1.This Act may be cited as the Chronic Kidney Disease Improvement in Research and Treatment Act of 2014
.
2.The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Title I—Improving Understanding of Chronic Kidney Disease through Expanded Research and
Coordination
Sec. 101. Identifying gaps in chronic kidney disease research.
Sec. 102. Coordinating research on chronic kidney disease.
Sec. 103. Understanding the progression of kidney disease and treatment of kidney failure in
minority populations.
Title II—Promoting Access to Chronic Kidney Disease Treatments
Sec. 201. Increasing access to Medicare kidney disease education benefit.
Sec. 202. Improving access to chronic kidney disease treatment in underserved rural and urban
areas.
Sec. 203. Promoting access to home dialysis treatments.
Sec. 204. Expand access for patients with acute kidney injury.
Title III—Creating Economic Stability for Providers Caring for Individuals with Chronic Kidney
Disease
Sec. 301. Stabilizing Medicare payments for services provided to beneficiaries with stage V chronic
kidney disease receiving dialysis services.
Sec. 302. Allowing individuals with kidney failure to retain access to private insurance.
Sec. 303. Providing individuals with kidney failure access to managed care and coordinated care
programs.
<enum>I</enum><header>Improving Understanding of Chronic Kidney Disease through Expanded Research and Coordination</header>
<section id="H2F14B5AC19E04D1E965BAD02C35762D7"><enum>101.</enum><header>Identifying gaps in chronic kidney disease research</header>
<subsection id="HC9F70D97EC194824B862E09CF047DC84"><enum>(a)</enum><header>Report</header><text>Not later than one year after the date of enactment of this Act, the Comptroller General of the
United States shall develop and submit to the Congress a comprehensive
report assessing the adequacy of Federal expenditures in chronic kidney
disease research relative to Federal expenditures for chronic kidney
disease care.</text>
</subsection><subsection id="HFE09629B5E9A47E6ABF28728BC3CBC90"><enum>(b)</enum><header>Contents</header><text>The report required by this section shall—</text>
<paragraph id="H3518821DC588499B9DD011577083E94C"><enum>(1)</enum><text>analyze the current chronic kidney disease research projects being funded by Federal agencies;</text>
</paragraph><paragraph id="H53642EE0D7914C67A244D876B7EE9439"><enum>(2)</enum><text>identify, including by surveying the kidney care community, areas of chronic kidney disease
knowledge gaps that are not part of current Federal research efforts;</text>
</paragraph><paragraph id="H5B309343B1944AD69D9AD325413596B5"><enum>(3)</enum><text>report on the level of Federal expenditures on kidney research as compared to the amount of Federal
expenditures on treating individuals with chronic kidney disease; and</text>
</paragraph><paragraph id="HFCB83962B1D14073846060FFE3E520BA"><enum>(4)</enum><text>identify areas of kidney failure knowledge gaps in research to assess treatment patterns associated
with providing care to minority populations that are disproportionately
affected by kidney failure.</text>
</paragraph></subsection></section><section id="H08ECFEF196D64E3CA429015BF6D85007"><enum>102.</enum><header>Coordinating research on chronic kidney disease</header>
<subsection id="H3B9F08013B8046508CC3D9845EE93D5E"><enum>(a)</enum><header>Interagency committee</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall establish and maintain an interagency committee
for the purpose of improving the coordination of chronic kidney disease
research.</text>
</subsection><subsection id="HE8DF3FE0015045A7BF82D32F8DA66EAA"><enum>(b)</enum><header>Reports</header><text>For the purpose described in subsection (a), the interagency committee established under such
subsection shall issue public reports that—</text>
<paragraph id="H3A3F8A995CAC4BB99DD39768DD7181E9"><enum>(1)</enum><text>include a strategic plan, including recommendations for—</text>
<subparagraph id="HA77945F2D5E84E60925996D6E48BFA2E"><enum>(A)</enum><text>improving communication and coordination among Federal agencies;</text>
</subparagraph><subparagraph id="HAA053AFF6A4744D88DB51785444B2806"><enum>(B)</enum><text>procedures for monitoring Federal chronic kidney disease research activities; and</text>
