1.Short
title; table of contents
(a)This Act may be cited
as the Kidney Care Quality and
Education Act of 2007
.
(b)The table of contents for this Act is as follows:
Sec. 1. Short title; table of
contents.
TITLE I—Improving quality through patient education, access, and
safety initiatives
Sec. 101. Support of public and patient education initiatives
regarding kidney disease.
Sec. 102. Medicare coverage of kidney disease patient education
services.
Sec. 103. Blood flow monitoring demonstration
projects.
Sec. 104. Institute of Medicine Evaluation and report on
treatment modalities for patients with kidney failure.
Sec. 105. Required training for patient care dialysis
technicians.
TITLE II—Assuring quality of care for providers, facilities, and
physicians that provide services to individuals with end-stage renal disease
who are enrolled in part B
Sec. 201. Establishment of the End-Stage Renal Disease (ESRD)
Advisory Committee.
Sec. 202. Update for the Medicare ESRD composite rate for 2008,
2009, and 2010.
Sec. 203. Continuous quality improvement initiative in the
Medicare end-stage renal disease program.
Sec. 204. Extension of Medicare secondary payer.
<enum>I</enum><header>Improving quality
through patient education, access, and safety initiatives</header>
<section id="ID3d96fcd604604b5f9a39de5dab7b67fd"><enum>101.</enum><header>Support of
public and patient education initiatives regarding kidney disease</header>
<subsection id="ID3c5b7c3d39c84f58b0a6d7b21a39770b"><enum>(a)</enum><header>Chronic kidney
disease demonstration projects</header>
<paragraph id="IDc1bf766ffe9745caa3562adb538fab60"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) shall establish
demonstration projects to—</text>
<subparagraph id="ID963e213afadb4939bf87f178f5c4828d"><enum>(A)</enum><text>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 id="IDc939f21c96ee43c99109f1d3036f51fc"><enum>(B)</enum><text>enhance
surveillance systems and expand research to better assess the prevalence and
incidence of chronic kidney disease.</text>
</subparagraph></paragraph><paragraph id="ID5f7334ba5b7c486eb6a1df925919d868"><enum>(2)</enum><header>Scope and
duration</header>
<subparagraph id="ID0b918793f91c49388b5f036b3aed5aff"><enum>(A)</enum><header>Scope</header><text>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 individuals with end-stage renal disease who are enrolled in part B of title
XVIII of the Social Security Act and ensure the participation of individuals
who reside in rural and urban areas.</text>
</subparagraph><subparagraph id="IDba8246d038724c04998ab557263e3b21"><enum>(B)</enum><header>Duration</header><text>The
demonstration projects under this subsection shall be conducted for a period
that is not longer than 5 years that begins on January 1, 2009.</text>
</subparagraph></paragraph><paragraph id="IDe0e8c29cb64d4e52bfc7ec4cab320877"><enum>(3)</enum><header>Evaluation and
report</header>
<subparagraph id="ID1a1d45043c6f42c98ba700391efc42bb"><enum>(A)</enum><header>Evaluation</header><text>The
Secretary shall conduct an evaluation of the demonstration projects conducted
under this subsection.</text>
</subparagraph><subparagraph id="ID6e8a1ca647fd4e1cbcbbdbd1133f749f"><enum>(B)</enum><header>Report</header><text>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 id="ID002b7a96aab947b795aa030cf5a2590b"><enum>(4)</enum><header>Authorization
of appropriations</header><text>There are authorized to be appropriated to
carry out this subsection $2,000,000 for each of fiscal years 2009 through
2013.</text>
</paragraph></subsection><subsection id="ID73871633d91440019c4f47e75476d131"><enum>(b)</enum><header>ESRD
self-management demonstration projects</header>
<paragraph id="ID0ff9083f149e4f26aac02ea5bd14705b"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish demonstration projects to
enable individuals with end-stage renal disease to develop self-management
skills.</text>
</paragraph><paragraph id="id2E2AE96F4CAC487D93D6726CBFE7CCD9"><enum>(2)</enum><header>Application</header><text>The
provisions of paragraph (2) (relating to scope and duration) and paragraph (3)
(relating to an evaluation and a report) of subsection (a) shall apply to the
demonstration projects under this subsection in the same manner as such
provisions apply to the demonstration projects under subsection (a).</text>
</paragraph><paragraph id="ID98107d345ede4ed28818c911a3249a7b"><enum>(3)</enum><header>Authorization
of appropriations</header><text>There are authorized to be appropriated to
carry out this subsection $2,000,000 for each of fiscal years 2009 through
2013.</text>
</paragraph></subsection></section><section id="IDacf4c7718bde41eeb63354c332bfbd00"><enum>102.</enum><header>Medicare
coverage of kidney disease patient education services</header>
<subsection id="IDc75abe35ce774899b05ddbe98e2960f4"><enum>(a)</enum><header>Coverage of
kidney disease education services</header>
<paragraph id="IDcbdd97bd324e4d77acb70fe43f7bf781"><enum>(1)</enum><header>Coverage</header><text>Section
1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is
amended—</text>
<subparagraph id="IDe082fc086e984e1baa4b9ab3cf2312d5"><enum>(A)</enum><text>in subparagraph
(Z), by striking <quote>and</quote> after the semicolon at the end;</text>
</subparagraph><subparagraph id="ID9a6fe385f1194a7a8f2e33c1ba68edcf"><enum>(B)</enum><text>in subparagraph
(AA), by adding <quote>and</quote> after the semicolon at the end; and</text>
</subparagraph><subparagraph id="IDe764080e7e5b41f6a2189085ccce861d"><enum>(C)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="id63B2A0074CA64961B0C161FB83725896" style="OLC">
<subparagraph id="ID97d4bbd109604109b1c436f467114841"><enum>(BB)</enum><text>kidney disease
education services (as defined in subsection
(ccc));</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="IDd3427959f3624ed4b3bfdfb56bcccdd8"><enum>(2)</enum><header>Services
