[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4729 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 4729

  To amend the Social Security Act to provide for coverage under the 
  Medicare Program of chronic kidney disease patients who are not end-
                     stage renal disease patients.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 14, 2002

     Mr. Stark (for himself, Mr. McDermott, Mrs. Thurman, and Mrs. 
 Christensen) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, 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 amend the Social Security Act to provide for coverage under the 
  Medicare Program of chronic kidney disease patients who are not end-
                     stage renal disease patients.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Chronic Kidney Disease 
Management Act of 2002''.

SEC. 2. DELAYING ONSET OF ESRD.

    (a) Medicare Coverage of Chronic Kidney Disease Patients.--
            (1) In general.--Section 226A of the Social Security Act 
        (42 U.S.C. 426-1) is amended--
                    (A) by redesignating the last subsection as 
                subsection (e); and
                    (B) by inserting after subsection (c) the following 
                new subsection:
    ``(d)(1)(A) Notwithstanding any provision to the contrary in 
section 226 or title XVIII, every qualified chronic kidney disease 
patient (as defined in paragraph (2)) shall, in accordance with the 
succeeding provisions of this section, be entitled to benefits under 
part A and eligible to enroll under part B of title XVIII, subject to 
the deductible, premium, and coinsurance provisions of that title.
    ``(B) No qualified chronic kidney disease patient may enroll under 
part C of title XVIII.
    ``(2) For purposes of this subsection, the term ``qualified chronic 
kidney disease patient'' means an individual--
            ``(A) who would otherwise be described in subsection (a) 
        but for paragraph (2) of that subsection;
            ``(B) who has been diagnosed with chronic kidney disease;
            ``(C) with respect to whom, a physician certifies that--
                    ``(i) the individual, under generally accepted 
                clinical standards, will likely need dialysis 
                treatments or a kidney transplant within the two-year 
                period beginning on the date of certification; and
                    ``(ii) the individual may benefit from a program of 
                pre-ESRD services (as defined in section 1861(ww)(1)); 
                and
            ``(D) who certifies that the individual does not have 
        health insurance coverage.''.
            (2) Conforming amendments.--Section 1811 of such Act (42 
        U.S.C. 1395c) is amended by inserting before the period the 
        following: ``or who are qualified chronic kidney disease 
        patient (as defined in section 226A(d)(2))''.
    (3) Effective Date.--The amendments made by this subsection shall 
take effect January 1, 2004.
    (b) Coverage of pre-ESRD Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (U);
                    (B) by inserting ``and'' at the end of subparagraph 
                (V); and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(W) pre-ESRD services (as defined in subsection (ww)(1)) 
        for an individual who has been diagnosed with chronic kidney 
        disease and, with respect to whom, a physician certifies that--
                    ``(i) the individual, under generally accepted 
                clinical standards, will likely need dialysis 
                treatments within the two-year period beginning on the 
                date of certification; and
                    ``(ii) the individual may benefit from a program of 
                pre-ESRD services;''.
            (2) Services Described.--Section 1861 of the Social 
        Security Act (42 U.S.C. 1395x) is amended by adding at the end 
        the following new subsection:

                          ``Pre-ESRD Services

    ``(ww)(1) The term `pre-ESRD Services' means any or all of the 
following services:
            ``(A) Individual and group nutritional counseling services 
        for the purpose of chronic kidney disease management that are 
        furnished by a registered dietitian or nutrition professional 
        (as defined in subsection (vv)(2)) pursuant to a referral by a 
        physician (as defined in subsection (r)(1)).
            ``(B) Counseling furnished by qualified health care 
        providers that--
                    ``(i) provides comprehensive information regarding 
                the management of comorbidities, and the prevention of 
                uremic complications;
                    ``(ii) ensures active participation of the 
                individual in the choice of therapy or therapies; and
                    ``(iii) provides comprehensive information 
                regarding modalities of treatment for kidney disease 
                and end-stage renal disease, including organ 
                transplantation, hemodialysis, peritoneal dialysis, and 
                home dialysis.
            ``(C) Counseling, items and services, including tissue 
        typing, furnished by qualified health care providers for 
        preparation of possible organ transplantation.
            ``(D) Items and services furnished by qualified health care 
        providers for the preparation of vascular access required for 
        dialysis treatment.
            ``(E) Such other services as the Secretary determines 
        appropriate, in consultation with national organizations 
        representing individuals and entities who furnish pre-ESRD 
        services and patients receiving such services.
    ``(2) The Secretary shall establish such criteria as the Secretary 
determines appropriate for qualifications required for individuals to 
furnish pre-ESRD services under paragraph (1).''.
            (3) Payment amount.--
                    (A) In general.--Section 1833(a)(1) of the Social 
                Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                            (i) by striking ``and'' before ``(U)''; and
                            (ii) by inserting before the semicolon at 
                        the end the following: ``, and (V) with respect 
                        to pre-ESRD services, the amount paid shall be 
                        80 percent of the amount determined under the 
                        fee schedule established under section 
                        1834(e)''.
                    (B) Establishment of fee schedule.--Section 1834 of 
                such Act (42 U.S.C. 1395m) is amended by inserting 
                after subsection (d) the following new subsection:
    ``(e) Fee Schedule for pre-ESRD Services.--
            ``(1) In general.--The Secretary shall establish a fee 
        schedule for payment for pre-ESRD services in accordance with 
        the requirements of this subsection.
            ``(2) Considerations.--In establishing such fee schedule, 
        the Secretary shall--
                    ``(A) establish mechanisms to promote the efficient 
                delivery of care;
                    ``(B) establish definitions for pre-ESRD services 
                which link payments to the type of services provided;
                    ``(C) consider appropriate regional and operational 
                differences; and
                    ``(D) consider adjustments to payment rates to 
                account for inflation and other relevant factors.
            ``(3) Consultation.--In establishing the fee schedule for 
        pre-ESRD services under this subsection, the Secretary shall 
        consult with various national organizations representing 
        individuals and entities who furnish pre-ESRD services and 
        patients receiving such services.
            ``(4) Coding system.--The Secretary may require the claim 
        for any services for which the amount of payment is determined 
        under this subsection to include a code (or codes) under a 
        uniform coding system specified by the Secretary that 
        identifies the services furnished.''.
            (3) Permitting dialysis facilities to bill for pre-ESRD 
        services furnished in the facility.--Section 1881(b) is amended 
        by adding at the end the following new paragraph:
    ``(12) A renal dialysis facility may provide for the furnishing of 
some or all pre-ESRD services (as defined in section 1861(ww)(2). The 
facility may submit to the Secretary a claim for payment for such 
services furnished in the facility, and the Secretary shall not require 
the facility, or the employee of the facility who is qualified to 
furnish such services, to apply for a separate provider number for 
purposes of payment under this title.''.
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