</subparagraph><subparagraph id="HB56D8EDDB4844682B3E95499D3324711"><enum>(C)</enum><text>ways to maximize the efficiency of the Federal chronic kidney disease research investment and
minimize the potential for unnecessary duplication;</text>
</subparagraph></paragraph><paragraph id="H7ACE977814EF4013B230A4B710443641"><enum>(2)</enum><text>include a portfolio analysis that provides information on chronic kidney disease research projects,
organized by the strategic plan objectives; and</text>
</paragraph><paragraph id="H7E9B41D141084431B42316BB13EF4041"><enum>(3)</enum><text>address such other topics as the interagency committee determines appropriate.</text>
</paragraph></subsection><subsection id="HF4ED9E8289094719AD45779A7247C541"><enum>(c)</enum><header>Meetings</header><text>The interagency committee established under subsection (a) shall meet not less than semi-annually.</text>
</subsection></section><section id="H0B15FD87C5334659A9199AE1728A0F10"><enum>103.</enum><header>Understanding the progression of kidney disease and treatment of kidney failure in minority
populations</header><text display-inline="no-display-inline">Not later than one year after the date of enactment of this Act, the Secretary of Health and Human
Services shall—</text>
<paragraph id="H81496651D4C54379991B65F748738D47"><enum>(1)</enum><text>complete a study on—</text>
<subparagraph id="HA1945ADE722F4B7DB14047E0226DF44F"><enum>(A)</enum><text>the social, behavioral, and biological factors leading to kidney disease;</text>
</subparagraph><subparagraph id="H36AF4B5378264B38B5890CE9AB7CE434"><enum>(B)</enum><text>efforts to slow the progression of kidney disease in minority populations that are
disproportionately affected by such disease; and</text>
</subparagraph><subparagraph id="HB29E54260FBA429780457DB38595DE1F"><enum>(C)</enum><text>treatment patterns associated with providing care, under the Medicare program under title XVIII of
the Social Security Act, the Medicaid program under title XIX of such Act,
and through private health insurance, to minority populations that are
disproportionately affected by kidney failure; and</text>
</subparagraph></paragraph><paragraph id="HEDE651E80B0D4FADAB896CC150BF1ECA"><enum>(2)</enum><text>submit a report to the Congress on the results of such study.</text>
</paragraph></section><enum>II</enum><header>Promoting Access to Chronic Kidney Disease Treatments</header>
<section id="HD3C9EE79FA9F4DC79ACFEC450BE09D05"><enum>201.</enum><header>Increasing access to Medicare kidney disease education benefit</header>
<subsection id="H59294087C6E743C898F92115ACB79F1C"><enum>(a)</enum><header>In general</header><text>Section 1861(ggg) of the Social Security Act (42 U.S.C. 1395x(ggg)) is amended—</text>
<paragraph id="H672F239DC6454745BE37C2CD35316573"><enum>(1)</enum><text>in paragraph (1)—</text>
<subparagraph id="HA2F04BCA4E9145AC95024FCAA55C1DC6"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (A), by inserting <quote> or stage V</quote> after <quote>stage IV</quote>;</text>
</subparagraph><subparagraph id="H8275DB37D32B4308BD8873C520CB4D4B"><enum>(B)</enum><text display-inline="yes-display-inline">in subparagraph (B), by inserting <quote>or of a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in
section 1861(aa)(5)) assisting in the treatment of the individual’s kidney
condition</quote> after <quote>kidney condition</quote>; and</text>
</subparagraph></paragraph><paragraph id="H5808ED95497F4491AAC5F87ED9DF454E"><enum>(2)</enum><text>in paragraph (2)—</text>
<subparagraph id="HDC569854EC934F92BF62A81FC2B0300F"><enum>(A)</enum><text>by striking subparagraph (B); and</text>
</subparagraph><subparagraph id="H77BE3CB4CB64456CA8231A8D981A03B4"><enum>(B)</enum><text>in subparagraph (A)—</text>
<clause id="HA4A0F38197394892B051B3AF72F93808"><enum>(i)</enum><text>by striking <quote>(A)</quote> after <quote>(2)</quote>;</text>
</clause><clause id="HC5AFD8F97EFA43C991C64CA26DFA5B4F"><enum>(ii)</enum><text>by striking <quote>and</quote> at the end of clause (i);</text>
</clause><clause id="H4A78211D71154F908F9426A67DC0790C"><enum>(iii)</enum><text>by striking the period at the end of clause (ii) and inserting <quote>; and</quote>;</text>
</clause><clause id="HAF8A8BD4C80C4712A7206305B56B8909"><enum>(iv)</enum><text>by redesignating clauses (i) and (ii) as subparagraphs (A) and (B), respectively; and</text>
</clause><clause id="H1A1EFAAF623D457E9378B3AB16098B65"><enum>(v)</enum><text>by adding at the end the following:</text>