described</header><text>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 display-inline="no-display-inline" id="id08AF5786AC1F4FDAAA227C169B7C16AD" other-style="archaic" style="other">
<subsection id="ID96fd6dc3d02b4d0bb74e766b1f9a0d07"><enum>(ccc)</enum><header>Kidney disease education services</header><paragraph commented="no" display-inline="yes-display-inline" id="id10E5D2014EB04ACB917CFB3B78133BA9"><enum>(1)</enum><text>The term <term>kidney
disease education services</term> means educational services that are—</text>
<subparagraph id="id7812F2774E6C457EBDB3750AE1A1C521" indent="up1"><enum>(A)</enum><text>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 id="id54D2A9F57578465282EA4832169010EF" indent="up1"><enum>(B)</enum><text>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 id="idC8B7566FEDBD4501AFBA25080B5F01CA" indent="up1"><enum>(C)</enum><text>designed—</text>
<clause id="id05C2C79713894B45AC42361B40848EB2"><enum>(i)</enum><text>to provide comprehensive
information regarding—</text>
<subclause id="ID58b54d5f02a4417d81597656dfcff449"><enum>(I)</enum><text>the management of comorbidities;</text>
</subclause><subclause id="ID61917df5dc8242b587f8def026e8ac3e"><enum>(II)</enum><text>the prevention of uremic complications;
and</text>
</subclause><subclause id="ID4967121ecddc4c0aa3415002feb446a5"><enum>(III)</enum><text>each option for renal replacement
therapy (including home and in-center as well as vascular access options and
transplantation); and</text>
</subclause></clause><clause id="ID75c12fdfc36842e196228ee18f6b38db"><enum>(ii)</enum><text>to ensure that the individual has
the opportunity to actively participate in the choice of therapy.</text>
</clause></subparagraph></paragraph><paragraph id="ID48ea77f2a586485bbf68626ad3d60680" indent="up1"><enum>(2)</enum><text>The term <term>qualified
person</term> means—</text>
<subparagraph id="ID8c6ed7e6780546239246fd17a448f540"><enum>(A)</enum><text>a physician (as described in
subsection (r)(1));</text>
</subparagraph><subparagraph id="ID22bfc4b064db42218f75a38027c40530"><enum>(B)</enum><text>an individual who—</text>
<clause id="ID9319bb78659b484188f7bf5f52f91fc8"><enum>(i)</enum><text>is—</text>
<subclause id="ID8509d0957026402f8211bf416a330ec2"><enum>(I)</enum><text>a registered nurse;</text>
</subclause><subclause id="IDef5a5cde3de94e74a0d643f91a0d665e"><enum>(II)</enum><text>a registered dietitian or nutrition
professional (as defined in subsection (vv)(2));</text>
</subclause><subclause id="ID76b4d455b2404d7ab61ff3ab74bff7dd"><enum>(III)</enum><text>a clinical social worker (as defined in
subsection (hh)(1));</text>
</subclause><subclause id="ID9c800a0f417b479cbb20f596ffe556c9"><enum>(IV)</enum><text>a physician assistant, nurse
practitioner, or clinical nurse specialist (as those terms are defined in
subsection (aa)(5)); or</text>
</subclause><subclause id="IDe731b117998e4cb1aa0ddcb368e60612"><enum>(V)</enum><text>a transplant coordinator; and</text>
</subclause></clause><clause id="ID883954d3634e4ff18fdee9f3426c4125"><enum>(ii)</enum><text>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 id="ID1a7e03c67e08417f88a9d78f70f4a065"><enum>(C)</enum><text>a renal dialysis facility subject to
the requirements of section 1881(b)(1) with personnel who—</text>
<clause id="ID87bf3e438b7a4a529664e47af2dbbb2c"><enum>(i)</enum><text>provide the services described in
paragraph (1); and</text>
</clause><clause id="ID065865458c744296a6534e439b5a2f2a"><enum>(ii)</enum><text>meet the requirements of
subparagraph (A) or (B).</text>
</clause></subparagraph></paragraph><paragraph id="IDbe622003720c4bcdaa1103cf529ddaa0" indent="up1"><enum>(3)</enum><text>The Secretary shall develop the
information to be provided under paragraph (1)(C)(i) and the requirements under
(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 id="ID60b928d2c7c841aeaaf17bf2a4ef7c3c" indent="up1"><enum>(4)</enum><text>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 id="ID50c4d3af86ab495cbcb473bda038834d" indent="up1"><enum>(5)</enum><text>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 id="ID8669960a5b8244c8896a112e3dd50429" indent="up1"><enum>(6)</enum><text>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 id="IDf7ae77bd6b024e5f9d832097942815ba"><enum>(3)</enum><header>Payment under
the physician fee schedule</header><text>Section 1848(j)(3) of the Social
Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting
<quote>(2)(BB),</quote> after <quote>(2)(AA),</quote>.</text>
</paragraph><paragraph id="ID3c076dd9c74145709c79303a839efddf"><enum>(4)</enum><header>Payment to
renal dialysis facilities</header><text>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="id9B39B343B6F64A6888D5E8A774A3B0EB" style="OLC">
<paragraph id="ID8b7b4648e2b04ab585f96a04146380e5"><enum>(14)</enum><text>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(ccc)). 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 id="ID4ac5cb18e6e64ff3bba40af8760ec52f"><enum>(5)</enum><header>Limitation on
number of sessions</header><text>Section 1862(a)(1) of the Social Security Act
(42 U.S.C. 1395y(a)(1)) is amended—</text>
<subparagraph id="ID4859ae82751643bfb2d9d4d769cf190c"><enum>(A)</enum><text>in subparagraph
(M), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="ID1b45e7e57e004e1fb4f1d0ed3d56347c"><enum>(B)</enum><text>in subparagraph
(N), by striking the semicolon at the end and inserting <quote>, and</quote>;
and</text>
</subparagraph><subparagraph id="IDd030a575abd84df39bf7a81cfc2e2dc1"><enum>(C)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idD4BDCD77C60F42BD91C434D32168286D" style="OLC">
<subparagraph id="ID328f14ee16bf4de187b620123e447efc"><enum>(O)</enum><text>in the case of
kidney disease education services (as defined in section 1861(ccc)), 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 id="ID2601f01380af490fab544f219b4fdbd2"><enum>(6)</enum><header>Annual report
