1.
Short title; table of contents
(a)
This Act may be cited as the
Kidney Care Quality and Improvement
Act of 2005
.
(b)
The table of contents for
this Act is as follows:
Sec. 1. Short
title.
TITLE I—Recognizing and improving quality for
patients
Sec. 101. Modification of physician surgical reimbursement for
dialysis access procedures to align incentives for cost and
quality.
Sec. 102. Demonstration project for outcomes-based ESRD
reimbursement system.
Sec. 103. Required training for patient care dialysis
technicians.
TITLE II—Ensuring quality through improvements in the ESRD
payment system
Sec. 201. Establishment of annual update framework for the
medicare ESRD composite rate.
Sec. 202. Extension of medicare secondary payer.
Sec. 203. GAO study and report on impact of
G-codes.
TITLE III—Improving quality through patient education, access,
and safety initiatives
Sec. 301. Support of public and patient education initiatives
regarding kidney disease.
Sec. 302. Medicare coverage of kidney disease patient education
services.
Sec. 303. Blood flow monitoring demonstration
projects.
TITLE IV—Improving quality through improved coverage
Sec. 401. Improving the home dialysis benefit.
Sec. 402. Institute of Medicine evaluation and report on home
dialysis.
Sec. 403. Establishment of an End-Stage Renal Disease (ESRD)
Advisory committee.
<enum>I</enum>
<header>Recognizing and improving quality for patients</header>
<section commented="no" display-inline="no-display-inline" id="ID08cdf2a99955430b943d3c0f06f4a4fe" section-type="subsequent-section">
<enum>101.</enum>
<header>Modification of physician surgical reimbursement for dialysis
access procedures to align incentives for cost and quality</header>
<subsection commented="no" display-inline="no-display-inline" id="id3FA113DD989B4D6B9D8385F7214A36B5">
<enum>(a)</enum>
<header>Full coverage of dialysis access procedures in the ambulatory
surgical center setting</header>
<text display-inline="yes-display-inline">Not later than January 1,
2007, the Secretary of Health and Human Services shall—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id7158991752384BA980444D2005D794B4">
<enum>(1)</enum>
<text display-inline="yes-display-inline">review the surgical
procedures specified under section 1833(i)(1) of the Social Security Act (42
U.S.C. 1395l(i)(1)) and evaluate whether to include in such procedures the full
range of dialysis access procedures, including all reasonable and necessary
intervention procedures for the repair and maintenance of an individual's
dialysis access, such as the placement, insertion, and maintenance services
related to fistulas, synthetic grafts, tunnel catheters, and peritoneal
dialysis catheters; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5C7D3016CED746D0BA155588D978E8B3">
<enum>(2)</enum>
<text display-inline="yes-display-inline">revise such units to reflect
the findings of the evaluation.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="IDfe8934a35c2d466bb3e36f36dc857b59">
<enum>(b)</enum>
<header>Revision of RBRVS to reflect the difficulty of vascular access
procedures</header>
<text display-inline="yes-display-inline">Not later than January 1,
2007, the Secretary of Health and Human Services shall—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id0C82966198BD4F45B80F681013D77C00">
<enum>(1)</enum>
<text display-inline="yes-display-inline">review the relative value
units determined under section 1848(c)(2) of the Social Security Act (42 U.S.C.
1395w–4(c)(2)) that are applicable with respect to physicians' services for
vascular access procedures; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id323F38BB19C34C93A96BD647E640D688">
<enum>(2)</enum>
<text display-inline="yes-display-inline">revise such units to
accurately reflect the difficulty of such procedures.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="ID5b9e429c0805452a9e096ab7f08d0848" section-type="subsequent-section">
<enum>102.</enum>
<header>Demonstration project for outcomes-based ESRD reimbursement
system</header>
<subsection commented="no" display-inline="no-display-inline" id="IDd56008471dbb42f387c53384f6ea6c17">
<enum>(a)</enum>
<header>Establishment</header>
<text display-inline="yes-display-inline">Subject to the succeeding
provisions of this section, the Secretary of Health and Human Services (in this
section referred to as the <term>Secretary</term>) shall establish
demonstration projects under which the Secretary shall evaluate methods that
improve the quality of care provided to medicare beneficiaries with end-stage
renal disease.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="ID440492b035784e5089de86276a9fe663">
<enum>(b)</enum>
<header>Outcomes-Based ESRD reimbursement system</header>
<paragraph commented="no" display-inline="no-display-inline" id="ID732bf167e2ab44c693d2f99773def6c3">
<enum>(1)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">Under the demonstration
projects, the Secretary shall provide financial incentives to providers of
services and renal dialysis facilities that demonstrate improved quality of
care to such beneficiaries.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDc057bac52102445a80cc0cc0db8ef4b5">
<enum>(2)</enum>
<header>Consideration of outcomes and case-mix</header>
<text display-inline="yes-display-inline">In determining whether a
provider or facility has demonstrated an improved quality of care under
paragraph (1), the Secretary shall take into account the outcomes of
individuals receiving services from the provider or facility and the case-mix
of the provider or facility, paying particular attention to improved patient
safety, better vaccination rates, and improved care for diabetes.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDf4aaf6f0db1a413fb414e3d577f9d777">
<enum>(3)</enum>
<header>Incentives described</header>
<text display-inline="yes-display-inline">The financial incentives
provided under paragraph (1) shall—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDd5af86b1d5ea4690b0918ebf5b219011">
<enum>(A)</enum>
<text display-inline="yes-display-inline">reflect the interactions of
payments under parts A and B of title XVIII of the Social Security Act;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID07616ebf17cb4f3589dc78f2de2ec0ab">
<enum>(B)</enum>
<text display-inline="yes-display-inline">recognize improvements based
on high quality outcomes during previous periods as well as recent changes in
performance to reward long-term improvements.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="IDe4a48b1cd52e4d0cb9da480b763b9175">
<enum>(c)</enum>
<header>Duration</header>
