,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ihia  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #bb1 #bjbf,mr4  
,wilson ( ,s\? ,c>ol9a 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 direct ! ,secret>y ( ,heal?
 & ,human ,s]vices to conduct a         
demon/ration program to %>e sav+s )     
plans t inve/ 9 prev5t+ ! progression ( 
kidney disease to end-/age r5al disease4
  #a4 ,%ort title2 table ( cont5ts  7a7 
,%ort title ,?is ,act may be cit$ z !   
,,prev5t ,,esrd ,act4  7b7 ,table (     
cont5ts ,! table ( cont5ts = ?is ,act is
 z foll[s3  ,sec4 #a4 ,%ort title2 table
 ( cont5ts4 ,sec4 #b4 ,f9d+s4 ,sec4 #c4 
,kidney disease li/5+ session4 ,sec4 #d4
 ,multipay] kidney c>e m$ic>e sav+s     
demon/ration program4  #b4 ,f9d+s       

,congress f9ds ! foll[+3 7#a7 ,kidney   
disease impacts ne>ly #cf1jjj1jjj       
,am]icans1 ) _m n gett+ ! education1    
scre5+1 or c>e t !y ne$ to delay or     
prev5t progression to kidney failure or 
end-/age r5al disease 7,,esrd74 ,inde$1 
#i 9 #aj ,unit$ ,/ates pati5ts ) kidney 
disease are unaw>e !y h ! disease4  7#b7
 ,kidney disease acc\nts =              
#abf1jjj1jjj1jjj 9 direct heal? c>e     
sp5d+ ea* ye>1 ) an outsiz$ impact on ! 
,m$ic>e program1 :i* cov]s mo/ pati5ts  
once !y progress to ,,esrd4 ,curr5tly1  
,m$ic>e sp5ds m ?an #ej1jjj1jjj1jjj ea* 
ye> on treatm5t relat$ to ,,esrd4  7#c7 
,giv5 ! trem5d\s burd5 t ,,esrd places  
on ,m$ic>e & ! ,nation's heal? c>e      
sy/em1 ! ,f$]al ,gov]nm5t has a unique  
role to play 9 advanc+ policies int5d$  
to sl[ or prev5t progression to ,,esrd4 
7#d7 ,a volunt>y paym5t model t all[s   
heal? insurance plans1 includ+ gr\p     
heal? insurance & individual heal?      
insurance plans sold 9 ! comm]cial      
m>ket1 to %>e 9 ! sav+s !y create =     

,m$ic>e by prev5t+ or delay+ ,,esrd c\ld
 help promote e>li] scre5+ & enhanc$    
treatm5t = pati5ts ) kidney disease4    
#c4 ,kidney disease li/5+ session ,n    
lat] ?an #ahj days aft] ! date (        
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all ho/ a     
li/5+ session to raise aw>5ess reg>d+   
kidney disease & to id5tify policy      
solutions to improve rates ( scre5+1    
diagnosis1 & treatm5t ( e>li] /ages (   
kidney disease 9 an ef=t to prev5t or   
delay ! onset ( ,,esrd4 ,! ,secret>y    
%all include exp]ts 9 all elem5ts (     
kidney disease1 includ+ cl9ical exp]ts1 
pati5ts & pati5t advocates1 heal? plans1
 & innovators1 z p>ticipants 9 ! li/5+  
session4  #d4 ,multipay] kidney c>e     
m$ic>e sav+s demon/ration program ,title
 ,,xviii ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acie et seq47 is am5d$ by   
ins]t+ aft] section #ahff;,g 7#db       
,u4,s4,c4 #acie;cc-#g7 ! foll[+ new     
section3  #ahff;,h4 ,multipay] kidney   
c>e m$ic>e sav+s demon/ration program   

7a7 ,implem5tation ( demon/ration       
program  7#a7 ,9 g5]al ,n lat] ?an      
,janu>y #a1 #bjbg1 ! ,secret>y ( ,heal? 
& ,human ,s]vices %all implem5t a       
#aj-ye> demon/ration program 79 ?is     
section ref]r$ to z ! ,program7 = !     
purpose ( increas+ access = qualify+    
kidney disease enrollees to specifi$    
kidney c>e s]vices to prev5t !          
progression to end-/age r5al disease    
7,,esrd74  7#b7 ,specifi$ kidney c>e    
s]vices def9$  7,a7 ,= ! purposes ( ?is 
section1 ! t]m specifi$ kidney c>e      
s]vices means items & s]vices furni%$ to
 individuals diagnos$ ) kidney disease  
to prev5t ! progression to ,,esrd & t   
w\ld be cov]$ "u ?is title if furni%$ to
 an individual entitl$ to "p ,a or      
enroll$ 9 "p ,b1 to include prescription
 drugs eligible = cov]age "u "p ,d4     
7,b7 ,! ,secret>y %all specify ! scope (
 specifi$ kidney c>e s]vices1 :i* %all  
include at a m9imum items & s]vices )9 !
 foll[+ categories & align ) ! typical  
scope ( b5efits (f]$ by insur]s = ea*   