<quoted-block id="H7468DCDD33E64347ABFE46EFB4347AB5" style="OLC">
<subparagraph id="HC5A3715F38014E24A7AB883ECA30A625"><enum>(C)</enum><text>a renal dialysis facility subject to the requirements of section 1881(b)(1) with personnel who—</text>
<clause id="HA672BEE0C2534D509CFA8D9D883EA53F"><enum>(i)</enum><text>provide the services described in paragraph (1); and</text>
</clause><clause id="H6005E99AC5A144A3B7A9FD6A9E7FDA59"><enum>(ii)</enum><text>is a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or
clinical nurse specialist (as defined in subsection (aa)(5)).</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></subsection><subsection id="H807E2019205B4206A0102579516F7FE7"><enum>(b)</enum><header>Payment to renal dialysis facilities</header><text>Section 1881(b) of such Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block id="H181FD058C94B468CAC0A7EE94DB46EAD" style="OLC">
<paragraph id="H94D2AD46B06C46EF8ABE0011D5B2AB02"><enum>(15)</enum><text>For purposes of paragraph (14), the single payment for renal dialysis services under such paragraph
shall not take into account the amount of payment for kidney disease
education services (as defined in section 1861(ggg)). Instead, payment for
such services shall be made to the renal dialysis facility on an
assignment-related basis under section 1848.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H6C5318CF6AF2408F98111E3FB725A0B9"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section apply to kidney disease education services furnished on or
after January 1, 2015.</text>
</subsection></section><section id="H7BD7A852055B4F558F58FF681F40EEC6"><enum>202.</enum><header>Improving access to chronic kidney disease treatment in underserved rural and urban areas</header>
<subsection id="H681056A8CC6E4B78B91C0441A92342B4"><enum>(a)</enum><header>Definition of primary care services</header><text display-inline="yes-display-inline">Section 331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 254d(a)(3)(D)) is amended by
inserting <quote>and includes renal dialysis services</quote> before the period at the end.</text>
</subsection><subsection id="H0EF59C7093394592A21CC18C87648C13"><enum>(b)</enum><header>National Health Service Corps Scholarship Program</header><text display-inline="yes-display-inline">Section 338A(a)(2) of the Public Health Service Act (42 U.S.C. 254l(a)(2)) is amended by inserting <quote>, including nephrologists and non-physician practitioners providing renal dialysis services</quote> before the period at the end.</text>
</subsection><subsection id="H9F0CF704A55748B586D9F3D9DCE79856"><enum>(c)</enum><header>National Health Service Corps Loan Repayment Program</header><text display-inline="yes-display-inline">Section 338B(a)(2) of the Public Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended by
inserting <quote>, including nephrologists and non-physician practitioners providing renal dialysis services</quote> before the period at the end.</text>
</subsection></section><section commented="no" id="HFF786BFA2D7D4CBD94061F931ADD55DC"><enum>203.</enum><header>Promoting access to home dialysis treatments</header>
<subsection commented="no" id="H8C9347DA653743639DC7E3999817DDD4"><enum>(a)</enum><header>Monthly capitation payments</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law, with respect to dialysis services furnished on or after
January 1, 2015, the Secretary of Health and Human Services shall apply
with respect to visits by a physician provided within a month to an end
stage renal disease patient receiving dialysis services at home, the
alternative Medicare billing procedures, as described in the final rule
promulgated by the Secretary in the Federal Register on November 7, 2003
(68 Fed. Reg. 63216), for physicians managing patients on dialysis, with
respect to visits by such a physician provided within a month to an end
stage renal disease patient who is hospitalized during the month.</text>
</subsection><subsection commented="no" id="H7B977A81BE4F43A5A9F07B09370FEB50"><enum>(b)</enum><header>Telehealth</header><text display-inline="yes-display-inline">Section 1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by
adding at the end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H404E6A5B7D26406B8CA085C3568DE4CC" style="OLC">
