,i  #aaith ,,congress  #b;d ,session    
,h4 ,r4 #hcgf  ,,in ,,the ,,house ,,of  
,,representatives  ,april #bj1 #bjbf,mr4
 ,kelly of ,pennsylvania 7for himself   
and ,ms4 ,del,bene7 introduced the      
following bill2 which was referred to   
the ,committee on ,ways and ,means1 and 
in addition to the ,committee on ,energy
 and ,commerce1 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 clarify   
the policy for coverage under the       
,medicare program for palliative        
dialysis services1 and clarify separate 
payment for such palliative dialysis    
services1 furnished by renal dialysis   
facilities and providers of services to 
certain individuals electing hospice    
care1 and for other purposes4  #a4      
,short title ,this ,act may be cited as 
the ,concurrent ,care for ,comfort ,act4

  #b4 ,clarification and application of 
policy providing for coverage of        
concurrent palliative dialysis services 
and hospice care to individuals electing
 hospice care  7a7 ,in general ,section 
#ahab7;d77#b77;,a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;d7d77#b77;,a77 is amended by      
inserting 1 to palliative dialysis      
services 7as defined in section         
#ahha7;b77#ae77;,e77 furnished by a     
provider of services or renal dialysis  
facility to a palliative dialysis       
eligible individual 7as defined in such 
section71 after 7if not an employee of  
the hospice program74  7b7 ,separate    
payment for palliative dialysis services
 furnished by providers of services and 
kidney dialysis facilities  7#a7        
,payment separate from hospice care     
bundle ,section #ahad7;i7 of the ,social
 ,security ,act 7#db ,u4,s4,c4          
#acie;f7i77 is amended by adding at the 
end the following new paragraph3  7#h7  
,in the case of palliative dialysis     

services 7as defined in section         
#ahha7;b77#ae77;,e77 furnished by a     
provider of services or renal dialysis  
facility to a palliative dialysis       
eligible individual 7as defined in such 
section7 during a period of an election 
under section #ahab7;d77#a7 made by such
 individual1 the provider of services or
 renal dialysis facility shall bill and 
be paid for such dialysis in accordance 
with section #ahha7;b77#ae74  4  7#b7   
,payment methodology ,section #ahha7;b7 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acier7b77 is amended by      
adding at the end the following new     
paragraph3  7#ae7 ,payment for          
palliative dialysis services furnished  
to individuals electing hospice care    
7,a7 ,in general ,for #bjbf and each    
subsequent year1 the ,secretary shall1  
taking into account the assessment and  
considerations described in subparagraph
 7,b7 and pursuant to rulemaking1       
establish a methodology for determining1
 with respect to a palliative dialysis  

eligible individual whose election under
 section #ahab7;d77#a7 to receive       
hospice care is for a period occurring  
during such year1 the payment amounts   
under this title for palliative dialysis
 services furnished by a provider of    
services or renal dialysis facility     
during such period to such individual in
 a facility or to such individual at    
home4  7,b7 ,considerations ,in         
implementing the methodology under      
subparagraph 7,a71 the ,secretary       
shall--  7i7 consider calculating       
payment amounts for such services based 
on the amounts that would otherwise be  
calculated under the system established 
under paragraph 7#ad7 for comparable    
renal dialysis services described in    
such paragraph2 and  7ii7 consider1     
after assessing the resources directly  
or indirectly related to furnishing     
palliative dialysis services necessary  
for providers of services and renal     
dialysis facilities to furnish          
palliative dialysis services to         

palliative dialysis eligible individuals
 in a facility or to such individuals at
 home1 any adjustments that should be   
applied in calculating such payments    
amounts based on such assessment4  7,c7 
,limitations  7i7 ,in general ,subject  
to clause 7ii71 payment may not be made 
under this title for more than ten      
sessions of palliative dialysis services
 furnished to a palliative dialysis     
eligible individual4 ,in the case of    
home dialysis1 including peritoneal     
dialysis1 this subparagraph shall be    
applied by converting the number of days
 of such dialysis to hemodialysis       
equivalent sessions1 in accordance with 
the methodology specified in section #ej
 of ,chapter #aa of the ,medicare       
,benefit ,policy ,manual1 or any        
successor to such section4  7ii7        
,secretarial authority to modify        
limitation  7,i7 ,assessment and        
determination ,for #bjbi the ,secretary 
shall 7and for any subsequent year1 the 
,secretary may7 pursuant to rulemaking--

  7aa7 assess the appropriateness of the
 limitation specified under clause 7i7  
for such year1 based on data on         
determinations regarding coverage of    
palliative dialysis services furnished  
to palliative dialysis eligible         
individuals pursuant to this paragraph  
and stakeholder feedback on such        
coverage2 and  7bb7 based on such       
assessment1 determine for such year     
whether to apply a limit on the number  
of sessions of palliative dialysis      
services 7other than the number         
specified under clause 7i77 and1 if so1 
specify such other number that is to be 
applied for such year4  7,,ii7          
,application of modified number limit   
,for any year for which the ,secretary  
specifies a number pursuant to subclause
 7,i77bb7 other than the number         
specified in clause 7i71 clause 7i7     
shall be applied as if the reference to 
ten sessions were a reference to such   
different number of treatments specified
 by the ,secretary4  7,d7 ,cost-sharing 

,under the methodology under            
subparagraph 7,a71 the deductible and   
coinsurance provisions under this title 
that would apply with respect to kidney 
dialysis services for which payment may 
be made under this section 7other than  
this paragraph7 shall also apply with   
respect to palliative dialysis services 
furnished to a palliative dialysis      
eligible individual for which payment is
 made pursuant to this paragraph4  7,e7 
,palliative dialysis services and       
palliative dialysis eligible individual 
defined ,for purposes of this paragraph3
 7i7 ,palliative dialysis services ,the 
term palliative dialysis services means1
 with respect to a palliative dialysis  
eligible individual1 dialysis services  
specified by the ,secretary that are    
furnished to the individual 7in a       
facility or at home7 as palliative care1
 and not for purposes of treatment or   
maintenance1 in accordance with a plan  
of care certified by the individual's   
physician in consultation with the      

interdisciplinary group described in    
section #ahfa7;dd77#b77;,b71 and which  
may include other services specified by 
the ,secretary1 such as non-emergency   
transportation for which payment would  
otherwise be available under this       
section in connection with receipt of   
maintenance dialysis services4  7ii7    
,palliative dialysis eligible individual
 ,the term palliative dialysis eligible 
individual means an individual with     
end-stage renal disease who makes an    
election under section #ahab7;d77#a7 and
 who as of the date of such election was
 receiving renal dialysis services 7as  
described in section                    
#ahha7;b77#ad77;,b774  7,f7             
,clarification ,none of the provisions  
of this paragraph shall affect coverage 
or payment under this title which would 
otherwise apply for renal dialysis      
services for treatment or maintenance   
for individuals with end-stage renal    
disease who make an election for hospice
 care under section #ahab7;d77#a7 on the

 basis of a primary health condition    
other than a terminal condition that is 
not related to end-stage renal disease4 
4