type ( insurance cov]age specifi$ 9     
p>agraph 7#c73  7i7 ,scre5+ measures1   
includ+ ur9alysis 7e4g41 prote9uria &   
kidney-specific dip/icks71 blood-bas$   
te/+1 g5etic te/+1 & o!r =ms ( scre5+   
necess>y to scre5 = & diagnose kidney   
disease4  7ii7 ,all drugs approv$ "u    
section #cee ( title #ba1 ,unit$ ,/ates 
,code1 & all biologicals lic5s$ "u      
section #bfb ( title #db1 ,unit$ ,/ates 
,code1 by ! ,food & ,drug ,adm9i/ration 
) an indication = sl[+ ! decl9e or loss 
( kidney function or to r$uce ! risk (  
decl9e 9 kidney function4  7ii7         
,nutrition s]vices & education4  7iii7  
,disease managem5t support1 includ+     
pati5t education1 foll[-up support to   
l9k diagnoses to c>e1 g5etic c\nsel+1   
access to community heal? work]s1 &     
ref]rals to s]vices to support          
heal?-relat$ social ne$s4  7iv7         
,consultation & evaluation reg>d+ kidney
 heal?4  7v7 ,o!r items & s]vices       
specifi$ by ! ,secret>y4  7,c7 ,!       
specifi$ kidney c>e s]vices %all include

 items & s]vices furni%$ via teleheal?  
if m$ically appropriate & consi/5t ) o!r
 applicable requirem5ts4  7#c7 ,eligible
 plans ,9 ?is section1 ! t]m eligible   
plan means a gr\p heal? plan 7z def9$ "u
 section #bgia7;b77#d7 ( ! ,public      
,heal? ,s]vice ,act71 a plan (f]$ by a  
heal? insurance issu] 7z def9$ "u       
section #bgia7;b77#b7 ( su* ,act71 a    
,/ate ,m$icaid program1 a ,m$icaid      
manag$ c>e plan1 a plan t enrolls       
individuals "u "p ,c ( ?is title1 or any
 o!r type ( plan specifi$ by !          
,secret>y4  7#d7 ,p>ticipat+ plans ,9   
?is section1 ! t]m p>ticipat+ plan means
 an eligible plan t volunt>ily appli$ = 
! ,program1 0 select$ to p>ticipate     
pursuant to an application & selection  
process e/abli%$ by ! ,secret>y1 & signs
 an agreem5t ) ! ,secret>y to p>ticipate
 9 ! ,program4  7#e7 ,eligible enrollees
 ,9 ?is section1 ! t]m qualify+ kidney  
disease enrollee means an individual :o 
is enroll$ 9 a p>ticipat+ plan1 has a   
curr5t diagnosis ( kidney disease1 &    

meets su* o!r crit]ia z ! ,secret>y     
det]m9es appropriate4  7b7 ,program     
design  7#a7 ,program agreem5t ,"u !    
,program1 ! ,secret>y %all ent] into    
agreem5ts ) p>ticipat+ plans1 pursuant  
to :i* ! p>ticipat+ plans-- 7,a7 mu/    
implem5t c]ta9 activities1 z specifi$ by
 ! ,secret>y1 design$ to ensure access  
to specifi$ kidney c>e s]vices1 includ+ 
to develop a scre5+ plan to ensure      
regul> scre5+ ( all enrollees = kidney  
disease dur+ annual exams ) prim>y c>e  
provid]s & o!rwise2  7,b7 mu/ submit    
hi/orical & plan ye> data1 includ+      
protect$ heal? in=mation1 z necess>y 7z 
def9$ 9 regulations issu$ pursuant to   
section #agiba7ab7 ( title #db1 ,unit$  
,/ates ,code71 9 a =m & mann] specifi$  
by ! ,secret>y1 subject to v]ification &
 audit by ! ,secret>y1 includ+-- 7i7 !  
preval5ce & incid5ce ( kidney disease & 
,,esrd & ! /age ( *ronic kidney disease 
7,,ckd7 or o!r type ( kidney disease2   
7ii7 ! rate ( transition to ! next /age 
( ,,ckd 7if applicable7 & f ,,ckd to    