to Congress</header><text>Not later than April 1, 2009, and annually
thereafter, the Secretary of Health and Human Services shall submit a report to
Congress on the number of Medicare beneficiaries who are entitled to kidney
disease education services (as defined in section 1861(ccc) 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 id="ID3fd9a078b2ad4f0eab59559f064c3ef0"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to services
furnished on or after January 1, 2009.</text>
</subsection></section><section id="IDb13593ebed1548b8b7f986e7361ae4f0"><enum>103.</enum><header>Blood flow
monitoring demonstration projects</header>
<subsection id="ID53771b1fa74442609fe56e586c60e9a9"><enum>(a)</enum><header>Establishment</header><text>The
Secretary of Health and Human Services (in this section referred to as the
<quote>Secretary</quote>) 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 id="IDaf9542b0e6e543dab726d504d4b1fe49"><enum>(b)</enum><header>Duration</header><text>The
demonstration projects under this section shall be conducted for a period of
not longer than 5 years that begins on January 1, 2009.</text>
</subsection><subsection id="ID958e96d8b7224578a2b10d1c346a67fd"><enum>(c)</enum><header>Evaluation and
report</header>
<paragraph id="IDbf952145898246baa505f1739d2ebb8a"><enum>(1)</enum><header>Evaluation</header><text>The
Secretary shall conduct an evaluation of the demonstration projects conducted
under this section.</text>
</paragraph><paragraph id="ID5da9dd643165488097876412050a7322"><enum>(2)</enum><header>Report</header><text>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 id="IDc724455d1b844d148744f1f54fa5ea7d"><enum>(d)</enum><header>Waiver
authority</header><text>The Secretary shall waive compliance with the
requirements of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
to the extent, and for such period as, the Secretary determines is necessary to
conduct the demonstration projects.</text>
</subsection><subsection id="IDc3f7dd3978cc4221915d44525f6363ed"><enum>(e)</enum><header>Authorization
of appropriations</header>
<paragraph id="IDfc3761e32b3c42b095c15160bd6219f9"><enum>(1)</enum><header>In
general</header><text>Payments for the costs of carrying out the demonstration
projects under this section shall be made from the Federal Supplementary
Medical Insurance Trust Fund under section 1841 of the Social Security Act (42
U.S.C. 1395t).</text>
</paragraph><paragraph id="ID269ac672afe94a218a42b9bfdc05e3d3"><enum>(2)</enum><header>Amount</header><text>There
are authorized to be appropriated from such Trust Fund $1,000,000 for each of
fiscal years 2009 through 2013 to carry out this section.</text>
</paragraph></subsection></section><section id="ID070cdb958bfb46b8837efb356b608b87"><enum>104.</enum><header>Institute of
Medicine evaluation and report on treatment modalities for patients with kidney
failure</header>
<subsection id="ID4539a43a3b4744d3bda18664c83f8f9f"><enum>(a)</enum><header>Evaluation</header>
<paragraph id="IDdf0bee9ba1c24e269acf984dfd2b25c6"><enum>(1)</enum><header>In
general</header><text>Not later than 2 months after the date of enactment of
this Act, the Secretary of Health and Human Services (in this section referred
to as the <quote>Secretary</quote>) shall enter into an arrangement under which
the Institute of Medicine of the National Academy of Sciences (in this section
referred to as the <quote>Institute</quote>) 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 or other treatment
modalities under the Medicare program under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.).</text>
</paragraph><paragraph id="ID5ff8e8da8719468dabe72afebf5c1d16"><enum>(2)</enum><header>Specific
matters evaluated</header><text>In conducting the evaluation under paragraph
(1), the Institute shall—</text>
<subparagraph id="ID052415bac3f9468992badba62b5d7f3b"><enum>(A)</enum><text>compare current
Medicare home dialysis costs and payments with current in-center and hospital
dialysis costs and payments;</text>
</subparagraph><subparagraph id="ID17d4c4bc7aff42079997c59a4b5e8368"><enum>(B)</enum><text>catalogue and
evaluate the incentives and disincentives in the current reimbursement system
that influence whether patients receive home dialysis services or other
treatment modalities;</text>
</subparagraph><subparagraph id="ID03b31d6043ad4d2fb434c243cfb4357e"><enum>(C)</enum><text>evaluate patient
education services and how such services impact the treatment choices made by
patients; and</text>
</subparagraph><subparagraph id="IDcc9eed6d04ae46cb81c1beb96c0ba297"><enum>(D)</enum><text>consider such
other matters as the Institute determines appropriate.</text>
</subparagraph></paragraph><paragraph id="IDe36f06b942234b7ebb6162b5db3c0d94"><enum>(3)</enum><header>Scope of
review</header><text>In conducting the evaluation under paragraph (1), 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 id="IDaf1485a6f5ca40b3acbd37992e668cbf"><enum>(b)</enum><header>Report</header><text>Not
later than 19 months after the date of enactment of this Act, the Institute
shall submit to the Secretary and to Congress a report on the evaluation
conducted under subsection (a)(1). Such report shall contain a detailed
description of the findings of such evaluation and recommendations for
implementing incentives to encourage patients to elect to receive home dialysis
services or other treatment modalities under the Medicare program.</text>
</subsection><subsection id="IDc6769c3d6b874c06adda8939db703de0"><enum>(c)</enum><header>Authorization
of appropriations</header><text>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 id="IDa5ad139f3b284b6d9d9ddec301eb9fea"><enum>105.</enum><header>Required
training for patient care dialysis technicians</header>
<subsection id="ID695c32e90f874d43855b35a1ebabdbdc"><enum>(a)</enum><header>In
general</header><text>Section 1881 of the Social Security Act (42 U.S.C.
