[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1068 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 1068

   To direct the Secretary of Health and Human Services to conduct a 
   demonstration project under which payment shall be made under the 
  medicare program for renal disease management services furnished to 
 individuals at risk for end stage renal disease to accurately assess 
whether those management services can prevent the progression of renal 
 disease to renal failure and thereby delay the onset of dialysis and 
                cause savings for the medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 27, 1995

  Mr. Stark introduced the following bill; which was referred to the 
 Committee on Commerce and, in addition, to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
   To direct the Secretary of Health and Human Services to conduct a 
   demonstration project under which payment shall be made under the 
  medicare program for renal disease management services furnished to 
 individuals at risk for end stage renal disease to accurately assess 
whether those management services can prevent the progression of renal 
 disease to renal failure and thereby delay the onset of dialysis and 
                cause savings for the medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. ESTABLISHMENT OF DEMONSTRATION PROJECT.

    (a) In General.--Not later than six months after the date of the 
enactment of this Act, the Secretary of Health and Human Services 
(hereafter referred to as the ``Secretary'') shall conduct a 
demonstration project under which the Secretary shall make payment 
under the medicare program for renal disease management services 
furnished to eligible individuals participating in the project to 
accurately assess whether those management services can prevent the 
progression of renal disease to renal failure and thereby delay the 
onset of dialysis and cause savings for the medicare program.
    (b) Selection of Sites.--The Secretary shall conduct the 
demonstration project under this Act at two sites selected by the 
Secretary in accordance with such criteria as the Secretary may 
establish.

SEC. 2. DESCRIPTION OF ELIGIBLE INDIVIDUALS AND COVERED SERVICES.

    (a) Eligible Individuals.--An individual is an eligible individual 
for purposes of participation in the demonstration project if--
            (1) the individual's attending physician certifies that the 
        individual is at risk for, but does not suffer from, end stage 
        renal disease (in accordance with criteria established by the 
        Secretary);
            (2) the individual is not entitled to benefits under Part A 
        or enrolled under part B of the medicare program; and
            (3) the individual meets such other requirements as the 
        Secretary may impose.
    (b) Renal Disease Management Services Described.--For purposes of 
this Act, ``renal disease management services'' are services designed 
to prevent the onset of end stage renal disease, including--
            (1) dietary counseling and improvement in nutritional 
        status;
            (2) the management of diabetes, hypertension, and other 
        conditions associated with the onset of end stage renal 
        disease;
            (3) reduction of cardiovascular risk factors;
            (4) correction of metabolic, endocrinologic, and 
        hematologic abnormalities;
            (5) improvements in patient education of the causes and 
        course of the disease;
            (6) the evaluation and control of environmental 
        nephrotoxins; and
            (7) such other services as the Secretary considers 
        appropriate.

SEC. 3. DETERMINATION OF AMOUNT OF PAYMENT FOR COVERED SERVICES.

    (a) Application of Medicare Payment Methodologies.--To the extent 
that a renal disease management service for which payment may be made 
under the demonstration project is a service for which payment may be 
made under title XVIII of the Social Security Act, the amount of 
payment made for the service under the demonstration project shall be 
determined in accordance with the methodology used to determine the 
amount of payment for the service under such title.
    (b) Payment for Services Not Covered Under Medicare.--To the extent 
that a renal disease management service for which payment may be made 
under the demonstration project is not a service for which payment may 
be made under title XVIII of the Social Security Act, the amount of 
payment made for the service under the demonstration project shall be 
determined in accordance with such methodology as the Secretary may 
establish.

SEC. 4. INDEPENDENT MONITORING OF PROJECT.

    The Secretary shall enter into a contract with an entity not 
otherwise participating in or affiliated with the demonstration project 
to monitor the project and to assess and make public the extent to 
which--
            (1) the implementation of renal disease management services 
        produces increased job retention, preservation of meaningful 
        and taxable income, or improvement in the quality of life as 
        measured by health status questionnaires or other tools as 
        established by the Secretary;
            (2) renal disease management services affect the patient's 
        functional outcome and/or natural history of their kidney 
        disease as compared to a well-matched control group and 
        measured by variables as the Secretary may establish; and
            (3) the implementation of renal disease management services 
        in eligible individuals as a means to aggressively manage the 
        factors contributing to kidney disease has delayed the 
        progression of renal disease and, therefore, the onset of 
        dialysis.

SEC. 5. TERMINATION OF PROJECT.

    The demonstration project conducted under this Act shall terminate 
upon the expiration of the three-year period which begins on the first 
date on which the project is in effect.
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