,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #hhge  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #ai1 #bjbf,mrs4  
,mill] ( ,we/ ,virg9ia 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 include c]ta9 
additional s]vices z self-c>e home      
dialysis support s]vices "u ! ,m$ic>e   
program4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,improv+ ,home ,dialysis    
,act ( #bjbf4  #b4 ,includ+ c]ta9       
additional s]vices z self-c>e home      
dialysis support s]vices "u ! ,m$ic>e   
program  7a7 ,9 g5]al ,section          
#ahha7;b77#i7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acierr7b77#i77 is      
am5d$-- 7#a7 9 subp>agraph 7,c71 by     
/rik+ & at ! end2  7#b7 by r$esignat+   

subp>agraph 7,d7 z subp>agraph 7,f72    
7#c7 by ins]t+ aft] subp>agraph 7,c7 !  
foll[+ new subp>agraphs3  7,d7 beg9n+   
,janu>y #a1 #bjbh1 /aff-assi/$ home     
dialysis respite c>e furni%$ to a pati5t
 9 ! place ( resid5ce us$ z su* pati5t's
 home 7o!r ?an a skill$ nurs+ facility  
or a nurs+ facility 7z def9$ 9 section  
#aiai7;a7772  7,e7 beg9n+ ,janu>y #a1   
#bjbh1 r5al m5tal heal? s]vices furni%$ 
to a pati5t 9 ! place ( resid5ce us$ z  
su* pati5t's home 7o!r ?an a skill$     
nurs+ facility or a nurs+ facility 7z   
def9$ 9 section #aiai7;a7772 &  2 &     
7#d7 by add+ at ! end ! foll[+ flu%     
matt]3 ,= purposes ( subp>agraph 7,d71 !
 t]m /aff-assi/$ home dialysis respite  
c>e means dialysis s]vices furni%$ by   
qualifi$ p]sonnel to a pati5t dialyz+ at
 home :o is tempor>ily unable to        
compet5tly dialyze at home indep5d5tly  
dur+ ! #cj-;day p]iod beg9n+ on ! fir/  
day t ! pati5t initiates home dialysis  
7or1 9 ! case ( a pati5t ^: tempor>y    
inability to compet5tly dialyze is      

attributable to a physical limitation1  
at any "t74 ,= purposes ( ! prec$+      
s5t5ce1 ! t]m qualifi$ p]sonnel means a 
regi/]$ nurse1 a lic5s$ practical nurse1
 a c]tifi$ pati5t c>e te*nician1 or     
ano!r qualifi$ m$ical pr(essional       
specifi$ by ! ,secret>y1 :o meets       
requirem5ts 7z det]m9$ by ! ,secret>y7 t
 ensure compet5cy 9 pati5t c>e &        
modality usage1 includ+ complet+ tra9+  
specific to /aff-assi/$ home dialysis   
respite c>e z specifi$ by ! ,secret>y4  
,= purposes ( subp>agraph 7,e71 ! t]m   
r5al m5tal heal? s]vices means s]vices  
describ$ 9 section #did4ij7;a77#f7 (    
title #db1 ,code ( ,f$]al ,regulations  
7or a successor regulation71 furni%$ to 
a pati5t dialyz+ at home dur+ ! #fj-;day
 p]iod beg9n+ on ! fir/ day t ! pati5t  
initiates home dialysis by an individual
 :o meets ! /&>d specifi$ 9 section     
#did4adj7;d7 ( title #db1 ,code ( ,f$]al
 ,regulations 7or a successor           
regulation74 4  7b7 ,paym5t adju/m5ts = 
c]ta9 self-c>e home dialysis support    

s]vices  7#a7 ,9 g5]al ,section         
#ahha7;b77#ad7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acierr7b77#ad77 is 
am5d$-- 7,a7 9 subp>agraph 7,d7-- 7i7 9 
clause 7iii71 by /rik+ & at ! end2  7ii7
 by r$esignat+ clause 7iv7 z clause     
7vi72 &  7iii7 by ins]t+ aft] clause    
7iii7 ! foll[+ new clauses3  7iv7 %all  
include a paym5t adju/m5t = /aff-assi/$ 
home dialysis respite c>e 7z describ$ 9 
p>agraph 7#i77;,d77 9 accordance )      
subp>agraph 7,j72  7v7 %all include a   
paym5t adju/m5t = r5al m5tal heal?      
s]vices 7z describ$ 9 p>agraph          
7#i77;,e77 9 accordance ) subp>agraph   
7,k72 &  2 &  7,b7 by add+ at ! end !   
foll[+ new subp>agraphs3  7,j7 7i7 ,=   
purposes ( subp>agraph 7,d77iv71 subject
 to clause 7ii71 a paym5t adju/m5t %all 
be made = ea* session ( /aff-assi/$ home
 dialysis respite c>e 7z describ$ 9     
p>agraph 7#i77;,d77 furni%$ dur+ a ye>  
equal to ! am\nt ( ! add-on p] treatm5t 
adju/m5t = home & self-dialysis tra9+   
furni%$ 9 #bjbe 7or1 9 ! case ( su* c>e 

t is n furni%$ 9 a rural area 7z def9$ =
 purposes ( su* subp>agraph71 #ge p]c5t 
( su* am\nt74  7ii7 ,9 no case may a    
paym5t adju/m5t "u subp>agraph 7,d77iv7 
be made = /aff-assi/$ home dialysis     
respite c>e furni%$ to an individual--  
7,i7 = m ?an #bj sessions 9 a cal5d>    
ye>2 or  7,,ii7 on a day :5 su*         
individual 0 n dialyz+ at home4  7iii7  
,any paym5t adju/m5t "u subp>agraph     
7,d77iv7 = /aff-assi/$ home dialysis    
respite c>e %all n be made 9 a budget   
neutral mann]4  7,k7 7i7 ,= purposes (  
subp>agraph 7,d77v71 subject to clause  
7ii71 a paym5t adju/m5t %all be made =  
ea* session ( r5al m5tal heal? s]vices  
7z describ$ 9 p>agraph 7#i77;,e77       
furni%$ dur+ a ye> equal to #ej p]c5t   
7or #be p]c5t1 9 ! case ( su* s]vices t 
are n furni%$ 9 a rural area 7z def9$ = 
purposes ( subp>agraph 7,d777 ( ! am\nt 
( ! add-on p] treatm5t adju/m5t = home &
 self-dialysis tra9+ furni%$ 9 #bjbe4   
7ii7 ,9 no case may a paym5t adju/m5t "u
 subp>agraph 7,d77v7 be made = r5al     

m5tal heal? s]vices furni%$ to an       
individual-- 7,i7 = m ?an #d sessions   
occurr+ dur+ ! #fj-;day p]iod beg9n+ on 
! fir/ day t ! individual initiates home
 dialysis2 or  7,,ii7 on a day :5 su*   
individual 0 n dialyz+ at home4  7iii7  
,any paym5t adju/m5t "u subp>agraph     
7,d77v7 = r5al m5tal heal? s]vices %all 
n be made 9 a budget neutral mann]4  4  
7#b7 ,con=m+ am5dm5t ,section           
#ahcd7r77#a7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciem7r77#a77 is am5d$  
by /rik+ subp>agraph 7,d77iv77,,ii7 &   
ins]t+ subp>agraph 7,d77vi77,,ii74