1395rr) is amended by adding the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="id1272C4627D23441DB85FE0149D1DC00A" style="OLC">
<subsection id="ID6f567785ef5c4453bb64e236b5d3fa8b"><enum>(h)</enum><paragraph commented="no" display-inline="yes-display-inline" id="idCCB13426B23F4EF0ACBEE746C74E188C"><enum>(1)</enum><text>Except as provided in
paragraph (3), beginning January 1, 2009, 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 id="id3B89F78ABA2046C4B4FF2F9AE71B11C0" indent="up1"><enum>(A)</enum><text>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 id="ID387e5cfe15b248a1a38e2a607d857efc" indent="up1"><enum>(B)</enum><text>has been certified by a nationally
recognized certification entity for dialysis technicians; and</text>
</subparagraph><subparagraph id="ID5a1f1c25cb1d4fdda5ed5999e6af7cca" indent="up1"><enum>(C)</enum><text>is competent to provide
dialysis-related services.</text>
</subparagraph></paragraph><paragraph id="IDc94e52d7476745649e05232ca9a8e8f1" indent="up1"><enum>(2)</enum><text>Beginning January 1, 2010, 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 id="IDd98a3a787d0a44618fb899263b497590" indent="up1"><enum>(3)</enum><text>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 id="ID11f26b4169104d3bb05787d69a3cfa86" indent="up1"><enum>(4)</enum><text>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 recertified as described in paragraph (1)(B).</text>
</paragraph><paragraph id="IDe2464de43d5c472d8d00885737f0bbe1" indent="up1"><enum>(5)</enum><text>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>Assuring quality
of care for providers, facilities, and physicians that provide services to
individuals with end-stage renal disease who are enrolled in part B</header>
<section id="IDbed334b8b72e4c9588adba5c32fcc991"><enum>201.</enum><header>Establishment
of the End-Stage Renal Disease (ESRD) Advisory Committee</header>
<subsection id="ID7bebe4a7e113482b93e05d12c96ed524"><enum>(a)</enum><header>In
general</header><text>Pursuant to section 222 of the Public Health Service Act
(42 U.S.C. 217a), the Secretary of Health and Human Services (in this section
referred to as the <quote>Secretary</quote>) 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 id="ID3926084acaae41e880e4e5b55f385227"><enum>(b)</enum><header>Membership</header>
<paragraph id="idA0DA3F957473450D923FB4AAC901912D"><enum>(1)</enum><header>In
general</header><text>The Committee shall consist of such members as the
Secretary may appoint who shall serve for such term as the Secretary may
specify. The Secretary shall ensure that a representative of the Centers for
Medicare & Medicaid Services is included among the members of the
Committee.</text>
</paragraph><paragraph id="id6721572B72114BE7967FAC7157AD77BC"><enum>(2)</enum><header>Consultation</header><text>In
appointing members of the Committee, the Secretary shall consult with patients,
facilities and providers, physicians, nurses, a representative from the
pediatric community, payers and insurers, manufacturers, and a representative
of the Centers for Medicare & Medicaid Services who coordinates activities
related to end-stage renal disease within the Centers.</text>
</paragraph></subsection><subsection id="IDcb7c4e1ae6e347f386265680e5b82c12"><enum>(c)</enum><header>Purpose of the
committee</header>
<paragraph id="IDc00203eb41b945b4a54b3a2d51b6f963"><enum>(1)</enum><header>Duties</header><text>The
Committee shall provide a forum for expert discussion and deliberation and the
formulation of advice and recommendations to the Secretary regarding Medicare
coverage for individuals with end-stage renal disease, as described under
section 1881 of the Social Security Act (42 U.S.C. 1395rr).</text>
</paragraph><paragraph id="ID98fd8e25b16b4ae682b275b77219e0f4"><enum>(2)</enum><header>Recommendations</header>
<subparagraph id="id7D12259E531F4EA28FC4AB1E998BA567"><enum>(A)</enum><header>Annual
recommendations</header><text>The Committee shall provide annual
recommendations to the Secretary regarding—</text>
<clause id="ID3ba4e5d8ffa04addbab140dd699cfe8c"><enum>(i)</enum><text>selecting,
modifying, and updating clinical and quality of life measures;</text>
</clause><clause id="IDa3482bbcb3a34b71a529929b509f4e2d"><enum>(ii)</enum><text>modifying the
payment structure;</text>
</clause><clause id="ID3faac384027e4a3bbe123c0faa83e454"><enum>(iii)</enum><text>determining
hardship criteria to exempt certain facilities and providers from the program;
and</text>
</clause><clause id="ID86a10ca150da4201a1c23813d41851c5"><enum>(iv)</enum><text>other issues
related to implementation of a quality initiative by the Secretary.</text>
</clause></subparagraph><subparagraph id="idAE29432B11CC49DEB18D1BB14E9B4485"><enum>(B)</enum><header>Periodic
recommendations</header><text>The Committee shall provide periodic advice and
recommendations to the Secretary regarding Medicare coverage for individuals
with end-stage renal disease, as described in such section 1881.</text>
</subparagraph></paragraph></subsection></section><section id="IDf681e7bdc8644e85892759e02376cd74"><enum>202.</enum><header>Update for the
Medicare ESRD composite rate for 2008, 2009, and 2010</header><text display-inline="no-display-inline">Section 1881(b)(12)(G) of the Social
Security Act (42 U.S.C. 1395rr(b)(12)(G)), as amended by section 103 of the Tax
Relief and Health Care Act of 2006 (Public Law 109–432), is amended—</text>
<paragraph id="id2D0354222E1047D3B9947450D211D6D8"><enum>(1)</enum><text display-inline="yes-display-inline">in clause (i), by striking
<quote>and</quote> at the end;</text>
</paragraph><paragraph id="id4591E3E4081441EDAA93CAC90619ED64"><enum>(2)</enum><text>in clause
(ii)—</text>
<subparagraph id="id6044AA77DB1A4B7D8E60533975514426"><enum>(A)</enum><text>by inserting
<quote>and before January 1, 2008,</quote> after <quote>April 1, 2007</quote>;
and</text>
</subparagraph><subparagraph id="id46D658EA70A1440C8F56849154876D09"><enum>(B)</enum><text>by striking the
period at the end and inserting a semicolon; and</text>
</subparagraph></paragraph><paragraph id="idD21BF853144641E6B4C5B6A74108D320"><enum>(3)</enum><text>by adding at the
end the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="id090717822BC9434694B61E6A33401BE7" style="OLC">
<clause commented="no" id="IDddc12ffd81e140e798657a11e3cd510d" indent="up2"><enum>(iii)</enum><text>furnished during 2008, by the amount
equal to the ESRD market basket (as developed pursuant to section 422(b) of the
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
(Public Law 106–554), as enacted into law by section 1(a)(6) of Public Law
106-554) percentage increase for 2008 above the amount of such composite rate
component for such services furnished on December 31, 2007;</text>
</clause><clause commented="no" id="IDf1b237945cdd4f97a0bbf957e6d62151" indent="up2"><enum>(iv)</enum><text>furnished during 2009, by the amount
equal to the ESRD market basket (as so developed) percentage increase for 2009
above the amount of such composite rate component for such services furnished
on December 31, 2008; and</text>
</clause><clause commented="no" id="ID5a176d949ffb4a92906e23acda98fb13" indent="up2"><enum>(v)</enum><text>furnished on or after January 1, 2010,
by the amount equal to the ESRD market basket (as so developed) percentage
increase for 2010 above the amount of such composite rate component for such
services furnished on December 31,
2009.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section commented="no" id="ID87f396b4a9fc4ce3863b74e7cc57e598"><enum>203.</enum><header>Continuous
quality improvement initiative in the Medicare end-stage renal disease
program</header>
<subsection commented="no" id="ID650a63e0dbcb4adbb4759b02ca1bf006"><enum>(a)</enum><header>Establishment
of the program</header><text>Section 1881 of the Social Security Act (42 U.S.C.