<subclause commented="no" id="H5A791A423F224C4EB9CF6C00A8459DC4"><enum>(IX)</enum><text display-inline="yes-display-inline">A renal dialysis facility (as defined in section 1881).</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" id="HCB8D0DA97B1C4E249389DCB638CDDB9A"><enum>204.</enum><header>Expand access for patients with acute kidney injury</header><text display-inline="no-display-inline">Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is amended—</text>
<paragraph commented="no" id="H4471A043D7CB4ADE9CD5FE6161156A1E"><enum>(1)</enum><text>in paragraph (1), by inserting <quote>or acute kidney injury</quote> after <quote>individuals who have been determined to have end stage renal disease</quote>;</text>
</paragraph><paragraph commented="no" id="HAB6A54FCD43D470796D4835BCDFB9D2D"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (2)(A), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>;</text>
</paragraph><paragraph commented="no" id="H0E2F0A9AF29346C5AE7390C69C2D87C2"><enum>(3)</enum><text display-inline="yes-display-inline">in paragraph (2)(B), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>;</text>
</paragraph><paragraph id="HAA1AA53BDDC949D6AE8B49797EB40F20"><enum>(4)</enum><text>in paragraph (3), in the matter preceding subparagraph (A), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>;</text>
</paragraph><paragraph id="H92459A854EE34532A3FEF17D7246F1F0"><enum>(5)</enum><text display-inline="yes-display-inline">in paragraph (11)(A), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>;</text>
</paragraph><paragraph commented="no" id="H881BAD06B81D4B329D0177D3531314E5"><enum>(6)</enum><text display-inline="yes-display-inline">in paragraph (11)(B), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>;</text>
</paragraph><paragraph id="H6E12F1D72B6644309D3DCAF6E308AC02"><enum>(7)</enum><text display-inline="yes-display-inline">in paragraph (14)(B)—</text>
<subparagraph id="HA6E363B4B6DF4278A8D1D7CA177A60F6"><enum>(A)</enum><text display-inline="yes-display-inline">in clause (ii), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>;</text>
</subparagraph><subparagraph id="HFE3B0574E382436A8C79755F3D37C50B"><enum>(B)</enum><text display-inline="yes-display-inline">in clause (iii), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>; and</text>
</subparagraph><subparagraph id="HA9AF03C1F8D446CE98106E5EA2EBBE1D"><enum>(C)</enum><text display-inline="yes-display-inline">in clause (iv), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>; and</text>
</subparagraph></paragraph><paragraph commented="no" id="H8CFB5A1E73BE440AA0FF6107C0698439"><enum>(8)</enum><text display-inline="yes-display-inline">in paragraph (14)(H)(i), by inserting <quote>or acute kidney injury</quote> after <quote>end stage renal disease</quote>.</text>
</paragraph></section><enum>III</enum><header>Creating Economic Stability for Providers Caring for Individuals with Chronic Kidney Disease</header>
<section commented="no" id="H4A784A7A4E9742BB9D584F160F9DB91F"><enum>301.</enum><header>Stabilizing Medicare payments for services provided to beneficiaries with stage V chronic kidney
disease receiving dialysis services</header><text display-inline="no-display-inline">Section 1881(b)(14) of the Social Security Act (42 U.S.C. 1395rr(b)(14)) is amended—</text>
<paragraph commented="no" id="HC084F00C020141EAB10071C3F8ED6EA4"><enum>(1)</enum><text>in subparagraph (D), in the matter preceding clause (i), by striking <quote>Such system</quote> and inserting <quote>Subject to subparagraph (J), such system</quote>; and</text>
</paragraph><paragraph commented="no" id="H06755FCCC7264C6DA378EA38491D8BB9"><enum>(2)</enum><text>by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H70E78D6D148947CC99BA5548B1707DA7" style="OLC">
<subparagraph commented="no" id="HE91863E82D524038AC14596A4B9B5048" indent="up2"><enum>(J)</enum>
<clause commented="no" display-inline="yes-display-inline" id="HD82C01FC34DD40FFA13F6BDB62692E7C"><enum>(i)</enum><text>For payment for renal dialysis services furnished on or after January 1, 2015, under the system
under this paragraph—</text>
<subclause commented="no" id="HD3C8F3EB40AF479293F65DDCCBF40F63" indent="up1"><enum>(I)</enum><text>the payment adjustment described in clause (i) of subparagraph (D) shall not take into account
comorbidities;</text>