<text display-inline="yes-display-inline">The Secretary shall conduct
the demonstration project under this section for a period that is not longer
than 5 years that begins on January 1, 2007.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="IDbce650374abe4ce4b3f305b2adf4e74c">
<enum>(d)</enum>
<header>Evaluation and report</header>
<paragraph commented="no" display-inline="no-display-inline" id="ID48e3208c5dff480594919d4c5a1ed61b">
<enum>(1)</enum>
<header>Evaluation</header>
<text display-inline="yes-display-inline">The Secretary shall conduct
an evaluation of the demonstration projects conducted under this
section.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID7a237721b20341868fe15f52891f8e8e">
<enum>(2)</enum>
<header>Report</header>
<text display-inline="yes-display-inline">Not later than 6 months after
the date on which the demonstration projects are completed, the Secretary shall
submit to Congress a report on the evaluation conducted under paragraph (1)
together with recommendations for such legislation and administrative action as
the Secretary determines appropriate.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID848f86880b1b40f49179c7331dca87fa">
<enum>(e)</enum>
<header>Waiver authority</header>
<text display-inline="yes-display-inline">The Secretary shall waive
compliance with the requirements of title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) to such extent and for such period as the Secretary
determines is necessary to conduct the demonstration projects.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="ID7b5dcc9248854ecfad5c1fd8526bc3bd">
<enum>(f)</enum>
<header>Authorization of appropriations</header>
<paragraph commented="no" display-inline="no-display-inline" id="ID4d5f17495f68419ba4ff3c6c78adc179">
<enum>(1)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">Payments for the costs of
carrying out the demonstration project under this section shall be made from
the Federal Supplementary Medical Insurance Trust Fund under section 1841 of
such Act (42 U.S.C. 1395t).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDa2f688e8c32844c88d98533fb4ce187d">
<enum>(2)</enum>
<header>Amount</header>
<text display-inline="yes-display-inline">There are authorized to be
appropriated from such Trust Fund such sums as may be necessary to carry out
this section.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="IDceee992aa85743c09912d28962efd6e2" section-type="subsequent-section">
<enum>103.</enum>
<header>Required training for patient care dialysis
technicians</header>
<subsection commented="no" display-inline="no-display-inline" id="id2DC11E80AE844B7085C170367B988184">
<enum>(a)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">Section 1881 of the Social
Security Act (42 U.S.C. 1395rr) is amended by adding the following:</text>
<quoted-block display-inline="no-display-inline" id="id27FEB70D0AA6489E830EF5AAB3B1F514" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="ID6ab45e07100b4b51975b2c548574ab36">
<enum>(h)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="id27FE4D9A548E452E8CC57E7BC98CCE68"><enum>(1)</enum>
<text display-inline="yes-display-inline">Except as provided in
paragraph (3), beginning January 1, 2007, a provider of services or a renal
dialysis facility may not use any individual as a patient care dialysis
technician for more than 4 months unless the individual—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDee11ff383b14494b9cbe8fd47f2d44dd" indent="up1">
<enum>(A)</enum>
<text display-inline="yes-display-inline">has completed a training
program in the care and treatment of an individual with chronic kidney failure
who is undergoing dialysis treatment;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idE7735518589C48B78D1C55E1BE3D8324" indent="up1">
<enum>(B)</enum>
<text display-inline="yes-display-inline">has been certified by a
nationally recognized certification entity for dialysis technicians; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDdd31986f055144a1bdd5e25ab36dac83" indent="up1">
<enum>(C)</enum>
<text display-inline="yes-display-inline">is competent to provide
dialysis-related services.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDbcf3f233af6d4be68a8b0896169cbc70" indent="up1">
<enum>(2)</enum>
<text display-inline="yes-display-inline">Beginning January 1, 2008,
a provider of services or a renal dialysis facility may not use on a temporary,
per diem, leased, or on any basis other than as a permanent employee, any
individual as a patient care dialysis technician unless the individual meets
the requirements described in subparagraphs (A), (B), and (C) of paragraph
(1).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID2d90112a65e248ce850282cfe732d399" indent="up1">
<enum>(3)</enum>
<text display-inline="yes-display-inline">A provider of services or a
renal dialysis facility may permit an individual enrolled in a training program
described in paragraph (1)(A) to serve as a patient care dialysis technician
while they are so enrolled.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDf85cdd37a8654a6e897e21301ab76500" indent="up1">
<enum>(4)</enum>
<text display-inline="yes-display-inline">For purposes of paragraph
(1), if, since the most recent completion by an individual of a training
program described in paragraph (1)(A), there has been a period of 24
consecutive months during which the individual has not performed
dialysis-related services for monetary compensation, such individual shall be
required to complete a new training program or become re-certified as described
in paragraph (1)(B).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDe90597e718dd4cd491adbfc4f3c7715a" indent="up1">
<enum>(5)</enum>
<text display-inline="yes-display-inline">A provider of services or a
renal dialysis facility shall provide such regular performance review and
regular in-service education as assures that individuals serving as patient
care dialysis technicians for the provider or facility are competent to perform
dialysis-related services.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section>
<enum>II</enum>
<header>Ensuring quality through improvements in the ESRD payment
system</header>
<section commented="no" display-inline="no-display-inline" id="id8B42E469B38C454A8346C55A14090CE4" section-type="subsequent-section">
<enum>201.</enum>
<header>Establishment of annual update framework for the medicare ESRD
composite rate</header>
<subsection commented="no" display-inline="no-display-inline" id="idF6684ECC09924723A8FABA374E4BFDFB">
<enum>(a)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">Section 1881(b)(12)(F) of the