,,ersd among its enrollee population2   
7iii7 ! utilization ( specifi$ kidney   
c>e s]vices by qualify+ kidney disease  
enrollees2  7iv7 ! quality ( c>e & heal?
 outcomes among qualify+ kidney disease 
enrollees2 &  7v7 kidney disease scre5+ 
rates = all plan enrollees & = specific 
at-risk subpopulations z ! ,secret>y may
 specify1 su* z enrollees diagnos$ )    
diabetes or hyp]t5sion & enrollees      
resid+ 9 rural areas2  7,c7 mu/ cov] all
 specifi$ kidney c>e s]vices & mu/ apply
 ! l[e/ level ( co/ %>+ "u ! plan's     
b5efit design to su* s]vices & %all n   
apply utilization managem5t to specifi$ 
kidney c>e s]vices t are drugs &        
biologicals 9 a mann] m re/rictive ?an !
 ,food & ,drug ,adm9i/ration-approv$    
label+2  7,d7 mu/ provide cov]age )\t   
co/-%>+ = all plan enrollees = scre5+ = 
kidney disease2 &  7,e7 may be eligible 
to receive paym5t = a portion ( ! sav+s 
t accrue to ,m$ic>e1 z e/imat$ by !     
,secret>y "u subsection 7c77#c71 if !   
numb] ( ! plan's qualify+ kidney disease

 enrollees :o progress to ! next /age ( 
,,ckd or to ,,esrd is bel[ ! risk-adju/$
 b5*m>k e/abli%$ by ! ,secret>y "u      
subsection 7c77#a77;,c74  7#b7          
,t]m9ation  7,a7 ,t]m9ation by !        
,secret>y ,! ,secret>y may t]m9ate an   
agreem5t ) a p>ticipat+ plan if ! plan  
fails to comply ) ! t]ms ( ! program    
agreem5t describ$ 9 p>agraph 7#a74  7,b7
 ,treatm5t ( %>$ sav+s 9 ! ev5t (       
t]m9ation ,if ! agreem5t betwe5 !       
,secret>y & a p>ticipat+ plan is t]m9at$
 9 ! middle ( a ye> ( ! ,program1 !     
p>ticipat+ plan is n eligible = any %>$ 
sav+s paym5ts "u ! ,program = t ye> & ! 
,secret>y may rec\p %>$ sav+s paid = a  
prior ye>4  7#c7 ,evaluation ,!         
,secret>y %all design ! ,program 9 a    
mann] to enable indep5d5t evaluation1   
us+ novel me?ods1 ( ! ext5t to :i* !    
,program--  7,a7 pres]ves kidney        
function or o!rwise delays ! developm5t 
( ,,esrd among qualify+ kidney disease  
enrollees 9 p>ticipat+ plans & mat*$    
control gr\ps f nonp>ticipat+ plans1 )  

controls select$ bas$ on demographic1   
cl9ical1 & geographic *>act]i/ics2 &    
7,b7 r$uces exp5ditures "u ! ,m$ic>e    
program1 z e/imat$ ?r\gh a comp>ison    
betwe5 p>ticipat+ plans & appropriate   
control gr\ps1 adju/+ = relevant        
demographic1 cl9ical1 & geographic      
factors4  7#d7 ,consultation ,9 design+ 
! ,program1 includ+ 9 implem5t+ !       
def9ition ( specifi$ kidney c>e s]vices 
z describ$ 9 subsection 7a77#b71 !      
,secret>y %all1 n lat] ?an #c mon?s aft]
 ! date ( enactm5t ( ?is section1       
solicit public input 9 ! =m ( a reque/ =
 in=mation & public li/5+ sessions &    
%all consult ) speciali/s 9 ! field (   
kidney c>e1 sponsors & adm9i/rators (   
eligible plans1 & repres5tatives (      
pati5t advocacy gr\ps4  7c7 ,%>$ sav+s  
paym5ts  7#a7 ,eligibility = %>$ sav+s  
paym5ts  7,a7 ,9 g5]al ,"u ! ,program1  
subject to ! prohibition 9 ?is          
subsection on avoidance ( at-risk       
individuals & any o!r conditions        
e/abli%$ by ! ,secret>y1 = ea* ye> a    