</subclause><subclause commented="no" id="H54BEA51A140143A9BF2490DA403DA9B6" indent="up1"><enum>(II)</enum><text>the payment adjustment described in clause (ii) of such subparagraph shall not be included;</text>
</subclause><subclause commented="no" id="H5C6DC91C991C46049A7BF4BB57FAC568" indent="up1"><enum>(III)</enum><text>the standardization factor described in the final rule published in the Federal Register on
November 8, 2012 (77 Fed. Reg. 67470), shall be established using the most
currently available data (and not historical data) and adjusted on an
annual basis, based on such available data, to account for any change in
utilization of drugs and any modification in adjustors applied under this
paragraph; and</text>
</subclause><subclause id="H0D11C0513A8A40E8B7AEFA468AD0657E" indent="up1"><enum>(IV)</enum><text display-inline="yes-display-inline">the Secretary shall take into account reasonable costs consistent with paragraph (2)(B) when
calculating such payments.</text>
</subclause></clause><clause commented="no" id="H97855F2B13E7480DBD1485926824A26C" indent="up1"><enum>(ii)</enum><text>Not later than January 1, 2015, the Secretary shall amend the ESRD facility cost report to—</text>
<subclause commented="no" id="H1AD756A0F68F455FAAEAA31EBE8AB9DE"><enum>(I)</enum><text>include the per treatment network fee (as described in paragraph (7)) as an allowable cost; and</text>
</subclause><subclause commented="no" id="H23701541816542879F66E2BBFABD5787"><enum>(II)</enum><text>eliminate the limitation for reporting medical director fees on such reports in order to take into
account the wages of a board-certified nephrologist.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section commented="no" id="HEDE4168CBC8A4D5BB8DAEA50349D8A04"><enum>302.</enum><header>Allowing individuals with kidney failure to retain access to private insurance</header>
<subsection id="H02C40E7A01D3466A97BC95A5982A6132"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C.1395y(b)(1)(C) is amended—</text>
<paragraph commented="no" id="H7640C09AAC264A2F9214A18D91B574C0"><enum>(1)</enum><text>in the last sentence, by inserting <quote>and before January 1, 2015</quote> after <quote>prior to such date</quote>; and</text>
</paragraph><paragraph commented="no" id="H88E1DBCD8C4E4F69A4E63A876FA2E5EE"><enum>(2)</enum><text>by adding at the end the following new sentence: <quote>Effective for items and services furnished on or after January 1, 2015 (with respect to periods
beginning on or after the date that is 42 months prior to such date),
clauses (i) and (ii) shall be applied by substituting <quote>42-month</quote> for <quote>12-month</quote> each place it appears.</quote>.</text>
</paragraph></subsection><subsection id="H465CC205BB76409B9170C767B667C0A0"><enum>(b)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendments made by this subsection shall take effect on the date of enactment of this Act. For
purposes of determining an individual’s status under section 1862(b)(1)(C)
of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by
subsection (a), an individual who is within the coordinating period as of
the date of enactment of this Act shall have that period extended to the
full 42 months described in the last sentence of such section, as added by
the amendment made by subsection (a)(2).</text>
</subsection></section><section commented="no" id="H1954F54DD45F48E4841653CD5ACC9939"><enum>303.</enum><header>Providing individuals with kidney failure access to managed care and coordinated care programs</header>
<subsection commented="no" id="HF20ABF7019974DA1BF6BD192A3E1C08C"><enum>(a)</enum><header>Expanding access to Medicare Advantage</header>
<paragraph commented="no" id="H8742DB009EAC4D8E8F9661E412CC4F2B"><enum>(1)</enum><header>Eligibility under Medicare Advantage</header>
<subparagraph commented="no" id="HFD7592CE4B774C30AF855924FA61D204"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1851(a)(3) of the Social Security Act (42 U.S.C. 1395w–21(a)(3)) is amended—</text>
<clause commented="no" id="HDF4ED22869CE483993CFB3912F5F4D21"><enum>(i)</enum><text>by striking subparagraph (B); and</text>
</clause><clause commented="no" id="H203E06B0D68244C4B1F588210C5DCD2E"><enum>(ii)</enum><text>by striking <quote><header-in-text level="paragraph" style="OLC">eligible individual.—</header-in-text></quote> and all that follows through <quote>In this title</quote> and inserting <quote><header-in-text level="paragraph" style="OLC">eligible individual.—</header-in-text>In this title</quote>.</text>