Social Security Act (42 U.S.C. 1395rr(b)(12)(F)) is amended to read as
follows:</text>
<quoted-block display-inline="no-display-inline" id="id1964D11D04C049AFBDDE328B77A82295" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="ID2492c03984b6427a90506824fb3077cc" indent="up2">
<enum>(F)</enum>
<text display-inline="yes-display-inline">Beginning with 2006, the
Secretary shall annually increase the basic case-mix adjusted payment amounts
established under this paragraph—</text>
<clause commented="no" display-inline="no-display-inline" id="IDefdb729340c942dfb822db7e2411e865">
<enum>(i)</enum>
<text display-inline="yes-display-inline">with respect to the
component of the basic case-mix adjusted system described in clause (ii) of
subparagraph (B), by—</text>
<subclause commented="no" display-inline="no-display-inline" id="ID89865ee3ea3744ef96987a53cc07121c">
<enum>(I)</enum>
<text display-inline="yes-display-inline">applying the estimated
growth in expenditures for drugs and biologicals (including erythropoietin)
that are separately billable to such component; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="id22620EB7A85F47D18C0219A9C69208FE">
<enum>(II)</enum>
<text display-inline="yes-display-inline">converting the amount
determined in subclause (I) to an increase applicable to the basic case-mix
adjusted payment amounts established under such subparagraph; and</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="ID5838712436304ec9bbb93b24609ac1d5">
<enum>(ii)</enum>
<text display-inline="yes-display-inline">with respect to the
composite rate component of the basic case-mix adjusted system described in
subparagraph (B)(i), for dialysis services furnished—</text>
<subclause commented="no" display-inline="no-display-inline" id="id5DE6D5FC27404094A3DCB95B99087FB8">
<enum>(I)</enum>
<text display-inline="yes-display-inline">during 2006, by 2.5 percent
above such payment amounts for such services furnished on December 31,
2005;</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="id602066AF977C49FC8645B2558232887E">
<enum>(II)</enum>
<text display-inline="yes-display-inline">during 2007 through 2014,
by an amount equal to 1 percent of the ESRD market basket percentage increase
(as defined in paragraph (14)(A), and including any additional factors that may
increase costs described in paragraph (14)(B)) above such composite rate
payment amounts for such services furnished on December 31 of the previous
year; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="idEF5A2F035F844055A60A724087768FA3">
<enum>(III)</enum>
<text display-inline="yes-display-inline">during 2015 and subsequent
years, by the ESRD market basket percentage increase (as defined in paragraph
(14)(A) and including any additional factors that may increase costs described
in paragraph (14)(B)) above such composite rate payment amounts for such
services furnished on December 31 of the previous year.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="IDa5fdfaf0e93f49d2ae14b7f69f36e731">
<enum>(b)</enum>
<header>ESRD market basket percentage increase defined</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 act-name="" display-inline="no-display-inline" id="idE69805B5689F4978AB5D58F8A520E04D" style="traditional">
<paragraph commented="no" display-inline="no-display-inline" id="id63187A5BF85F4A92BD5C4A72B0DE5972" indent="up1">
<enum>(14)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="idF6FED394F6814880A1E8B1C5D605A087"><enum>(A)</enum>
<text display-inline="yes-display-inline">For purposes of this title,
the term <quote>ESRD market basket percentage increase</quote> means, with
respect to a calendar year, the percentage (estimated by the Secretary before
the beginning of such year) by which—</text>
<clause commented="no" display-inline="no-display-inline" id="idFD86F7BA082A4193AD9E3BE635A02E9B" indent="up1">
<enum>(i)</enum>
<text display-inline="yes-display-inline">the cost of the mix of
goods and services included in the provision of dialysis services (including
the costs described in subparagraph (D)) that is determined based on an index
of appropriately weighted indicators of changes in wages and prices which are
representative of the mix of goods and services included in such dialysis
services for the calendar year; exceeds</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idAB27F1D52750404689E395374B4F1FFE" indent="up1">
<enum>(ii)</enum>
<text display-inline="yes-display-inline">the cost of such mix of
goods and services for the preceding calendar year.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id344DCDC69CB14625A53C39F77A1B9D97" indent="up1">
<enum>(B)</enum>
<text display-inline="yes-display-inline">In addition to determining
the percentage update under subparagraph (A), the Secretary shall also take
into account any change in the costs of furnishing the mix of goods and
services described in such subparagraph resulting from—</text>
<clause commented="no" display-inline="no-display-inline" id="id2A73B2FC00A642D3B64ADDBD4F872470">
<enum>(i)</enum>
<text display-inline="yes-display-inline">the adoption of scientific
and technological innovations used to provide dialysis services;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id52ECF830FBCF4E99AC3698C0CE62585A">
<enum>(ii)</enum>
<text display-inline="yes-display-inline">changes in the manner or
method of delivering dialysis services;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id443A8B85B349427CB895C53F2D41E46D">
<enum>(iii)</enum>
<text display-inline="yes-display-inline">productivity improvements
in the provision of dialysis services; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id62DB376674CC420BAC90D0581C74D372">
<enum>(iv)</enum>
<text display-inline="yes-display-inline">any other relevant
factor.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id373BF9AF9BF740A1A21D65A673EBAEF2" indent="up1">
<enum>(C)</enum>
<text display-inline="yes-display-inline">The Secretary shall
annually review and update the items and services included in the mix of goods
and services used to determine the percentage under subparagraph (A).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id8D48FC1092B7443892EB73591B7B0EFC" indent="up1">
<enum>(D)</enum>
<text display-inline="yes-display-inline">The costs described in this
subparagraph include—</text>
<clause commented="no" display-inline="no-display-inline" id="idFBFD2B5142C64954B69EF8E18E3D6AD4">
<enum>(i)</enum>
<text display-inline="yes-display-inline">labor costs, including
direct patient care costs and administrative labor costs, vacation and holiday
pay, payroll taxes, and employee benefits;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id0614FDB3C557436E9D2C243A621B6B71">