1395rr), as amended by section 105, is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="id6EA2A43F7A65427FAC1E6CC6FDE5ED78" style="OLC">
<subsection id="IDe88d841cf5ef4bba8919d4d7242271e3"><enum>(i)</enum><header>Continuous
quality improvement initiative in the end-stage renal disease program</header>
<paragraph id="ID69fd6a0ea0ed4870a9214dd7e7798b53"><enum>(1)</enum><header>In
general</header><text>Not later than January 1, 2008, the Secretary shall
establish a 3-year continuous quality improvement initiative (in this section
referred to as the <quote>quality initiative</quote>) under which quality
payments are provided to renal dialysis facilities, providers of services, and
physicians that provide items and services to individuals with end-stage renal
disease who are enrolled under part B and that meet quality benchmarks and
demonstrate quality improvements.</text>
</paragraph><paragraph id="ID26fd6262eacf46e89012c2c871edd56f"><enum>(2)</enum><header>Participation</header>
<subparagraph id="ID790a5c00c59f4ff48bda5ed874f9322e"><enum>(A)</enum><header>Facilities and
providers</header>
<clause id="id10DBE99A6CDE4D00953EC352CBF92DD2"><enum>(i)</enum><header>In
general</header><text>Except as provided in subparagraph (C)(i) and subject to
clause (ii), all independent dialysis facilities and hospital-based dialysis
providers that provide items and services to individuals with end-stage renal
disease who are enrolled in part B shall participate in the quality
initiative.</text>
</clause><clause id="id01FBA4FEEE9145DBB4F843643378D4FC"><enum>(ii)</enum><header>Positive
update required</header><text>The quality initiative shall not apply to
facilities and providers in a year unless the ESRD market basket percentage
increase described in subsection (b)(12)(G) for such year is positive.</text>
</clause></subparagraph><subparagraph id="ID3b39cf206ba64c4f9f1546784387889e"><enum>(B)</enum><header>Physicians</header>
<clause id="id1C49706C87674DD69BCB92DFF35044EA"><enum>(i)</enum><header>In
general</header><text>Except as provided in subparagraph (C)(i) and subject to
clause (ii), all physicians who receive the monthly capitated payment under
this title with respect to end-stage renal disease items and services shall
participate in the quality initiative.</text>
</clause><clause id="id70DBF0ABADCA48B0919DE97FB9EEAA3F"><enum>(ii)</enum><header>Positive
update required</header><text>The quality initiative shall not apply to
physicians in a year unless the update to the conversion factor under section
1848(d) for such year is positive.</text>
</clause></subparagraph><subparagraph id="ID35822d09fb324499af94cbdda8f5207e"><enum>(C)</enum><header>Pediatric
facilities, providers, and physicians</header>
<clause id="ID4829216477dd4dce894a04fcda093a07"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), a pediatric facility, provider,
or physician who provides items and services to individuals with end-stage
renal disease who are enrolled in part B and with at least 50 percent of its
patients being individuals under 18 years of age shall be required to report
data for pediatric-specific measures under this subsection in order to receive
the full market basket update during 2008, 2009, and 2010 under subsection
(b)(12)(G) or the full update under section 1848(d).</text>
</clause><clause id="id1177E11D585A4DB2A95878A168F36731"><enum>(ii)</enum><header>Positive
update required</header><text>The reporting requirement under clause (i) shall
not apply to—</text>
<subclause id="idB4F189AF2CBE44CF93910E512CECB35C"><enum>(I)</enum><text>pediatric
facilities and providers in a year unless the ESRD market basket percentage
increase described in subsection (b)(12)(G) for such year is positive;
and</text>
</subclause><subclause id="id77EA6DF6FC2943B0B85948A3152DD49F"><enum>(II)</enum><text>to pediatric
physicians in a year unless the update to the conversion factor under section
1848(d) for such year is positive.</text>
</subclause></clause><clause id="IDef3c7e3038384ada813916dab334ab6a"><enum>(iii)</enum><header>Evaluation</header><text>The
Secretary, in consultation with the End-Stage Renal Disease Advisory Committee
established under section 201 of the <short-title>Kidney
Care Quality and Education Act of 2007</short-title> (in this subsection
referred to as the <quote>ESRD Advisory Committee</quote>), shall evaluate and
make recommendations to Congress regarding the feasibility of incorporating
pediatric facilities, providers, and physicians described in clause (i) fully
into the quality initiative if the initiative were to extend beyond
2010.</text>
</clause></subparagraph></paragraph><paragraph id="ID5866c1f9bbd54c1e98ba842b7b026826"><enum>(3)</enum><header>Duration</header><text>The
quality initiative shall be conducted during a period of 3 years beginning
January 1, 2008.</text>
</paragraph><paragraph id="ID7efbc8aeafd846ac84c364983b2a8887"><enum>(4)</enum><header>Funding</header>
<subparagraph id="IDd8f8f41766c54ef5b6b89f139e166d36"><enum>(A)</enum><header>Bonus pool for
providers and facilities</header><text>During 2008, 2009, and 2010, the
Secretary shall set aside at least ¼, but no more than ½, of the ESRD market
basket amount under subsection (b)(12)(G) for each year, respectively, to
establish a bonus pool to be used to provide bonus payments for providers and
facilities described in paragraph (2)(A) that demonstrate improvements in
quality or attainment of quality benchmarks.</text>
</subparagraph><subparagraph id="ID6bb7a6d7874c4c0a9a72e5e3a1098b80"><enum>(B)</enum><header>Bonus pool for
physicians</header><text>During 2008, 2009, and 2010, the Secretary shall set
aside at least ¼, but no more than ½, of the portion of the physician fee
schedule update under section 1848(d) that applies to physicians who receive
the monthly capitated payment under this title with respect to end-stage renal
disease items and services for each year respectively to establish a bonus pool
to be used to provide bonus payments for physicians described in paragraph