</clause></subparagraph><subparagraph commented="no" id="H0258FA6FD9C94D1D912F1E7A0C231F83"><enum>(B)</enum><header>Conforming amendment</header><text>Section 1852(b)(1) of the Social Security Act (42 U.S.C. 1395w–22(b)(1)) is amended—</text>
<clause commented="no" id="HD729ADA1B22744C7BE88B2892C625A76"><enum>(i)</enum><text>by striking subparagraph (B); and</text>
</clause><clause commented="no" id="H2A75C96C25724A528D258529D227ADB4"><enum>(ii)</enum><text>by striking <quote><header-in-text level="paragraph" style="OLC">Beneficiaries.—</header-in-text></quote> and all that follows through <quote>A Medicare+Choice organization</quote> and inserting <quote><header-in-text level="paragraph" style="OLC">Beneficiaries.—</header-in-text>A Medicare Advantage organization</quote>.</text>
</clause></subparagraph><subparagraph id="HFAEB0C307527459EA1B8EA4EB537CACB"><enum>(C)</enum><header>Effective date</header><text>The amendments made by this paragraph shall apply with respect to plan years beginning on or after
January 1, 2015.</text>
</subparagraph></paragraph><paragraph commented="no" id="H327C04F69A1542EDB21F38890816CCCB"><enum>(2)</enum><header>Education</header><text display-inline="yes-display-inline">Section 1851(d)(2)(A)(iii) of the Social Security Act (42 U.S.C. 1395w–21(d)(2)(A)(iii)) is amended
by inserting before the period at the end the following <quote>, including any additional information that individuals determined to have end stage renal disease
may need to make informed decisions with respect to such an election</quote>.</text>
</paragraph><paragraph commented="no" id="HD5C23620CFD54B21A02EA1F905EB045A"><enum>(3)</enum><header>Quality metrics</header><text display-inline="yes-display-inline">Section 1852(e)(3)(A) of the Social Security Act (42 U.S.C. 1395w–22(e)(3)(A)) is amended by adding
at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H514FC350681D497AA7AD7E5C61EC9C64" style="OLC">
<clause commented="no" id="HE02DD1E71A294F58A72B8165254BA887"><enum>(v)</enum><header>Requirements with respect to individuals with ESRD</header><text display-inline="yes-display-inline">In addition to the data required to be collected, analyzed, and reported under clause (i) and
notwithstanding the limitations under subparagraph (B), as part of the
quality improvement program under paragraph (1), each MA organization
shall provide for the collection, analysis, and reporting of data,
determined in consultation with the kidney care community, that permits
the measurement of health outcomes and other indices of quality with
respect to individuals determined to have end stage renal disease.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection display-inline="no-display-inline" id="H7C2EC5B4D28743AC9A3AFE6A46A43793"><enum>(b)</enum><header>Permanent extension of Medicare Advantage ESRD Special Needs Plans authority</header><text display-inline="yes-display-inline">Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w–28(f)(1)) is amended by inserting <quote>, in the case of a specialized MA plan for special needs individuals who have not been determined
to have end stage renal disease,</quote> before <quote>for periods before January 1, 2017</quote>.</text>
</subsection><subsection id="H498DB33CB3C94899B2222A851A8A9692"><enum>(c)</enum><header>Voluntary ESRD coordinated care gainsharing program</header>
<paragraph id="H33BF5DB3C3EB42FFA0DCFC09B8E26DD6"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is amended by adding at the end
the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HFA134EC2221A4AC9AD9CA2F9F8AA4002" style="OLC">
<paragraph id="H649053AB40F94E868F48A890D88D0668" indent="up1"><enum>(15)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H2AA0184D34CF4358B7E5263B99A47F56"><enum>(A)</enum><text display-inline="yes-display-inline">Not later than January 1, 2016, the Secretary shall, in accordance with this paragraph, establish
an ESRD Care Coordination gainsharing program for nephrologists, renal
dialysis facilities, and providers of services that develop coordinated
care organizations to provide a full range of clinical and supportive
services (as described in subparagraph (D)) to individuals determined to
have end stage renal disease.</text>