<enum>(ii)</enum>
<text display-inline="yes-display-inline">other direct costs,
including drugs, supplies, and laboratory fees;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id2B4510D6751C43B49FB17A2DA111C086">
<enum>(iii)</enum>
<text display-inline="yes-display-inline">overhead costs, including
medical director fees, temporary services, general and administrative costs,
interest expenses, and bad debt;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idAA4377D9527D41138E5B61A73F3920DF">
<enum>(iv)</enum>
<text display-inline="yes-display-inline">capital costs, including
rent, real estate taxes, depreciation, utilities, repairs, and maintenance;
and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idD1A20C34A05349619F7C0682A6FD7A64">
<enum>(v)</enum>
<text display-inline="yes-display-inline">such other allowable costs
as the Secretary may specify.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" display-inline="no-display-inline" id="IDac736b54f2044219b4227413d5f4c43d" section-type="subsequent-section">
<enum>202.</enum>
<header>Extension of medicare secondary payer</header>
<subsection commented="no" display-inline="no-display-inline" id="ID422ebe9eedcc4f5d8886c3926c98169c">
<enum></enum><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" display-inline="no-display-inline" id="ID3ebb1f4b43604557b65f789eb3532509">
<enum>(1)</enum>
<text display-inline="yes-display-inline">in the last sentence, by
inserting <quote>, and before January 1, 2006</quote> after <quote>prior to
such date)</quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDad4f850dbadc47a4b800552ad7f0d02f">
<enum>(2)</enum>
<text display-inline="yes-display-inline">by adding at the end the
following new sentence: <quote>Effective for items and services furnished on or
after January 1, 2006 (with respect to periods beginning on or after the date
that is 30 months prior to such date), clauses (i) and (ii) shall be applied by
substituting <quote>33-month</quote> for <quote>12-month</quote> each place it
appears in the first sentence.</quote>.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id4E002401821648F693F59F2BA3E2BE3A" section-type="subsequent-section">
<enum>203.</enum>
<header>GAO study and report on impact of G-codes</header>
<subsection commented="no" display-inline="no-display-inline" id="idDF2E7CC76886471FA61D1934AD6D3A44">
<enum>(a)</enum>
<header>Study</header>
<text display-inline="yes-display-inline">The Comptroller General of
the United States shall conduct a study on the impact of the temporary codes
for nephrologists’ services applicable under the fee schedule for physicians'
services under section 1848 of the Social Security Act (42 U.S.C. 1395w–4)
(commonly known as <quote>G-codes</quote>).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id2F8171DD478748B49567D3D0FF0F7AB7">
<enum>(b)</enum>
<header>Report</header>
<text display-inline="yes-display-inline">Not later than the date that
is 6 months after the date of enactment of this Act, the Comptroller General
shall submit to Congress a report on the study conducted under subsection (a)
together with recommendations for such legislation and administrative action as
the Comptroller General determines appropriate.</text>
</subsection></section>
<enum>III</enum>
<header>Improving quality through patient education, access, and safety
initiatives</header>
<section commented="no" display-inline="no-display-inline" id="ID53bd04430cbe4e9dade3f10ac8fad698" section-type="subsequent-section">
<enum>301.</enum>
<header>Support of public and patient education initiatives regarding
kidney disease</header>
<subsection commented="no" display-inline="no-display-inline" id="ID396c008d66f74337bc5d9c9c596de6b5">
<enum>(a)</enum>
<header>Chronic kidney disease demonstration projects</header>
<paragraph commented="no" display-inline="no-display-inline" id="IDc27acd36a9ca45098073f255683cb0d3">
<enum>(1)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">The Secretary of Health and
Human Services (in this section referred to as the <quote>Secretary</quote>)
shall establish demonstration projects to—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDe0867bdc19d44005917d1c5ae9230826">
<enum>(A)</enum>
<text display-inline="yes-display-inline">increase public awareness
about the factors that lead to chronic kidney disease, how to prevent it, how
to treat it, and how to avoid kidney failure; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID14d335c1fe674c4c8cc3381ac358dc8f">
<enum>(B)</enum>
<text display-inline="yes-display-inline">enhance surveillance systems
and expand research to better assess the prevalence and incidence of chronic
kidney disease.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID321bee4d2aaf41238877e3c4e96647f0">
<enum>(2)</enum>
<header>Scope and duration</header>
<subparagraph commented="no" display-inline="no-display-inline" id="ID4bbddd73ec9f4013ae9aa98a980aa390">
<enum>(A)</enum>
<header>Scope</header>
<text display-inline="yes-display-inline">The Secretary shall select at
least 3 States in which to conduct demonstration projects under this
subsection. In selecting the States under this subparagraph, the Secretary
shall take into account the size of the population of medicare beneficiaries
with end-stage renal disease and ensure the participation of individuals who
reside in rural and urban areas.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID980077212ae34cbbbd3da579cee63b50">
<enum>(B)</enum>
<header>Duration</header>
<text display-inline="yes-display-inline">The demonstration projects
under this subsection shall be conducted for a period that is not longer than 5
years that begins on January 1, 2007.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID46c19d2bb4ff4fa3bf2658c5732d7e8a">
<enum>(3)</enum>
<header>Evaluation and report</header>
<subparagraph commented="no" display-inline="no-display-inline" id="ID6aa9d336e9334792b1d9c45e5b8234bb">
<enum>(A)</enum>
<header>Evaluation</header>
<text display-inline="yes-display-inline">The Secretary shall conduct
an evaluation of the demonstration projects conducted under this
subsection.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDad20fab7affb43b384452fa8177cca34">
<enum>(B)</enum>
<header>Report</header>
<text display-inline="yes-display-inline">Not later than 6 months after
the date on which the demonstration projects under this subsection are
completed, the Secretary shall submit to Congress a report on the evaluation
conducted under subparagraph (A) together with recommendations for such
legislation and administrative action as the Secretary determines