(2)(B) that demonstrate improvements in quality or attainment of quality
benchmarks.</text>
</subparagraph></paragraph><paragraph id="ID0a185fce15d84258a02d22660d288625"><enum>(5)</enum><header>Establishment
of quality incentive payments</header>
<subparagraph id="ID00781f0377b84790b3e7effefa9b05b7"><enum>(A)</enum><header>Incentives for
reporting in 2008</header>
<clause id="id33426F99E5BF49EB922E71175C323F74"><enum>(i)</enum><header>In
general</header><text>During 2008, the Secretary shall make quality incentive
payments from the bonus pool described in paragraph (4)(A) to facilities and
providers and from the bonus pool described in paragraph (4)(B) to physicians
described in subparagraphs (A) and (B) of paragraph (2) for reporting data
about clinical and quality of life measures adopted by the Secretary in
consultation with the ESRD Advisory Committee.</text>
</clause><clause id="idB10C0DB909F74D7C86487DE6E92B923B"><enum>(ii)</enum><header>Extension</header><text>If
the Secretary determines that there are problems associated with reporting that
should be resolved before implementing the quality payment system under
subparagraph (B), the Secretary may extend the reporting period an additional
year.</text>
</clause><clause id="id815C5D48C70043BC8E607B128C8301F8"><enum>(iii)</enum><header>Exception to
reporting requirement</header><text>The Secretary shall establish criteria for
an application for a hardship exception that would allow small or rural
facilities and providers to receive the full update under subsection (b)(12)(G)
even if they are not able to report data.</text>
</clause></subparagraph><subparagraph id="ID428c42c3f9f94f838bb7dd07f3125ce9"><enum>(B)</enum><header>Quality
incentive payments in 2009 and 2010</header>
<clause id="idD4C4D94A73A6408D9E77D15B98D7B9A9"><enum>(i)</enum><header>In
general</header><text>During 2009 and 2010, the Secretary shall make quality
incentive payments from their respective bonus pools under paragraph (4) to
facilities, providers, and physicians described in subparagraphs (A) and (B) of
paragraph (2) with respect to a year if the Secretary determines that the
quality of care provided in that year by the facility, provider, or physician
to individuals with end-stage renal disease who are enrolled under part
B—</text>
<subclause id="IDf03ddbdaf69744fe9b3c6eb6c315d404"><enum>(I)</enum><text>has substantially
improved (as determined by the Secretary in consultation with the ESRD Advisory
Committee) over the prior year; or</text>
</subclause><subclause id="IDe95e8e9256f0409c8403ba5a0c886b29"><enum>(II)</enum><text>exceeds a
threshold established by the Secretary in consultation with the ESRD Advisory
Committee.</text>
</subclause></clause><clause id="ID1586b3549d314af68e9f9366d2e4d391"><enum>(ii)</enum><header>Requirements</header><text>In
determining which facilities, providers, or physicians qualify for the quality
incentive payments under clause (i), the Secretary shall do the
following:</text>
<subclause id="id52C35875536D4306BA426A42C1A634D3"><enum>(I)</enum><text>Adopt clinical
and quality of life measures in consultation with the ESRD Advisory
Committee.</text>
</subclause><subclause id="idA4A21E51728C4D79B396B46CA477D164"><enum>(II)</enum><text>For 2008, ensure
that payments will be based on the reporting of data regarding clinical and
quality of life measures adopted by the Secretary in consultation with the ESRD
Advisory Committee.</text>
</subclause><subclause id="IDa07872317ea341adafcd3529fe00c371"><enum>(III)</enum><text>For 2009 and
2010, subject to subparagraph (C), ensure that payments will be based upon the
composite score awarded to the facilities, providers, and physicians. The
composite score will be based upon the submission of data about clinical and
quality of life measures adopted by the Secretary in consultation with the ESRD
Advisory Committee.</text>
</subclause></clause></subparagraph><subparagraph id="IDfb1be0eaa97643e9b6f408ff47178e9f"><enum>(C)</enum><header>Determination
of amount of incentive payment</header>
<clause id="idE32058188AF94B14B24DC9DE001CD931"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), the Secretary shall determine the
amount of a quality incentive payment to a facility, provider, or physician
based upon a quintile scale of a weighted composite score of clinical and
quality of life measures.</text>
</clause><clause id="ID32783aa9bdd14ad18e1cddc186a35eb8"><enum>(ii)</enum><header>Limitation</header><text>The
Secretary shall establish the quality incentive payments so that the total
amount of such payments made in a year—</text>
<subclause id="id0EADD9B5707F4DD3A3F9972B6135FA2E"><enum>(I)</enum><text>to facilities and
providers from the bonus pool under paragraph (4)(A) is equal to the total
amount available for such payments for the year under such paragraph;
and</text>
</subclause><subclause id="id643D6CD6DAD94742AA37162C5D2431D8"><enum>(II)</enum><text>to physicians
from the bonus pool under paragraph (4)(B) is equal to the total amount
available for such payments for the year under such paragraph.</text>
</subclause></clause></subparagraph><subparagraph id="IDcac5dccee6694518993997c20206630a"><enum>(D)</enum><header>Requirements
for establishment of the composite score</header><text>In establishing the
composite score under this subsection, the Secretary shall—</text>
<clause id="ID11002e6bee56443494261e48467fa48e"><enum>(i)</enum><text>consult with the
ESRD Advisory Committee to develop the clinical and quality of life measures
and formula used to calculate the weighted composite score;</text>
</clause><clause id="ID857be3ee652f47488685af499d89b273"><enum>(ii)</enum><text>use a
transparent process consistent with the requirements of chapter 5 of title 5,
United States Code (commonly referred to as the <quote>Administrative Procedure
Act</quote>) to develop the measures and the formula used to calculate the
weighted composite score; and</text>
</clause><clause id="IDc87e5736f7e54b26a1f12b5abc28c37c"><enum>(iii)</enum><text>assure that the