</subparagraph><subparagraph id="HA30BC7D6B7A648BEB1EDB1B73AE552BD" indent="up1"><enum>(B)</enum><text>Under such program, subject to subparagraph (C), the payment amounts renal dialysis facilities and
providers of services described in subparagraph (A) would otherwise
receive under paragraph (14) and nephrologists described in subparagraph
(A) would otherwise receive under section 1848 with respect to dialysis
services furnished by such a facility, provider, or nephrologist during a
year, shall be increased by a portion of the amount (as determined by the
Secretary) of actual reductions in expenditure under this title
attributable to the coordinated care organization developed by such
facility, provider, or nephrologist involved, taking into account
non-dialysis expenditures under parts A and B, during the preceding
calendar year. The payment amount under this subparagraph shall be
provided to a nephrologist, renal dialysis facility, and provider of
services that developed the coordinated care organization no later than
March 31 of the year after the year during which such services are
provided by such nephrologist, facility, or provider.</text>
</subparagraph><subparagraph id="H3616D0382F9A441786D0FDD65EB8B916" indent="up1"><enum>(C)</enum><text>The aggregate incentive payment amounts provided under such program for a year may not exceed the
amount equal to 2 percent less than the estimated total amount of
non-dialysis expenditures under parts A and B for 2016 for items and
services that are not related to dialysis or transplant services.</text>
</subparagraph><subparagraph id="H2C3054B1BEE04189AB40CFD22292CEE3" indent="up1"><enum>(D)</enum><text>For purposes of subparagraph (A), the full range of clinical and supportive services includes at
least the following:</text>
<clause id="H96A515A590514AC98E7F18977BC5D34A"><enum>(i)</enum><text>Primary care and other preventative services.</text>
</clause><clause id="H482D8F05DE3B41948499CEFA8270FE5D"><enum>(ii)</enum><text>Specialty care for co-morbidities or non-renal acute conditions, including at least podiatry,
cardiology, and orthopedics.</text>
</clause><clause id="H5B10C03331F347429F71266D3085E674"><enum>(iii)</enum><text>Vascular access.</text>
</clause><clause id="HF281992AD2B9430BB5A5BE3D26F33F71"><enum>(iv)</enum><text>Laboratory testing and diagnostic imaging.</text>
</clause><clause id="H44DB3618E8F345A39876FF087C9089FB"><enum>(v)</enum><text>Pharmacy care management.</text>
</clause><clause id="HD805BE70EF554AEEA0A4D3FA5CFD0A26"><enum>(vi)</enum><text>Patient, family, and caregiver education.</text>
</clause><clause id="H699DA0297CC042248CDCD8BAD815BB69"><enum>(vii)</enum><text>Psychiatric, behavioral therapy, and counseling services.</text>
</clause></subparagraph><subparagraph commented="no" id="HAF874B7FAE434AACBB88062C08C05539" indent="up1"><enum>(E)</enum><text>In providing payment incentive amounts under such program, the Secretary shall apply a risk
adjustment methodology that—</text>
<clause commented="no" id="H21E93A688F4E45C88C374F1F8A2B0D90"><enum>(i)</enum><text>uses risk adjuster factors applied under part C; and</text>
</clause><clause commented="no" id="H659DE0A91AA544D7BD9AC97C0A9AD5BD"><enum>(ii)</enum><text>adjusts such payments to exclude the top 2 percent of outliers.</text>
</clause></subparagraph><subparagraph id="H2E06376979474178A1AB1EE3B7307AC9" indent="up1"><enum>(F)</enum><text>In establishing such program, the Secretary shall ensure that each of the following is satisfied:</text>
<clause id="H73D32F2D07A747AEB72CDD628D14FC98"><enum>(i)</enum><text>The program allows for all types and sizes of renal dialysis facilities and providers of services
described in subparagraph (A), including profit and not-for-profit, urban
and rural, as well as all other types and sizes of such facilities and
providers, to participate.</text>
</clause><clause id="H8BAB2E818A054B398563DBDAA6A0368C"><enum>(ii)</enum><text display-inline="yes-display-inline">The program rewards high quality, efficient facilities and providers through gain-sharing.</text>
</clause><clause id="H49C4C43B1C1B4F1FA04C1405A5D94B73"><enum>(iii)</enum><text display-inline="yes-display-inline">For purposes of determining the actual reductions in expenditures under this title attributable to
a coordinated care organization described in subparagraph (A), the program
includes a market-based benchmark system that will not be rebased against