appropriate.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID52a6e3c35eab41fb9b4dc4e6b873bc69">
<enum>(4)</enum>
<header>Authorization of appropriations</header>
<text display-inline="yes-display-inline">There are authorized to be
appropriated to carry out this subsection $2,000,000 for each of fiscal years
2007 through 2011.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID1b760f58604d4d2fa0f7f87ccbeefa39">
<enum>(b)</enum>
<header>ESRD Self-Management demonstration projects</header>
<paragraph commented="no" display-inline="no-display-inline" id="ID07445212e8e640f9be3dbdd457a900aa">
<enum>(1)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">The Secretary shall establish
demonstration projects to enable individuals with end-stage renal disease to
develop self-management skills.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDb4aa5755bf3043b4a09c04087e8f1a0c">
<enum>(2)</enum>
<header>Scope and duration</header>
<subparagraph commented="no" display-inline="no-display-inline" id="ID9b4b3cbcebe94cf7b865173db1ff70f1">
<enum>(A)</enum>
<header>Scope</header>
<text display-inline="yes-display-inline">The Secretary shall select at
least 3 States in which to conduct demonstration projects under this
subsection. In selecting the States under this subparagraph, the Secretary
shall take into account the size of the population of medicare beneficiaries
with end-stage renal disease and ensure the participation of individuals who
reside in rural and urban areas.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDecd5ff4b162149d299429224f3f46445">
<enum>(B)</enum>
<header>Duration</header>
<text display-inline="yes-display-inline">The demonstration projects
under this section shall be conducted for a period that is not longer than 5
years that begins on January 1, 2007.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID5b1f8bc709634b4aa7f6f322a75d0d53">
<enum>(3)</enum>
<header>Evaluation and report</header>
<subparagraph commented="no" display-inline="no-display-inline" id="IDb872241e24444360bdc6c2ea95813496">
<enum>(A)</enum>
<header>Evaluation</header>
<text display-inline="yes-display-inline">The Secretary shall conduct
an evaluation of the demonstration projects conducted under this
subsection.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID56e28b139375456d95b9d3edfd4796b4">
<enum>(B)</enum>
<header>Report</header>
<text display-inline="yes-display-inline">Not later than 6 months after
the date on which the demonstration projects under this subsection are
completed, the Secretary shall submit to Congress a report on the evaluation
conducted under subparagraph (A) together with recommendations for such
legislation and administrative action as the Secretary determines
appropriate.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDb971ac2b13f1490b84493a62b656a121">
<enum>(4)</enum>
<header>Authorization of appropriations</header>
<text display-inline="yes-display-inline">There are authorized to be
appropriated to carry out this subsection $2,000,000 for each of fiscal years
2007 through 2011.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="ID0d56645f996e4e16833e5a977116f111" section-type="subsequent-section">
<enum>302.</enum>
<header>Medicare coverage of kidney disease patient education
services</header>
<subsection commented="no" display-inline="no-display-inline" id="ID58d92026229c418792b0acbd0cbfc197">
<enum>(a)</enum>
<header>Coverage of kidney disease education services</header>
<paragraph commented="no" display-inline="no-display-inline" id="IDaf773aec205045d18827b976e5060522">
<enum>(1)</enum>
<header>Coverage</header>
<text display-inline="yes-display-inline">Section 1861(s)(2) of the
Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDb7bbdb2563624a67864ba66429880c13">
<enum>(A)</enum>
<text display-inline="yes-display-inline">in subparagraph (Y), by
striking <quote>and</quote> after the semicolon at the end;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID7381931776ce41c4b4dcd19d78097afb">
<enum>(B)</enum>
<text display-inline="yes-display-inline">in subparagraph (Z), by
adding <quote>and</quote> after the semicolon at the end; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID38d237ae45994c258aea6d9a133ba8bc">
<enum>(C)</enum>
<text display-inline="yes-display-inline">by adding at the end the
following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idE68A9F69E5BB48E3A7FFDB7722072602" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="IDf645960ffb12459aa4e2949563b27073" indent="up1">
<enum>(AA)</enum>
<text display-inline="yes-display-inline">kidney disease education
services (as defined in subsection (bbb));</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID365a784302c34b2a917374f1375b4816">
<enum>(2)</enum>
<header>Services described</header>
<text display-inline="yes-display-inline">Section 1861 of the Social
Security Act (42 U.S.C. 1395x) is amended by adding at the end the following
new subsection:</text>
<quoted-block act-name="" display-inline="no-display-inline" id="id062ACB416F534B30814FACB9B82B95F2" other-style="archaic" style="other">
<subsection commented="no" display-inline="no-display-inline" id="idCD346D725CD34917A0015BF2599072B6">
<enum>(bbb)</enum>
<header>Kidney disease education services</header><paragraph commented="no" display-inline="yes-display-inline" id="id6D1EC71EA13046FBB0D43CD2422743EA"><enum>(1)</enum>
<text display-inline="yes-display-inline">The term <term>kidney
disease education services</term> means educational services that are—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idF9E5DCFD79344A5199F04EC92A17C94D" indent="up1">
<enum>(A)</enum>
<text display-inline="yes-display-inline">furnished to an individual
with kidney disease who, according to accepted clinical guidelines identified
by the Secretary, will require dialysis or a kidney transplant;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID34e2f78611ec4f24b8bdc263d58ac1cb" indent="up1">
<enum>(B)</enum>
<text display-inline="yes-display-inline">furnished, upon the
referral of the physician managing the individual's kidney condition, by a
qualified person (as defined in paragraph (2)); and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDdeb1c6f7d2854665956c3538583dd8bb" indent="up1">
<enum>(C)</enum>
<text display-inline="yes-display-inline">designed—</text>
<clause commented="no" display-inline="no-display-inline" id="IDca302a52980b4fab9930e3d363d11a48">
<enum>(i)</enum>
<text display-inline="yes-display-inline">to provide comprehensive
information regarding—</text>
<subclause commented="no" display-inline="no-display-inline" id="ID6bf998ac67f34dfabfc6343f681cd97a">