payments reward facilities, providers, and physicians for—</text>
<subclause id="ID15bdf7a9f22b416ab3bb9af354301f7c"><enum>(I)</enum><text>the attainment of
minimum quality targets; and</text>
</subclause><subclause id="IDd255fef15a0b47c78b7300233d46b293"><enum>(II)</enum><text>substantial
improvement over the previous year, as demonstrated by the movement of a
facility, provider, or physician from 1 quintile to another.</text>
</subclause></clause></subparagraph></paragraph><paragraph id="ID1ef3b14be8cd450cabf6020e640665eb"><enum>(6)</enum><header>Requirements
for incentive payments</header>
<subparagraph id="ID559dee41ef854b1aae5dfde48e73648c"><enum>(A)</enum><header>In
general</header><text>In order for a facility, provider, or physician to be
eligible for quality incentive payments described in paragraph (5) for a year,
the provider, facility, or physician must have provided for the submission of
data in accordance with subparagraph (B) with respect to that year.</text>
</subparagraph><subparagraph id="ID94c16d1eb1cc4fa88a671fa0ca2e4295"><enum>(B)</enum><header>Submission of
data</header><text>For 2008, 2009, and 2010, each facility, provider, and
physician described in subparagraphs (A) and (B) of paragraph (2) shall submit
to the Secretary such data that the Secretary determines are appropriate for
the measurement of health outcomes and other indices of quality, including data
necessary for the operation of the continuous quality improvement initiative
under this subsection. Such data shall be submitted in a form and manner, and
at a time, specified by the Secretary for purposes of this subsection.</text>
</subparagraph><subparagraph id="ID7a5c7244a10a4a5e8024eba65736021f"><enum>(C)</enum><header>Attestation
regarding data</header><text>In order for a facility, provider, or physician to
be eligible for a quality incentive payment under this subsection for a year,
the facility, provider, or physician must have provided the Secretary (under
procedures established by the Secretary in consultation with the ESRD Advisory
Committee) with an attestation that the data submitted under this subsection
for the year are complete and accurate.</text>
</subparagraph></paragraph><paragraph id="ID0126f8a42fef4f62b4c6adee488ae57d"><enum>(7)</enum><header>Payment methods
and timing of payment</header>
<subparagraph id="IDbe275e2cb5384461b38360b1bb7fbd4b"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), the payment of quality
incentive payments shall be based on such method as the Secretary, in
consultation with the ESRD Advisory Committee, determines appropriate.</text>
</subparagraph><subparagraph id="IDa47a3f642abc4d3b8a936a2f83ff0334"><enum>(B)</enum><header>Timing</header><text>The
Secretary shall ensure that quality incentive payments with respect to a year
are made by no later than June 30 of the subsequent year.</text>
</subparagraph></paragraph><paragraph id="ID951a0914c78a44239fce57fef96ed627"><enum>(8)</enum><header>Feedback</header><text>The
Secretary shall provide quality incentive payments and feedback to facilities,
providers, and physicians as frequently as possible and as close to the date on
which such facilities, providers, and physicians submitted quality data.</text>
</paragraph><paragraph id="ID5ed972313aa543ae805f177eeaa5ef29"><enum>(9)</enum><header>Technical
assistance</header><text>The Secretary shall identify or establish an
appropriately skilled group or organization, such as the ESRD Networks, to
provide technical assistance to consistently low-performing facilities,
providers, or physicians that are in the bottom quintile.</text>
</paragraph><paragraph id="ID9e1525dc3dd34004b434e572a0dd0687"><enum>(10)</enum><header>Streamline
reporting</header><text>The Secretary shall—</text>
<subparagraph id="id11C6B465848E44898FEB48D179C111EE"><enum>(A)</enum><text>evaluate the
current data systems used by facilities, providers, and physicians to submit
data; and</text>
</subparagraph><subparagraph id="id783E890206564D76840221313A97BA4A"><enum>(B)</enum><text>eliminate
redundant reporting by consolidating all current data reporting into a new
web-based system in order to minimize redundancy and reduce regulatory and
administrative demands.</text>
</subparagraph></paragraph><paragraph id="IDdaf9c9a2d00340cc8445911774aad677"><enum>(11)</enum><header>Public
reporting</header>
<subparagraph id="ID941806b1b9a04635a3e6d9e648a2d898"><enum>(A)</enum><header>Availability to
the public</header><text>The Secretary shall establish procedures for making
weighted composite scores calculated under this subsection available to the
public in a clear and understandable form, including through its website and
the Medicare.gov comparison tool. Such procedures shall ensure that a facility,
provider, or physician has the opportunity to review the data that is to be
made public with respect to the facility, provider, or physician prior to such
data being made public.</text>
</subparagraph><subparagraph id="IDd8df5dad0e3d49b5b22321b99f5def81"><enum>(B)</enum><header>Certificates</header><text>The
Secretary shall provide certificates to facilities, providers, and physicians
who provide services to individuals with end-stage renal disease under this
title to display in patient areas. The certificate shall indicate the weighted
composite score obtained by the facility, provider, or physician under the
quality initiative.</text>
</subparagraph><subparagraph id="ID664505d5d4954d088cdce76cf8c4ab75"><enum>(C)</enum><header>Web-based
quality list</header><text>The Secretary shall establish a web-based quality
list for facilities, providers, and physicians who provide items and services
to individuals with end-stage renal disease who are enrolled under part B that
indicates whether measures were met or not.</text>
</subparagraph></paragraph><paragraph id="idEE8B13F40DD04AD49642FFB0F8EF100B"><enum>(12)</enum><header>Evaluations</header>
<subparagraph id="id0D10DE6A87B94AEBBABE5DB63D45AF95"><enum>(A)</enum><header>Evaluation by