p>ticipat+ plan has an agreem5t 9 effect
 "u ! ,program1 ! plan %all be eligible 
to receive a %>$ sav+s paym5t "u        
p>agraph 7#c71 provid$ t--  7i7 !       
p>ticipat+ plan cov]s specifi$ kidney   
c>e s]vices1 includ+ kidney disease     
scre5+ z describ$ 9 subsection          
7a77#b77;,b77i72 &  7ii7 ! p>ticipat+   
plan's ,,ckd & ,,esrd progression rates1
 adju/$ = enrollee *>act]i/ics1 are bel[
 ! b5*m>k describ$ 9 subp>agraph 7,b7 by
 at lea/ ! m9imum p]c5tage specifi$ by !
 ,secret>y4 ,?is m9imum p]c5tage %all   
reflect normal v>iation 9 kidney disease
 progression rates4  7,b7 ,b5*m>k ,= ea*
 ye> ( ! ,program1 ! ,secret>y %all     
e/abli% a b5*m>k = ea* p>ticipat+ plan  
bas$ on-- 7i7 ! plan's hi/orical        
progression rates to ! next /age ( ,,ckd
 or f ,,ckd to ,,esrd ov] ! mo/ rec5t #c
 ye>s us+ data submitt$ by ! plan1 :i*  
may be subject to v]ification & audit by
 ! ,secret>y to validate its accuracy2  
7ii7 national & regional disease        
preval5ce ov] ! mo/ rec5t #c ye>s2      

7iii7 adju/m5ts = enrollee *>act]i/ics2 
7iv7 adju/m5ts = increas$ scre5+ rates  
dur+ ! plan's p>ticipation 9 ! ,program2
 &  7v7 su* o!r factors z det]m9$       
appropriate by ! ,secret>y4  ,! b5*m>k  
%all be reset at ! />t ( ea* ye> ( !    
,program4  7#b7 ,quality p]=mance /&>ds 
,! ,secret>y %all e/abli% quality       
p]=mance /&>ds to assess ! quality ( c>e
 furni%$ by p>ticipat+ plans4 ,!        
,secret>y %all seek to improve ! quality
 ( c>e furni%$ by p>ticipat+ plans ov]  
"t by specify+ high] /&>ds1 new         
measures1 or bo? = purposes ( assess+   
su* quality ( c>e4  7#c7 ,am\nt ( %>$   
sav+s paym5t  7,a7 ,= ea* ye> ( !       
,program = ea* p>ticipat+ plan1 !       
,secret>y %all det]m9e1 & ! ,*ief       
,actu>y ( ! ,c5t]s = ,m$ic>e & ,m$icaid 
,s]vices %all c]tify1 ! sav+s t accrue  
to ,m$ic>e z a result ( ! p>ticipat+    
plan's p]=mance exce$+ ! b5*m>k z       
calculat$ "u p>agraph 7#a77;,b71 =      
example z a result ( an individual n    
obta9+ ,m$ic>e eligibility "u section   

#ahha on ! basis ( progress+ to ,,esrd  
dur+ t ye>4  7,b7 ,subject to p]=mance )
 respect to ! quality p]=mance /&>ds    
e/abli%$ by ! ,secret>y "u p>agraph     
7#b71 if a p>ticipat+ plan meets !      
eligibility requirem5ts describ$ above =
 a giv5 ye> ( ! ,program1 ! p>ticipat+  
plan %all be paid #be p]c5t ( ! ,m$ic>e 
sav+s am\nt describ$ 9 subp>agraph 7,a7 
= t plan4  7#d7 ,prohibition on         
avoidance ( at-risk pati5ts ,if !       
,secret>y det]m9es t a p>ticipat+ plan  
has tak5 action to avoid enroll+ kidney 
disease pati5ts at elevat$ risk (       
develop+ ,,esrd1 or fail$ to adh]e to ! 
t]ms ( ! p>ticipation agreem5t specifi$ 
9 subsection 7b77#a71 or takes o!r      
actions 9 ord] to increase ! likelihood 
( receiv+ %>$ sav+s paym5ts "u !        
,program1 ! ,secret>y may r$uce1 rec\p1 
or d5y %>$ sav+s paym5ts or t]m9ate !   
p>ticipat+ plan f ! ,program4  7#e7     
,optional advance inve/m5t paym5t ,!    
,secret>y may provide1 9 an am\nt       
det]m9$ by ! ,secret>y1 an advance      