<enum>(I)</enum>
<text display-inline="yes-display-inline">the management of
comorbidities;</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="ID4831baa38565470aa051ef27f60bb5de">
<enum>(II)</enum>
<text display-inline="yes-display-inline">the prevention of uremic
complications; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="IDca569e9e6dd242b38c651aff340439c8">
<enum>(III)</enum>
<text display-inline="yes-display-inline">each option for renal
replacement therapy (including home and in-center as well as vascular access
options and transplantation); and</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="ID0238f9fd876e4f7ba263dd28319b0e42">
<enum>(ii)</enum>
<text display-inline="yes-display-inline">to ensure that the
individual has the opportunity to actively participate in the choice of
therapy.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID8993088a38d142d294f39a392dff98f2" indent="up1">
<enum>(2)</enum>
<text display-inline="yes-display-inline">The term <term>qualified
person</term> means—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDfb444456d90e45ed861d3b17f1c9975a">
<enum>(A)</enum>
<text display-inline="yes-display-inline">a physician (as described
in subsection (r)(1));</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDb7c9ea962cc44ba38378e46f7611f62e">
<enum>(B)</enum>
<text display-inline="yes-display-inline">an individual who—</text>
<clause commented="no" display-inline="no-display-inline" id="ID66a7bb81a2e34f19a32a04cab9bd1089">
<enum>(i)</enum>
<text display-inline="yes-display-inline">is—</text>
<subclause commented="no" display-inline="no-display-inline" id="ID3924fd335c084f77bf7df89c8f584c88">
<enum>(I)</enum>
<text display-inline="yes-display-inline">a registered nurse;</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="ID1d5619bdc8234573802a0edbce338681">
<enum>(II)</enum>
<text display-inline="yes-display-inline">a registered dietitian or
nutrition professional (as defined in subsection (vv)(2));</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="ID9fd43c8ed19c46edb57dca9df59a92fa">
<enum>(III)</enum>
<text display-inline="yes-display-inline">a clinical social worker
(as defined in subsection (hh)(1));</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="ID7c6f980a70b444419c599bc395d3fb5d">
<enum>(IV)</enum>
<text display-inline="yes-display-inline">a physician assistant,
nurse practitioner, or clinical nurse specialist (as those terms are defined in
subsection (aa)(5)); or</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="IDda7f70c4a8c0419a969fccd75228d366">
<enum>(V)</enum>
<text display-inline="yes-display-inline">a transplant coordinator;
and</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="IDbba517854849479aaca67435d2141406">
<enum>(ii)</enum>
<text display-inline="yes-display-inline">meets such requirements
related to experience and other qualifications that the Secretary finds
necessary and appropriate for furnishing the services described in paragraph
(1); or</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID29119e31a5c54fe189a07bd343b2aded">
<enum>(C)</enum>
<text display-inline="yes-display-inline">a renal dialysis facility
subject to the requirements of section 1881(b)(1) with personnel who—</text>
<clause commented="no" display-inline="no-display-inline" id="ID01350546ca8f4f26ac2886f5c5fb86b4">
<enum>(i)</enum>
<text display-inline="yes-display-inline">provide the services
described in paragraph (1); and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDe3a5361abbab4c17b46d90065766daab">
<enum>(ii)</enum>
<text display-inline="yes-display-inline">meet the requirements of
subparagraph (A) or (B).</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID11fba8d9a51840708be34ca663746aae" indent="up1">
<enum>(3)</enum>
<text display-inline="yes-display-inline">The Secretary shall develop
the requirements under paragraphs (1)(C)(i) and (2)(B)(ii) after consulting
with physicians, health educators, professional organizations, accrediting
organizations, kidney patient organizations, dialysis facilities, transplant
centers, network organizations described in section 1881(c)(2), and other
knowledgeable persons.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDf7e0b1043f4d4dc2b900aa421fbed8a6" indent="up1">
<enum>(4)</enum>
<text display-inline="yes-display-inline">In promulgating regulations
to carry out this subsection, the Secretary shall ensure that each beneficiary
who is entitled to kidney disease education services under this title receives
such services in a timely manner to maximize the benefit of those
services.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID943aa0472be1433a83420c4d4de28a67" indent="up1">
<enum>(5)</enum>
<text display-inline="yes-display-inline">The Secretary shall monitor
the implementation of this subsection to ensure that beneficiaries who are
eligible for kidney disease education services receive such services in the
manner described in paragraph (4).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDd8d2167fdeff4779af0a6f619c46ee48" indent="up1">
<enum>(6)</enum>
<text display-inline="yes-display-inline">No individual shall be
eligible to be provided more than 6 sessions of kidney disease education
services under this title.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID439541354b244f2fb26bb02a044eff9d">
<enum>(3)</enum>
<header>Payment under the physician fee schedule</header>
<text display-inline="yes-display-inline">Section 1848(j)(3) of the
Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting
<quote>(2)(AA),</quote> after <quote>(2)(W),</quote>.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID1c6d2b1c3f6c4182a6923d1cc9fb9283">
<enum>(4)</enum>
<header>Payment to renal dialysis facilities</header>
<text display-inline="yes-display-inline">Section 1881(b) of the Social
Security Act (42 U.S.C. 1395rr(b)), as amended by section 201(b), is amended by
adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="idCC80E77A622C4BF48161E4C7B967E999" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="IDde8c52d8c6ed420fb6e99e45448fa32b" indent="up1">
<enum>(15)</enum>
<text display-inline="yes-display-inline">For purposes of paragraph
(12), the single composite weighted formulas determined under such paragraph
shall not take into account the amount of payment for kidney disease education
services (as defined in section 1861(bbb)). 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>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID0abb22f77cb041f9940d39ff648564a6">
<enum>(5)</enum>
<header>Limitation on number of sessions</header>
