,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #hcgf  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #bj1 #bjbf,mr4 
,kelly ( ,p5nsylvania 7= himself & ,ms4 
,del,bene7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,ways &     
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = 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   
cl>ify ! policy = cov]age "u ! ,m$ic>e  
program = palliative dialysis s]vices1 &
 cl>ify sep>ate paym5t = su* palliative 
dialysis s]vices1 furni%$ by r5al       
dialysis facilities & provid]s ( s]vices
 to c]ta9 individuals elect+ hospice    
c>e1 & = o!r purposes4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,concurr5t    
,c>e = ,com=t ,act4  #b4 ,cl>ification &
 application ( policy provid+ = cov]age 
( concurr5t palliative dialysis s]vices 
& hospice c>e to individuals elect+     

hospice c>e  7a7 ,9 g5]al ,section      
#ahab7;d77#b77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;d7d77#b77;,a77 is am5d$ by ins]t+ 
1 to palliative dialysis s]vices 7z     
def9$ 9 section #ahha7;b77#ae77;,e77    
furni%$ by a provid] ( s]vices or r5al  
dialysis facility to a palliative       
dialysis eligible individual 7z def9$ 9 
su* section71 aft] 7if n an employee ( !
 hospice program74  7b7 ,sep>ate paym5t 
= palliative dialysis s]vices furni%$ by
 provid]s ( s]vices & kidney dialysis   
facilities  7#a7 ,paym5t sep>ate f      
hospice c>e bundle ,section #ahad7;i7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acie;f7i77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#h7 ,9 ! case (  
palliative dialysis s]vices 7z def9$ 9  
section #ahha7;b77#ae77;,e77 furni%$ by 
a provid] ( s]vices or r5al dialysis    
facility to a palliative dialysis       
eligible individual 7z def9$ 9 su*      
section7 dur+ a p]iod ( an election "u  
section #ahab7;d77#a7 made by su*       

individual1 ! provid] ( s]vices or r5al 
dialysis facility %all bill & be paid = 
su* dialysis 9 accordance ) section     
#ahha7;b77#ae74  4  7#b7 ,paym5t        
me?odology ,section #ahha7;b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acier7b77 is am5d$ by add+ at ! end !  
foll[+ new p>agraph3  7#ae7 ,paym5t =   
palliative dialysis s]vices furni%$ to  
individuals elect+ hospice c>e  7,a7 ,9 
g5]al ,= #bjbf & ea* subsequ5t ye>1 !   
,secret>y %all1 tak+ into acc\nt !      
assessm5t & consid]ations describ$ 9    
subp>agraph 7,b7 & pursuant to rulemak+1
 e/abli% a me?odology = det]m9+1 )      
respect to a palliative dialysis        
eligible individual ^: election "u      
section #ahab7;d77#a7 to receive hospice
 c>e is = a p]iod occurr+ dur+ su* ye>1 
! paym5t am\nts "u ?is title =          
palliative dialysis s]vices furni%$ by a
 provid] ( s]vices or r5al dialysis     
facility dur+ su* p]iod to su*          
individual 9 a facility or to su*       
individual at home4  7,b7 ,consid]ations

 ,9 implem5t+ ! me?odology "u           
subp>agraph 7,a71 ! ,secret>y %all--    
7i7 consid] calculat+ paym5t am\nts =   
su* s]vices bas$ on ! am\nts t w\ld     
o!rwise be calculat$ "u ! sy/em e/abli%$
 "u p>agraph 7#ad7 = comp>able r5al     
dialysis s]vices describ$ 9 su*         
p>agraph2 &  7ii7 consid]1 aft] assess+ 
! res\rces directly or indirectly relat$
 to furni%+ palliative dialysis s]vices 
necess>y = provid]s ( s]vices & r5al    
dialysis facilities to furni% palliative
 dialysis s]vices to palliative dialysis
 eligible individuals 9 a facility or to
 su* individuals at home1 any adju/m5ts 
t %\ld be appli$ 9 calculat+ su* paym5ts
 am\nts bas$ on su* assessm5t4  7,c7    
,limitations  7i7 ,9 g5]al ,subject to  
clause 7ii71 paym5t may n be made "u ?is
 title = m ?an t5 sessions ( palliative 
dialysis s]vices furni%$ to a palliative
 dialysis eligible individual4 ,9 ! case
 ( home dialysis1 includ+ p]itoneal     
dialysis1 ?is subp>agraph %all be appli$
 by conv]t+ ! numb] ( days ( su*        