inve/m5t paym5t to ea* p>ticipat+ plan =
 ea* qualify+ kidney disease enrollee = 
ea* ye> ( ! plan's p>ticipation )       
respect to su* enrollee4 ,a p>ticipat+  
plan mu/ use su* advance inve/m5t paym5t
 to improve ! quality1 effici5cy1 or    
uptake ( specifi$ kidney c>e items &    
s]vices furni%$ to b5efici>ies1 :i* may 
include com+ into compliance ) ! plan's 
p>ticipation requirem5ts "u ! ,program  
describ$ 9 ?is section4 ,! p>ticipat+   
plan mu/ report to ! ,adm9i/rator ( !   
,c5t]s = ,m$ic>e & ,m$icaid ,s]vices h[ 
! plan us$ su* funds n lat] ?an #ahj    
days aft] ! end ( ! relevant ye> 9 a =m 
& mann] specifi$ by ! ,secret>y4 ,!     
total am\nt ( any su* advance inve/m5t  
paym5t 9 a giv5 ye> %all be d$uct$ f !  
%>$ sav+s paym5t receiv$ by ! p>ticipat+
 plan = ! relevant ye>1 if any1 up to ! 
am\nt ( su* %>$ sav+s 9 ! ev5t ! am\nt (
 ! advance inve/m5t paym5t exce$s !     
am\nt ( ! %>$ sav+s paym5t4  7d7        
,prohibition on duplicate paym5ts ,!    
,secret>y %all ensure t no duplicate    

paym5ts "u ?is section are made by      
,m$ic>e ) respect to a qualify+ kidney  
disease enrollee4  7e7 ,monitor+1       
evaluation1 & report+ by ! ,secret>y    
7#a7 ,monitor+ & evaluation ,! ,secret>y
 %all monitor & evaluate ! ,program on  
an ongo+ basis & %all conduct an        
int]m$iate & f9al evaluation ( !        
,program 9 accordance ) ! requirem5ts   
describ$ 9 subsection 7b77#c74 ,ea* su* 
evaluation %all det]m9e ! ext5t to :i* !
 purpose ( increas+ access = qualify+   
kidney disease enrollees to specifi$    
kidney c>e s]vices to prev5t !          
progression to ,,esrd has be5 accompli%$
 "u ! ,program4  7#b7 ,report+ ,!       
,secret>y %all submit to ,congress--    
7,a7 n lat] ?an #c ye>s aft] ! date ( ! 
implem5tation ( ! ,program1 a report )  
respect to ! int]m$iate evaluation2 &   
7,b7 a report ) respect to ! f9al       
evaluation n lat] ?an #f ye>s aft] su*  
date4  7f7 ,fund+  7#a7 ,adm9i/rative   
fund+ ,= purposes ( adm9i/]+ & c>ry+ out
 ! ,program1 o!r ?an = paym5ts = items &

 s]vices furni%$ "u ?is title1 advance  
inve/m5t paym5t "u subsection 7c77#e71 &
 %>$ sav+s paym5t "u subsection 7c77#c71
 9 addition to funds o!rwise            
appropriat$1 !re %all be transf]r$ to ! 
,secret>y = ! ,c5t]s = ,m$ic>e &        
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt f ! ,f$]al ,hospital ,insurance 
,tru/ ,fund "u section #ahag & ! ,f$]al 
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda 79 proportions   
det]m9$ appropriate by ! ,secret>y7     
#e1jjj1jjj = ea* ( fiscal ye>s #bjbf    
?r\gh #bjch4 ,am\nts transf]r$ "u ?is   
subsection = a fiscal ye> %all be       
available until exp5d$4  7#b7 ,%>$ sav+s
 paym5ts ,! %>$ sav+s paym5ts & advance 
inve/m5t paym5ts "u ! ,program1 = ea* ( 
program ye>s #bjbg ?r\gh #bjcg1 %all be 
made f ! ,f$]al ,hospital ,insurance    
,tru/ ,fund e/abli%$ "u section #ahag & 
! ,f$]al ,supplem5t>y ,m$ical ,insurance
 ,tru/ ,fund e/abli%$ "u section #ahda 9
 su* proportion z ! ,secret>y det]m9es  
reflects ! relative weight t b5efits "u 

"p ,a & "u "p ,b repres5ts ( ! actu>ial 
value ( ! ,m$ic>e sav+s det]m9$ "u      
subsection 7c77#c7 & ! advance inve/m5t 
paym5ts det]m9$ "u subsection 7c77#e74  
7g7 ,waiv] & implem5tation au?ority     
7#a7 ,! ,secret>y may implem5t          
provisions ( ?is section by program     
in/ruction1 agreem5t1 or o!rwise4  7#b7 
,! ,secret>y may waive any requirem5t ( 
titles ,,xi or ,,xviii & ( sections     
#aijb7;a77#a71 #aijb7;a77#ac71 &        
#aijc7m77#b77;,a77iii7 ( ?is ,act z may 
be necess>y to c>ry out ! ,program4     
7#c7 ,! ,pap]work ,r$uction ,act 7#dd   
,u4,s4,c4 #ceja et seq47 %all n apply to
 implem5tation & adm9i/ration ( !       
,program4  4