<text display-inline="yes-display-inline">Section 1862(a)(1) of the
Social Security Act (42 U.S.C. 1395y(a)(1)) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDf2e2883370b149cc80d619d8e767fa79">
<enum>(A)</enum>
<text display-inline="yes-display-inline">by striking
<quote>and</quote> at the end of subparagraph (L);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID595c3d105b6c45e3a4ce50d34e844c1c">
<enum>(B)</enum>
<text display-inline="yes-display-inline">by striking the semicolon at
the end of subparagraph (M) and inserting <quote>, and</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDd6938d01ff104d799cf9b5f3d46801eb">
<enum>(C)</enum>
<text display-inline="yes-display-inline">by adding at the end the
following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idE7F8B831C4B949E5BC402878FA13C468" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="ID671ad0372660442e9ce2883301bcc1a3" indent="up1">
<enum>(N)</enum>
<text display-inline="yes-display-inline">in the case of kidney
disease education services (as defined in section 1861(bbb)), which are
performed in excess of the number of sessions covered under such
section;</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID6feed3e1503e4592b5f251879b424286">
<enum>(6)</enum>
<header>Annual report to Congress</header>
<text display-inline="yes-display-inline">Not later than April 1, 2007,
and annually thereafter, the Secretary of Health and Human Services (in this
section referred to as the <term>Secretary</term>) shall submit to Congress a
report on the number of medicare beneficiaries who are entitled to kidney
disease education services (as defined in section 1861(bbb) of the Social
Security Act, as added by paragraph (2)) under title XVIII of such Act and who
receive such services, together with such recommendations for legislative and
administrative action as the Secretary determines to be appropriate to fulfill
the legislative intent that resulted in the enactment of that
subsection.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID7f5ba0d9e7b2437d8889ede97f6626ac">
<enum>(b)</enum>
<header>Effective date</header>
<text display-inline="yes-display-inline">The amendments made by this
section shall apply to services furnished on and after January 1, 2007.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="ID003c903af2144bc79b07591dc4161e49" section-type="subsequent-section">
<enum>303.</enum>
<header>Blood flow monitoring demonstration projects</header>
<subsection commented="no" display-inline="no-display-inline" id="IDf0553ce0ec714c59b59961a51b975cb7">
<enum>(a)</enum>
<header>Establishment</header>
<text display-inline="yes-display-inline">The Secretary of Health and
Human Services (in this section referred to as the <term>Secretary</term>)
shall establish demonstration projects to evaluate how blood flow monitoring
affects the quality and cost of care for medicare beneficiaries with end-stage
renal disease.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="ID977c8d8a6c4c4d81afa62df4b98809c0">
<enum>(b)</enum>
<header>Duration</header>
<text display-inline="yes-display-inline">The demonstration projects
under this section shall be conducted for a period of not longer than 5 years
that begins on January 1, 2007.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="IDaa29cf1af6944dc58dd54d1da22f56d7">
<enum>(c)</enum>
<header>Evaluation and report</header>
<paragraph commented="no" display-inline="no-display-inline" id="IDfb81dc495b174331854b9daa25ede0d2">
<enum>(1)</enum>
<header>Evaluation</header>
<text display-inline="yes-display-inline">The Secretary shall conduct
an evaluation of the demonstration projects conducted under this
section.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID888be9d7f9c7476d99d17ceefe5da602">
<enum>(2)</enum>
<header>Report</header>
<text display-inline="yes-display-inline">Not later than 6 months after
the date on which the demonstration projects under this section are completed,
the Secretary shall submit to Congress a report on the evaluation conducted
under paragraph (1) together with recommendations for such legislation and
administrative action as the Secretary determines appropriate.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID6af79b5c51494774a2865b7eed951cc0">
<enum>(d)</enum>
<header>Waiver authority</header>
<text display-inline="yes-display-inline">The Secretary shall waive
compliance with the requirements of title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) to such extent and for such period as the Secretary
determines is necessary to conduct the demonstration projects.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="ID67c1d8dec4e844c6aacbb8d216ae9027">
<enum>(e)</enum>
<header>Authorization of appropriations</header>
<paragraph commented="no" display-inline="no-display-inline" id="IDfc1e246921f1490ead75bf0248024891">
<enum>(1)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">Payments for the costs of
carrying out the demonstration project under this section shall be made from
the Federal Supplementary Medical Insurance Trust Fund under section 1841 of
such Act (42 U.S.C. 1395t).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID7350a51d534e428b95db77a66073ef58">
<enum>(2)</enum>
<header>Amount</header>
<text display-inline="yes-display-inline">There are authorized to be
appropriated from such Trust Fund $1,000,000 for each of fiscal years 2007
through 2011 to carry out this section.</text>
</paragraph></subsection></section>
<enum>IV</enum>
<header>Improving quality through improved coverage</header>
<section commented="no" display-inline="no-display-inline" id="IDd6d8908f9dbd4b4f899d5f9e8beee523" section-type="subsequent-section">
<enum>401.</enum>
<header>Improving the home dialysis benefit</header>
<subsection commented="no" display-inline="no-display-inline" id="ID44412db882e84a5bb85fe9cf51b713a6">
<enum>(a)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">The Secretary of Health and
Human Services (in this section referred to as the <term>Secretary</term>)
shall provide appropriate incentives to improve the home dialysis benefit for
individuals on behalf of whom payment may be made under section 1881 of the
Social Security Act (42 U.S.C. 1395rr).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="IDac2d851de25b42478608c1e5cb037ba7">
<enum>(b)</enum>
<header>Considerations</header>
<text display-inline="yes-display-inline">In developing the incentives
under subsection (a), the Secretary shall consider revising the fee schedule
for physicians' services under section 1848 of the Social Security Act (42