which such expenditures shall be compared.</text>
</clause><clause id="H50BD8AFFB3C04B3B851F12C7B96DCDEC"><enum>(iv)</enum><text display-inline="yes-display-inline">The program results in reductions of expenditures under parts A and B for services that are not
dialysis-related services.</text>
</clause><clause id="HEEAD75B8F9C1459CBB496FA8B3F08A19"><enum>(v)</enum><text display-inline="yes-display-inline">The program allows new applicants to participate in the program after the initial implementation
period.</text>
</clause><clause id="HE2602D7736284BD197C9A7D6A8212B78"><enum>(vi)</enum><text display-inline="yes-display-inline">The program establishes clear quality metrics in consultation with the kidney care community.</text>
</clause><clause id="H5F03E781E58E44989844F77F1159ACB6"><enum>(vii)</enum><text display-inline="yes-display-inline">The program provides for waivers of Federal laws or requirements, in consultation with interested
stakeholders.</text>
</clause><clause id="H9B154A05C44A44FE99454D447D246E88"><enum>(viii)</enum><text display-inline="yes-display-inline">Under such program the Secretary attributes individuals described in subparagraph (A) who receive
treatment through a care coordination organization described in such
subparagraph to such organization rather than to any other payment model
that requires beneficiary attribution.</text>
</clause><clause id="H1858F22479BA462FB93B7FC7BAE22138"><enum>(ix)</enum><text>Under such program the Secretary provides quarterly Medicare parts A and B claims data to
facilities and providers described in subparagraph (A) participating in
such program.</text>
</clause></subparagraph><subparagraph id="HC9E9C364CF6F4B99AE5B42BC21547294" indent="up1"><enum>(G)</enum><text display-inline="yes-display-inline">Not later than three years after the date of the implementation of the ESRD Care Coordination
gainsharing program, the Secretary shall submit to the Congress a report
on the waivers granted under subparagraph (F)(vii) and the effectiveness
of such waivers in allowing the coordination of care.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H1B53FC6F42994E8D9D16C5ACE5F3D3D5"><enum>(2)</enum><header>Conforming amendments</header>
<subparagraph id="HB66168196F864AFC8585445769C56085"><enum>(A)</enum><header>Section 1881</header><text display-inline="yes-display-inline">Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is amended—</text>
<clause id="H9E06EA9757D747F893CBC7F6400B9C0F"><enum>(i)</enum><text>in each of paragraphs (12)(A) and (13)(A), by striking <quote>paragraph (14)</quote> and inserting <quote>paragraphs (14) and (15)</quote>; and</text>
</clause><clause id="HC610652C98F049D48C9A1F64B51D9A21"><enum>(ii)</enum><text>in paragraph (14)(A)(i), by inserting <quote>and paragraph (15)</quote> after <quote>Subject to subparagraph (E)</quote>.</text>
</clause></subparagraph><subparagraph id="H43FAE8D22BD54AC188D75CD512EB3870"><enum>(B)</enum><header>Section 1848</header><text>Section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H60583BFF6CE2462BA2FA878E33E21E8B" style="OLC">
<subsection id="HDF5F324F6785485BAB3C1F65C1FF5BD1"><enum>(q)</enum><header>Voluntary ESRD coordinated care program</header><text display-inline="yes-display-inline">For provisions related to incentive payment amounts to nephrologists under the ESRD Care
Coordination gainsharing program, see section 1881(b)(15).</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection commented="no" id="HA5FC9D061B0346CD83FC8AEB500F40BD"><enum>(d)</enum><header>Patient information requirement</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall require hospitals that furnish items and services
to individuals entitled to benefits under part A of title XVIII of the
Social Security Act or eligible for benefits under part B of such title
and who subsequently receive dialysis services at a renal dialysis
facility (as defined in section 1881 of such Act (42 U.S.C. 1395rr)) to
provide to such facility health information with respect to such
individual, including a discharge summary and co-morbidity information,
upon request of the facility, not later than 7 days after notification by
the hospital of the provision of such services to such individual or of
the determination that such individual has end stage renal disease, as
applicable.</text>
</subsection></section>