[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6537 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 6537

To amend titles XVIII and XIX of the Social Security Act and other Acts 
 to improve Medicare and other benefits for beneficiaries with kidney 
                    disease, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 16, 2010

Mr. Lewis of Georgia 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 titles XVIII and XIX of the Social Security Act and other Acts 
 to improve Medicare and other benefits for beneficiaries with kidney 
                    disease, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Improving Care for 
Kidney Patients Act of 2010''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                    TITLE I--IMPROVING PATIENT CARE

Sec. 101. Improvement of pre-dialysis care for Medicaid beneficiaries.
Sec. 102. Study the progression kidney disease in minority populations.
Sec. 103. AHRQ recommendations on dialysis quality and care management 
                            research gaps.
Sec. 104. Kidney disease screening.
Sec. 105. Kidney disease education in hospitals.
Sec. 106. Increasing access to medicare kidney disease education 
                            benefit.
Sec. 107. Kidney disease accountable care organizations (ACOs).
Sec. 108. Coordination of care between hospitals and renal dialysis 
                            facilities.
Sec. 109. Clarification of coverage of certain occulsive dressings.
  TITLE II--PROVIDING ACCESS TO PATIENTS IN NEED OF DIALYSIS TREATMENT

Sec. 201. Survey requirements for renal dialysis facilities.
Sec. 202. GAO study on transportation barriers to accessing kidney 
                            care.
Sec. 203. Vascular access care service sites.
   TITLE III--ELIMINATING INEQUITIES FOR PATIENTS WITH KIDNEY FAILURE

Sec. 301. Patient choice of primary insurer.
Sec. 302. Access to medigap policies.
Sec. 303. Protecting individuals with kidney failure from unfair 
                            practices under health care reform.

                    TITLE I--IMPROVING PATIENT CARE

SEC. 101. IMPROVEMENT OF PRE-DIALYSIS CARE FOR MEDICAID BENEFICIARIES.

    (a) In General.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended by adding at the end the following new 
sentence: ``Notwithstanding the first sentence of this subsection, the 
Federal medical assistance percentage with respect to the placement of 
an arteriovenous fistula or graft for purposes of hemodialysis 
treatment shall be 100 percent''.
    (b) Effective Date.--The amendment made by subsection (a) apply to 
fistulas and grafts placed on or after January 1, 2011.

SEC. 102. STUDY THE PROGRESSION KIDNEY DISEASE IN MINORITY POPULATIONS.

    Not later than one year after the date of the enactment of this 
Act, the Secretary of Health and Human Services, acting through the 
Director of the Agency for Healthcare Research and Quality, shall 
complete a study (and submit a report to Congress) on--
            (1) the social, behavioral, and biological factors leading 
        to kidney disease; and
            (2) efforts to slow the progression of kidney disease in 
        minority populations that are disproportionately affected by 
        such disease.

SEC. 103. AHRQ RECOMMENDATIONS ON DIALYSIS QUALITY AND CARE MANAGEMENT 
              RESEARCH GAPS.

    Not later than 2 years after the date of the enactment of this Act, 
the Secretary of Health and Human Services, acting through the Director 
of the Agency for Healthcare Research and Quality, shall submit to 
Congress a report regarding the research gaps with respect to the 
development of quality measures and care management for patients with 
end-stage renal disease, including pediatric patients. Such report 
shall include recommendations about undertaking research to fill such 
gaps and prioritizing such research.

SEC. 104. KIDNEY DISEASE SCREENING.

    (a) In General.--Section 1128B(b)(3) of the Social Security Act (42 
U.S.C. 1320a-7b(b)(3)) is amended--
            (1) by striking ``and'' at the end of subparagraph (I);
            (2) in subparagraph (J), by moving the indentation 2 ems to 
        the left and by striking the period at the end and inserting 
        ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(K) a waiver of any fee or cost-sharing by a 
                renal dialysis facility for the purpose of providing 
                screening for chronic kidney disease so long as--
                            ``(i) receiving the screening is not 
                        conditioned on the individual's use of any 
                        other goods or services from the facility or 
                        any other particular health care provider;
                            ``(ii) individuals receiving the screening 
                        are referred to their own health care 
                        practitioner;
                            ``(iii) no special discounts or waivers are 
                        available for any follow-up services; and
                            ``(iv) the facility does not bill for the 
                        screening to any Federal or State health care 
                        program or to any other third party payor.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to waivers occurring after the date of the enactment of this Act.