the Secretary</header>
<clause id="id149CFD44AAAE4F42B1C81696AF37682E"><enum>(i)</enum><header>Recognizing
part A savings from continuous quality improvement initiative</header><text>Not
later than January 1, 2010, the Secretary shall evaluate and make
recommendations to Congress regarding the feasibility of continuing the quality
initiative by funding an annual increase to the composite rate by the ESRD
market basket amount under subsection (b)(12)(G) through reduced expenditures
under the Federal Hospital Insurance Trust Fund as a result of the quality
initiative.</text>
</clause><clause id="idD190CA1302CC4E85AEE669EFF42D1EB7"><enum>(ii)</enum><header>Recommendations
for an annual update mechanism</header><text>Not later than 12 months after the
date of enactment of this subsection, the Secretary, acting through the
Administrator of the Centers for Medicare & Medicaid Services, shall submit
a report to Congress using the data collected as part of the quality initiative
to make recommendations about establishing a permanent update mechanism for the
composite rate under this section.</text>
</clause></subparagraph><subparagraph id="id3FED60A9AFC7405DB19F905399218145"><enum>(B)</enum><header>Evaluation by
MEDPAC</header>
<clause id="idFF2C86D103E048DFAEBD5D804BF6E3D0"><enum>(i)</enum><header>Study</header><text>The
Medicare Payment Advisory Commission shall conduct a study on the advisability
and feasibility of making the quality initiative permanent.</text>
</clause><clause id="id1CEB401DA040453992D7E955FBF07E91"><enum>(ii)</enum><header>Report</header><text>Not
later than June 1, 2009, the Commission shall submit a report to Congress and
the Secretary on the study conducted under clause (i) together with
recommendations for such legislation and administrative actions as the
Commission considers appropriate, including the need for establishing an annual
update mechanism for the composite rate under this section.</text>
</clause></subparagraph><subparagraph id="idAA83E9F69B47459E8B225E1500C92E53"><enum>(C)</enum><header>Evaluation by
the Institute of Medicine</header>
<clause id="id6CFFB06A08C64833BDE3D3B93A016767"><enum>(i)</enum><header>In
general</header><text>Not later than 2 years after the date of enactment of
this subsection, the Secretary shall enter into an arrangement under which the
Institute of Medicine of the National Academy of Sciences (in this section
referred to as the <quote>Institute</quote>) shall conduct an evaluation of the
effectiveness of the quality initiative.</text>
</clause><clause id="id735BC59C260F4A2794B8C8BF604CDB3E"><enum>(ii)</enum><header>Scope of
review</header><text>The Institute shall consider a variety of perspectives,
including the perspectives of facilities, providers, physicians, nurses, other
health care professionals, and patients.</text>
</clause><clause id="id8AB81F5372534C91B5BEF847C4BEA6A0"><enum>(iii)</enum><header>Report</header><text>Not
later than 3 years after the date of enactment of this subsection, the
Institute shall submit to the Secretary and to Congress a report on the
evaluation conducted under clause (i). Such report shall contain a detailed
description of the findings of such evaluation and recommendations for
implementing on an ongoing basis the quality initiative.</text>
</clause><clause id="id306EECF8D82D4BF8A7A8FDCAC994B580"><enum>(iv)</enum><header>Authorization
of appropriations</header><text>There are authorized to be appropriated such
sums as may be necessary for the purpose of conducting the evaluation and
preparing the report required by this
subparagraph.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="IDa81474d631654cecb448961fe968fa4d"><enum>204.</enum><header>Extension of
Medicare secondary payer</header>
<subsection id="id3CA6E276C2C44CE4B82DC9C4275DFC01"><enum>(a)</enum><header>Extension</header>
<paragraph id="id4C5B8FCE0B274EE58C06718F252386C9"><enum>(1)</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>
<subparagraph id="ID904a72c0c7a74166bdbef4ef0f1f679b"><enum>(A)</enum><text>in the last
sentence, by inserting <quote>, and before January 1, 2008</quote> after
<quote>prior to such date)</quote>; and</text>
</subparagraph><subparagraph id="IDb04f856cbd184cea93685326e90119d4"><enum>(B)</enum><text>by adding at the
end the following new sentence: <quote>Effective for items and services
furnished on or after January 1, 2008 (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 in the first
sentence.</quote>.</text>
</subparagraph></paragraph><paragraph id="idDDE74EC04E34463BA4A374A86CE79BD8"><enum>(2)</enum><header>Effective
date</header><text>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 paragraph (1), 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 paragraph (1)(B).</text>
</paragraph></subsection><subsection id="id29FC1AFEE90C42759B220BB188600927"><enum>(b)</enum><header>OIG study and
report</header>
<paragraph id="id62A3A9DB9C06447188AF321809A02F73"><enum>(1)</enum><header>Study</header><text>The
Inspector General of the Department of Health and Human Services shall conduct
a study on—</text>
<subparagraph id="id37CFE1794A7E4076AECD11842F017842"><enum>(A)</enum><text>the enforcement
of the provisions of section 1862(b)(1)(C)(ii) of the Social Security Act (42
U.S.C. 1395y(b)(1)(C)(ii)); and</text>
</subparagraph><subparagraph id="id32FADD05E0904C29B42A1EC02ABFBA48"><enum>(B)</enum><text>how effective
such provisions are at protecting individuals on dialysis from receiving
differential treatment by health plans once the individual is diagnosed with
end stage renal disease.</text>
</subparagraph></paragraph><paragraph id="id5DE7014A9FFF425FA1D52B8368A886C2"><enum>(2)</enum><header>Report</header><text>Not
later than 1 year after the date of enactment of this Act, the Inspector
General of the Department of Health and Human Services shall submit to Congress
a report on the study conducted under paragraph (1), together with such
recommendations as the Inspector General determines appropriate.</text>
</paragraph></subsection></section>