U.S.C. 1395w–4) so that the amount paid for services related to end-stage renal
disease furnished to home dialysis patients is equal to the amount paid for
services related to end-stage renal disease furnished to other patients with 4
or more face-to-face physician visits per month.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="IDe8b8ffdeec84488fbd3500b3ddb3180b" section-type="subsequent-section">
<enum>402.</enum>
<header>Institute of Medicine evaluation and report on home
dialysis</header>
<subsection commented="no" display-inline="no-display-inline" id="IDf1e9e68853764ef6b41cb4cded94473f">
<enum>(a)</enum>
<header>Evaluation</header>
<paragraph commented="no" display-inline="no-display-inline" id="ID2c05bf78a9f64b4aa24d808ac01a769a">
<enum>(1)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">Not later than the date that
is 2 months after the date of enactment of this Act, the Secretary of Health
and Human Services (in this section referred to as the <term>Secretary</term>)
shall enter into an arrangement under which the Institute of Medicine of the
National Academy of Sciences (in this section referred to as the
<term>Institute</term>) shall conduct an evaluation of the barriers that exist
to increasing the number of individuals with end-stage renal disease who elect
to receive home dialysis services under the medicare program under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID26760956b615410fac2dfb59d6b5a2bc">
<enum>(2)</enum>
<header>Specific matters evaluated</header>
<text display-inline="yes-display-inline">In conducting the evaluation
under paragraph (1), the Institute shall—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDa5d8fca130e446c59194084e7f29b850">
<enum>(A)</enum>
<text display-inline="yes-display-inline">compare current medicare home
dialysis costs and payments with current in-center and hospital dialysis costs
and payments;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDe41b651f84b14bc9b0e5525324a8d047">
<enum>(B)</enum>
<text display-inline="yes-display-inline">catalogue and evaluate the
incentives and disincentives in the current reimbursement system that influence
whether patients receive home dialysis services;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDa35f9252a90e4f74bfa0000ddbbe9795">
<enum>(C)</enum>
<text display-inline="yes-display-inline">evaluate patient education
services and how such services impact the treatment choices made by patients;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDb1a2fc830e214883a805d4e020779e93">
<enum>(D)</enum>
<text display-inline="yes-display-inline">consider such other matters
as the Institute determines appropriate.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID02b14726b1c54296997315a1d613e768">
<enum>(3)</enum>
<header>Scope of review</header>
<text display-inline="yes-display-inline">The Institute shall consider
a variety of perspectives, including the perspectives of physicians, other
health care professionals, hospitals, dialysis facilities, health plans,
purchasers, and patients.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="IDc78f374279a24db3b763d774b493f0f6">
<enum>(b)</enum>
<header>Report</header>
<text display-inline="yes-display-inline">Not later than the date that
is 18 months after the date of enactment of this Act, the Institute shall
submit to the Secretary and appropriate committees of Congress a report on the
evaluation conducted under subsection (a)(1) describing the findings of such
evaluation and recommendations for implementing incentives to encourage
patients to elect to receive home dialysis services under the medicare
program.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="IDae62dbae3b4446b7bc49c8da50ecdb04">
<enum>(c)</enum>
<header>Authorization of appropriations</header>
<text display-inline="yes-display-inline">There are authorized to be
appropriated such sums as may be necessary for the purposes of conducting the
evaluation and preparing the report required by this section.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="ID85358174abba4ca5826c65b21f661dda" section-type="subsequent-section">
<enum>403.</enum>
<header>End-Stage renal disease (ESRD) advisory committee</header>
<subsection commented="no" display-inline="no-display-inline" id="IDe45c70f050c7492b8e43bf924c09acd3">
<enum>(a)</enum>
<header>Establishment</header>
<text display-inline="yes-display-inline">Pursuant to section 222 of
the Public Health Service Act (42 U.S.C. 217a), the Secretary of Health and
Human Services shall establish within 1 year of the date of enactment of this
Act an independent, multidisciplinary, nonpartisan End-Stage Renal Disease
Advisory Committee (in this section referred to as the
<quote>Committee</quote>).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="IDaaecfa282b824cbd96b5df43f87d98d6">
<enum>(b)</enum>
<header>Membership</header>
<text display-inline="yes-display-inline">The Committee shall consist
of such members as the Secretary may appoint who shall serve for such term as
the Secretary may specify. In appointing members of the Committee, the
Secretary shall consult with the dialysis community and shall include
individuals drawn from diverse backgrounds, such as medicine, nursing, health
care policy, the dialysis patient community, the dialysis provider community,
and health economics.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idA1C45E8475FD4104A6896D06502C7F95">
<enum>(c)</enum>
<header>Purpose of the committee</header>
<paragraph commented="no" display-inline="no-display-inline" id="id716E7DEC496E468785DC9EC8706D3317">
<enum>(1)</enum>
<header>Duties</header>
<text display-inline="yes-display-inline">The Committee shall provide a
forum for expert discussion and deliberation and the formulation of advice and
recommendations to the Secretary about medicare coverage for End-Stage Renal
Disease patients, as described under section 1881 of the Social Security Act
(42 U.S.C. 1395rr).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id913087B3C81643B2998B3CFD32497F2F">
<enum>(2)</enum>
<header>Report</header>
<text display-inline="yes-display-inline">The Committee shall provide
the Secretary with periodic reports that summarize the Committee's activities
and its recommendations for such legislation and administrative action as it
considers appropriate.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idECB8E6CD6ECD4E25BF15D1F40AECE1FA">
<enum>(d)</enum>
<header>Authorization of appropriations</header>
<text display-inline="yes-display-inline">There are authorized to be
appropriated such sums as may be necessary to carry out the purposes of this
section.</text>
</subsection></section>