dialysis to hemodialysis equival5t      
sessions1 9 accordance ) ! me?odology   
specifi$ 9 section #ej ( ,*apt] #aa ( ! 
,m$ic>e ,b5efit ,policy ,manual1 or any 
successor to su* section4  7ii7         
,secret>ial au?ority to modify          
limitation  7,i7 ,assessm5t &           
det]m9ation ,= #bjbi ! ,secret>y %all 7&
 = any subsequ5t ye>1 ! ,secret>y may7  
pursuant to rulemak+--  7aa7 assess !   
appropriat5ess ( ! limitation specifi$  
"u clause 7i7 = su* ye>1 bas$ on data on
 det]m9ations reg>d+ cov]age (          
palliative dialysis s]vices furni%$ to  
palliative dialysis eligible individuals
 pursuant to ?is p>agraph & /akehold]   
fe$back on su* cov]age2 &  7bb7 bas$ on 
su* assessm5t1 det]m9e = su* ye> :e!r to
 apply a limit on ! numb] ( sessions (  
palliative dialysis s]vices 7o!r ?an !  
numb] specifi$ "u clause 7i77 &1 if s1  
specify su* o!r numb] t is to be appli$ 
= su* ye>4  7,,ii7 ,application (       
modifi$ numb] limit ,= any ye> = :i* !  
,secret>y specifies a numb] pursuant to 

subclause 7,i77bb7 o!r ?an ! numb]      
specifi$ 9 clause 7i71 clause 7i7 %all  
be appli$ z if ! ref]5ce to t5 sessions 
7 a ref]5ce to su* diff]5t numb] (      
treatm5ts specifi$ by ! ,secret>y4  7,d7
 ,co/-%>+ ,"u ! me?odology "u           
subp>agraph 7,a71 ! d$uctible &         
co9surance provisions "u ?is title t    
w\ld apply ) respect to kidney dialysis 
s]vices = :i* paym5t may be made "u ?is 
section 7o!r ?an ?is p>agraph7 %all also
 apply ) respect to palliative dialysis 
s]vices furni%$ to a palliative dialysis
 eligible individual = :i* paym5t is    
made pursuant to ?is p>agraph4  7,e7    
,palliative dialysis s]vices &          
palliative dialysis eligible individual 
def9$ ,= purposes ( ?is p>agraph3 7i7   
,palliative dialysis s]vices ,! t]m     
palliative dialysis s]vices means1 )    
respect to a palliative dialysis        
eligible individual1 dialysis s]vices   
specifi$ by ! ,secret>y t are furni%$ to
 ! individual 79 a facility or at home7 
z palliative c>e1 & n = purposes (      

treatm5t or ma9t5ance1 9 accordance ) a 
plan ( c>e c]tifi$ by ! individual's    
physician 9 consultation ) !            
int]discipl9>y gr\p describ$ 9 section  
#ahfa7;dd77#b77;,b71 & :i* may include  
o!r s]vices specifi$ by ! ,secret>y1 su*
 z non-em]g5cy transportation = :i*     
paym5t w\ld o!rwise be available "u ?is 
section 9 connection ) receipt (        
ma9t5ance dialysis s]vices4  7ii7       
,palliative dialysis eligible individual
 ,! t]m palliative dialysis eligible    
individual means an individual )        
end-/age r5al disease :o makes an       
election "u section #ahab7;d77#a7 & :o z
 ( ! date ( su* election 0 receiv+ r5al 
dialysis s]vices 7z describ$ 9 section  
#ahha7;b77#ad77;,b774  7,f7             
,cl>ification ,none ( ! provisions ( ?is
 p>agraph %all affect cov]age or paym5t 
"u ?is title :i* w\ld o!rwise apply =   
r5al dialysis s]vices = treatm5t or     
ma9t5ance = individuals ) end-/age r5al 
disease :o make an election = hospice   
c>e "u section #ahab7;d77#a7 on ! basis 

( a prim>y heal? condition o!r ?an a    
t]m9al condition t is n relat$ to       
end-/age r5al disease4  4