SEC. 105. KIDNEY DISEASE EDUCATION IN HOSPITALS.

    (a) In General.--Section 1861(e)(6) of the Social Security Act (42 
U.S.C. 1395x(e)(6)) is amended--
            (1) by striking ``and (B)'' and inserting ``, (B)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (C) provides patients who are entitled to 
        benefits under this title or title XIX diagnosed with stage IV 
        or stage V kidney disease with educational materials regarding 
        the treatment of kidney disease''.
    (b) Technical Assistance.--Not later than one year after the date 
of the enactment of this Act, the Secretary of Health and Human 
Services shall develop protocols for the identification of chronic 
kidney disease in at-risk Medicare and Medicaid beneficiaries for use 
in the inpatient hospital setting under the amendment made by 
subsection (a)(2).
    (c) Effective Date.--The amendments made by subsection (a) shall 
take effect 1 year after the date of the enactment of this Act.

SEC. 106. INCREASING ACCESS TO MEDICARE KIDNEY DISEASE EDUCATION 
              BENEFIT.

    (a) In General.--Section 1861(ggg)(2) of the Social Security Act 
(42 U.S.C. 1395x(ggg)(2)) is amended--
            (1) by striking subparagraph (B); and
            (2) in subparagraph (A)--
                    (A) by striking ``(A)'' after ``(2)'';
                    (B) by striking ``and'' at the end of clause (i);
                    (C) by striking the period at the end of clause 
                (ii) and inserting ``; and'';
                    (D) by redesignating clauses (i) and (ii) as 
                subparagraphs (A) and (B), respectively; and
                    (E) by adding at the end the following:
            ``(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) is a physician (as defined in subsection 
                (r)(1)) or a physician assistant, nurse practitioner, 
                or clinical nurse specialist (as defined in subsection 
                (aa)(5)).''.
    (b) Payment to Renal Dialysis Facilities.--Section 1881(b) of such 
Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following 
new paragraph:
            ``(15) For purposes of paragraph (14), the single payment 
        for renal dialysis services under such paragraph shall not take 
        into account the amount of payment for kidney disease education 
        services (as defined in section 1861(ggg)). Instead, payment 
        for such services shall be made to the renal dialysis facility 
        on an assignment-related basis under section 1848.''.
    (c) Effective Date.--The amendments made by this section apply to 
kidney disease education services furnished on or after January 1, 
2011.

SEC. 107. KIDNEY DISEASE ACCOUNTABLE CARE ORGANIZATIONS (ACOS).

    Section 1899(b)(1) of the Social Security Act (42 U.S.C. 
1395jjj(b)(1)), as added by section 3022, and amended by section 10307, 
of the Patient Protection and Affordable Care Act (Public Law 111-148), 
is amended--
            (1) by redesignating subparagraph (E) as subparagraph (F); 
        and
            (2) by inserting after subparagraph (D) the following new 
        subparagraph:
                    ``(E) A group consisting of dialysis facilities, 
                nephrologists, and other providers of services and 
                suppliers that treat patients with kidney disease.''.

SEC. 108. COORDINATION OF CARE BETWEEN HOSPITALS AND RENAL DIALYSIS 
              FACILITIES.

    (a) In General.--Section 1861(ee)(2) of the Social Security Act (42 
U.S.C. 1395x(ee)(2)) is amended by adding at the end the following new 
subparagraph:
                    ``(I) In the case of a patient who has end stage 
                renal disease and is or will be receiving dialysis 
                treatments upon discharge, the hospital must transmit 
                the discharge summary and any other relevant health 
                information defined by the Secretary to the renal 
                dialysis facility or hospital-based provider when the 
                patient is discharged from the hospital.''.
    (b) Deadline.--The Secretary of Health and Human Services shall 
implement guidelines and standards to carry out the amendment made by 
subsection (a) not later than 6 months after the date of the enactment 
of this Act.

SEC. 109. CLARIFICATION OF COVERAGE OF CERTAIN OCCULSIVE DRESSINGS.

