ+ pati5t 7z def9$
 9 clause 7iv77,i77 or a return+ pati5t 
7z def9$ 9 clause 7iv77,,iii771 = a     
p]iod ( up to #ij days1 ref]r$ to z !   
initial p]iod1 :i* may be ext5d$ z      
det]m9$ necess>y by ! c>e team ( !      
individual 9 n m ?an #b int]vals ( up to
 #cj days ea*1 ea* ( :i* is ref]r$ to z 

an ext5d$ int]val2 &  7bb7 ) respect to 
a tempor>y assi/ance pati5t 7z def9$ 9  
clause 7iv77,v771 = any #cj-;day p]iod z
 det]m9$ necess>y by ! c>e team ( !     
individual1 not)/&+ :e!r su* an         
individual receives any r\t9e dialysis  
respite c>e dur+ su* p]iod4  7,,ii7     
,not)/&+ subclause 7,i71 /aff-assi/$    
home dialysis may be furni%$ = z long z 
! ,secret>y det]m9es appropriate to an  
individual :o-- 7aa7 is bl9d2  7bb7 has 
a cognitive or neurological impairm5t   
7includ+ a /roke1 ,alzheim]'s1 dem5tia1 
amyotrophic lat]al scl]osis1 or any o!r 
impairm5t det]m9$ by ! ,secret>y72 or   
7cc7 has any o!r illness or injury t    
r$uces mobility 7includ+ c]ebral palsy1 
sp9al cord injuries1 pati5ts on a       
v5tilator1 or any o!r illness or injury 
det]m9$ by ! ,secret>y74  7iii7 ,!      
,secret>y %all1 by regulation1 e/abli%  
an add-on paym5t am\nt = /aff-assi/$    
home dialysis to det]m9e ! am\nts       
payable to a qualifi$ provid] = assi/+ 9
 ! furni%+ ( /aff-assi/$ home dialysis  

on a frequ5cy z det]m9$ by ! ,secret>y &
 9 consultation ) cl9icians1 pati5ts1 & 
c>e p>tn]s to ensure maximum pati5t     
*oice1 access1 & flexibility4 ,9        
e/abli%+ ! add-on paym5t "u ?is clause1 
! ,secret>y %all consult ) /akehold]s1  
includ+ provid]s ( r5al dialysis        
s]vices1 individuals receiv+ home       
dialysis1 qualifi$ provid]s 7z def9$ 9  
clause 7iv77,,ii771 private insurance   
pay]s1 & ,m$ic>e ,advantage plans "u "p 
,c4  7iv7 ,9 ?is subp>agraph3 7,i7 ,!   
t]m initializ+ pati5t means an          
individual :o initiates a home dialysis 
modality1 includ+ home hemodialysis &   
p]itoneal dialysis4  7,,ii7 ,! t]m      
qualifi$ provid] means a tra9$          
pr(essional 7z det]m9$ by ! ,secret>y1  
includ+ a regi/]$ or lic5s$ practical   
nurse & a c]tifi$ pati5t c>e te*nician7 
:o-- 7aa7 furni%es r5al dialysis        
s]vices2  7bb7 meets requirem5ts 7z     
det]m9$ by ! ,secret>y7 t ensure        
compet5cy 9 pati5t c>e & modality usage2
 &  7cc7 dur+ a p]iod describ$ 9 clause 

7ii77,i71 provides 9-p]son assi/ance to 
an individual = an appropriate numb] (  
dialysis sessions1 z det]m9$ by ! c>e   
team ( ! individual bas$ on ! ne$s ( !  
individual1 c>egiv] availability1       
prescription1 & mode ( home dialysis4   
7,,iii7 ,! t]m return+ pati5t means an  
individual :o is return+ to home        
dialysis aft] a p]iod ( hospitalization 
or o!r non-home dialysis modality4      
7,,iv7 7aa7 ,! t]m /aff-assi/$ home     
dialysis means dialysis furni%$ by !    
individual 9 a home1 resid5ce1 or o!r   
approv$ sett+ ) ! assi/ance ( a qualifi$
 provid]1 ! frequ5cy ( :i* is det]m9$ by
 ! qualifi$ provid] 9 coord9ation ) !   
individual1 ! c>e p>tn]1 & ! c>e team ( 
! individual & outl9$ 9 a pati5t plan ( 
c>e4  7bb7 ,9 ?is subclause1 ! t]m c>e  
p>tn] means a fri5d or family memb] :o  
is designat$ by ! individual :o is tra9$
 to assi/ ! individual ) ! furni%+ (    
home dialysis4  7cc7 ,9 ?is subclause1 !
 t]m pati5t plan ( c>e has ! mean+ giv5 
su* t]m 9 section #did4ij ( title #db1  

,code ( ,f$]al ,regulations 7or any     
successor regulations74  7,v7 ,! t]m    
tempor>y assi/ance pati5t means an      
individual :o is receiv+ home dialysis &
 is tempor>ily unable to p]=m functions 
necess>y to home dialysis due to        
illness1 injury1 c>egiv] unavailability1
 or o!r tempor>y circum/ances n to exce$
 #cj days4  4  7b7 ,pati5t education &  
tra9+ relat+ to /aff-,assi/$ home       
dialysis  7#a7 ,9 g5]al ,section        
#ahha7;b77#e7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acierr7b77#e77 is      
am5d$-- 7,a7 9 subp>agraph 7,c71 by     
/rik+ at ! end &2  7,b7 9 subp>agraph   
7,d71 by /rik+ ! p]iod at ! end & ins]t+
 a semicolon2 &  7,c7 by add+ at ! end !
 foll[+ new subp>agraphs3  7,e7 educate 
individuals on ! opportunity to receive 
/aff-assi/$ home dialysis 7z def9$ 9    
p>agraph 7#ad77;,j77iv77,,iv77 dur+ !   
p]iods describ$ 9 p>agraph              
7#ad77;,j77ii72 &  7,f7 provide =       
regi/]$ or lic5s$ nurses1 c]tifi$ pati5t
 c>e te*nicians1 or o!r qualifi$        

