111 HR 306 IH: Kidney Disease Educational Benefits Act of 2009 U.S. House of Representatives 2009-01-08 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 111th CONGRESS 1st Session H. R. 306 IN THE HOUSE OF REPRESENTATIVES January 8, 2009 Mr. Kirk (for himself and Mr. McDermott) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to provide coverage for kidney disease education services under the Medicare Program, and for other purposes.

1.

Short title

This Act may be cited as the Kidney Disease Educational Benefits Act of 2009.

2.

Medicare coverage of kidney disease education services

(a)

Coverage of Kidney Disease Education Services

(1)

In general

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (A)in subsection (s)(2)— (i)in subparagraph (DD), by striking and at the end; (ii)in subparagraph (EE), by adding and at the end; and (iii)by adding at the end the following new subparagraph: (FF)kidney disease education services (as defined in subsection (hhh)); ; and (B)by adding at the end the following new subsection: (hhh)

Kidney Disease Education Services

(1)The term kidney disease education services means educational services that are— (A)furnished to an individual with kidney disease who, according to accepted clinical guidelines identified by the Secretary, will require dialysis or a kidney transplant; (B)furnished, upon the referral of the physician managing the individual’s kidney condition, by a qualified person (as defined in paragraph (2)); and (C)designed— (i)to provide comprehensive information regarding— (I)the management of comorbidities; (II)the prevention of uremic complications; and (III)each option for renal replacement therapy (including home and in-center, as well as vascular access options and transplantation); and (ii)to ensure that the individual has the opportunity to actively participate in the choice of therapy. (2)The term qualified person means— (A)a physician (as described in subsection (r)(1)); (B)an individual who— (i)is— (I)a registered nurse; (II)a registered dietitian or nutrition professional (as defined in subsection (vv)(2)); (III)a clinical social worker (as defined in subsection (hh)(1)); (IV)a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)); or (V)a transplant coordinator; and (ii)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 (C)a renal dialysis facility subject to the requirements of section 1881(b)(1) with personnel who— (i)provide the services described in paragraph (1); and (ii)meet the requirements of subparagraph (A) or (B). (3)The Secretary shall develop the requirements under paragraph (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. (4)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 that ensures that the beneficiary receives the maximum benefit of those services. (5)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). (6)No individual shall be eligible to be provided more than 6 sessions of kidney disease education services under this title. . (2)

Payment under physician fee schedule

Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting (2)(FF),, after (2)(EE),. (3)

Payment to renal dialysis facilities

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: (15)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(hhh)). Instead, payment for such services shall be made to the renal dialysis facility on an assignment-related basis under section 1848. . (4)

Limitation on number of sessions

Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended— (A)by striking and at the end of subparagraph (N); (B)by striking the semicolon at the end of subparagraph (O) and inserting , and; and (C)by adding at the end the following new subparagraph: (P)in the case of kidney disease education services (as defined in section 1861(hhh)), which are performed in excess of the number of sessions covered under such section; . (5)

Annual report to congress

Not later than April 1, 2010, and annually thereafter, the Secretary of Health and Human Services 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(hhh) of the Social Security Act, as added by paragraph (1)) 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. (b)

Effective Date

The amendments made by this section shall apply to services furnished on or after January 1, 2010.