provid]s 7z det]m9$ by a physician7 to  
tra9 individuals & _! c>e p>tn]s 9      
skills & proc$ures ne$$ to furni%       
/aff-assi/$ home dialysis1 includ+-- 7i7
 9 a gr\p-tra9+ environm5t ) o!r        
individuals & _! c>e p>tn]s :5          
appropriate & 9 accordance ) ! ,f$]al   
regulations 7conc]n+ ! privacy (        
individually id5tifiable heal?          
in=mation7 promulgat$ "u section        
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif2  7ii7 via teleheal? 7foll[+ an   
initial p]iod ( 9-p]son compet5cy tra9+1
 9 accordance ) /&>ds specifi$ by !     
,secret>y72  7iii7 ?r\gh int]discipl9>y 
team tra9+ 7z describ$ 9 ! int]pretive  
guidance relat+ to tag numb] ,v#eij (   
,advance ,copy--,end ,/age ,r5al        
,disease 7,,esrd7 ,program ,int]pretive 
,guidance ,v]sion #a4a 7publi%$ on      
,octob] #c1 #bjjh772 &  7iv7 9 ! home or
 resid5ce ( an individual1 9 a dialysis 
facility1 9 a /&-alone tra9+ facility1  
or ! place 9 :i* ! individual has be5   

approv$ to p]=m home dialysis by ! c>e  
team4  4  7#b7 ,effective date ,!       
am5dm5ts made by ?is subsection %all    
take effect on ! date t is "o ye> aft] !
 date ( ! enactm5t ( ?is ,act4  7c7 ,o!r
 provisions  7#a7 ,anti-kickback /atute 
,section #aabh;,b7b77#c7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;b7b77#c77 is am5d$-- 7,a7 by 
mov+ subp>agraphs 7,j7 & 7,k7 #b ems to 
! left2  7,b7 9 subp>agraph 7,k71 by    
/rik+ & at ! end2  7,c7 9 subp>agraph   
7,l71 by /rik+ ! p]iod at ! end & ins]t+
 2 &2 &  7,d7 by add+ at ! end ! foll[+ 
new subp>agraph3  7,m7 any remun]ation  
relat+ to ! furni%+ ( /aff-assi/$ home  
dialysis 7z def9$ 9 section             
#ahha7;b77#ad77;,j77iv77,,iv774  4  7#b7
 ,/udy ,n lat] ?an #b ye>s aft] ! date (
 ! enactm5t ( ?is ,act1 ! ,secret>y (   
,heal? & ,human ,s]vices 79 ?is section 
ref]r$ to z ! ,secret>y7 %all submit1 to
 ! ,committee on ,f9ance ( ! ,s5ate & ! 
,committees on ,en]gy & ,comm]ce & ,ways
 & ,means ( ! ,h\se ( ,repres5tatives1 a

 report t-- 7,a7 exam9es racial         
disp>ities 9 ! utilization ( home       
dialysis 7z def9$ 9 section             
#ahha7;b77#ad77;,j77iv77,,iv7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acierr7b77#ad77;,j77iv77,,iv771 z add$ 
by subsection 7a771 & makes             
recomm5dations on h[ to improve access  
to home dialysis = communities ( color2 
7,b7 exam9es cov]age =1 & utilization (1
 home dialysis 9 rural communities1 &   
makes recomm5dations on h[ to improve   
access to home dialysis = su* rural     
communities2 &  7,c7 analyzes cl9ical & 
quality ( life outcomes = pati5ts1      
disaggregat$ by geographic & demographic
 indicators1 :o receive diff]5t dialysis
 modalities1 includ+ /aff-assi/$ home   
dialysis1 unassi/$ home dialysis1 &     
dialysis furni%$ 9 a facility4  7#c7    
,pati5t decision tool ,n lat] ?an       
,decemb] #ca1 #bjbe1 = ! purposes (     
section #ahha7;b77#ad77;,j77 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acierr7b77#ad77;,j771 z add$ by        

subsection 7a71 ! ,secret>y %all conv5e 
a pati5t panel to develop a pati5t-c5t]$
 decision tool to assi/ dialysis pati5ts
 9 evaluat+ _! life/yle & goals & 9     
*oos+ ! dialysis sett+ & modality4 ,su* 
tool %all include an ackn[l$gm5t t !    
pati5t is capable ( home dialysis &     
wants home dialysis1 if t is ! modality 
su* pati5t *ooses4  7#d7 ,pati5t quality
 ( life metric ,section                 
#ahha7;h77#b77;,a77iv7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acierr7h77#b77;,a77iv77 is am5d$-- 7,a7
 9 subclause 7,,ii71 by /rik+ & at !    
end2  7,b7 9 subclause 7,,iii71 by /rik+
 ! p]iod at ! end & ins]t+ 2 &2 &  7,c7 
by add+ at ! end ! foll[+ new subclause3
  7,,iv7 pati5t quality ( life = all    
individuals utiliz+ dialysis reg>dless (
 modality1 ) ! int5t ( measur+ & improv+
 pati5t quality ( life on dialysis4  4