    (a) In General.--Section 1861(s)(5) of the Social Security Act (42 
U.S.C. 1395x(s)(5)) is amended by inserting before the semicolon the 
following: ``and specialized occlusive dressings used by a patient with 
receiving dialysis treatment to protect the individual against life 
threatening catheter-related infections during maintenance of personal 
hygiene at home (such as during bathing and showering)''.
    (b) Exclusion From ESRD Bundled Payment Rate.--The last sentence of 
section 1881(b)(14)(B) of such Act (42 U.S.C. 1395rr(b)(14)(B)) is 
amended by inserting before the period at the end the following: ``or 
occlusive dressings described in section 1861(s)(5)''.
    (c) Payment Under Surgical Dressing Provisions.--Section 1834(i)(1) 
of such Act (42 U.S.C. 1395m(i)(1)) is amended by inserting ``, 
including specialized occlusive dressings described in such section'' 
after ``1861(s)(5)''.
    (d) Effective Date.--The amendments made by this section shall 
apply to dressings furnished on or after January 1, 2011.

  TITLE II--PROVIDING ACCESS TO PATIENTS IN NEED OF DIALYSIS TREATMENT

SEC. 201. SURVEY REQUIREMENTS FOR RENAL DIALYSIS FACILITIES.

    Section 1864 of the Social Security Act (42 U.S.C. 1395aa) is 
amended--
            (1) by redesignating subsection (e) as subsection (f) and 
        by inserting after subsection (d) the following new subsection:
    ``(e)(1) If the Secretary has entered into an agreement with any 
State under this section under which the appropriate State or local 
agency that performs any survey related to determining the compliance 
of a renal dialysis facility subject to the requirements of section 
1881(b) and the State licensure survey requirements are consistent with 
or exceed such Federal requirements, the Secretary must accept the 
results of the State licensure survey for purposes of determining 
Federal certification of compliance. In the case of such an initial 
survey of a renal dialysis facility, the Secretary may allow any State 
to waive the reimbursement for conducting the survey under this 
subsection if it requests such a waiver.
    ``(2) In the case of a renal dialysis facility that has waited for 
more than 6 months to receive the results of an initial survey under 
this section, the Secretary shall establish a specific timetable for 
completing and reporting the results of the survey.'';
            (2) in subsection (f), as so redesignated--
                    (A) by striking ``Notwithstanding any other 
                provision of law,'' and inserting ``(1) Notwithstanding 
                any other provision of law and except as provided in 
                paragraph (2)''; and
                    (B) by adding at the end the following:
    ``(2) The Secretary may assess and collect fees for the initial 
Medicare survey from a renal dialysis facility subject to the 
requirements of section 1881(b) in an amount not to exceed a reasonable 
fee necessary to cover the costs of initial surveys conducted for 
purposes of determining the compliance of a renal dialysis facility 
with the requirements of section 1881(b). Fees may be assessed and 
collected under this paragraph only in such manner as would result in 
an aggregate amount of fees collected during any fiscal year which 
equals the aggregate amount of costs for such fiscal year for initial 
surveys of such facilities under this section. A renal dialysis 
facility's liability for such fees shall be reasonably based on the 
proportion of the survey costs which relate to such facility. Any funds 
collected under this paragraph shall be used only to conduct the 
initial survey of the facilities providing the fees.
    ``(3) Fees authorized under paragraph (2) shall be collected by the 
Secretary and available only to the extent and in the amount provided 
in advance in appropriations Acts and upon request of the Secretary, 
subject to the amount and usage limitations of such paragraph. Such 
fees so collected are authorized to remain available until expended.''.

SEC. 202. GAO STUDY ON TRANSPORTATION BARRIERS TO ACCESSING KIDNEY 
              CARE.

    (a) In General.--The Comptroller General of the United States shall 
conduct an evaluation of the transportation barriers facing dialysis 
patients that result in less than 100 percent compliance with their 
plan of care under the Medicare program.
    (b) Specific Matters Evaluated.--In conducting the evaluation under 
subsection (a), the Comptroller General shall examine--
            (1) the costs associated with providing dialysis services;
            (2) the number and characteristics of patients who miss at 
        least 2 dialysis treatments during a month or have shortened 
        treatments because of barriers to transportation; and
            (3) the potential sources of providing dialysis patients 
        with such transportation services.
    (c) Report.--Not later than the date that is 6 months after the 
date of the 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.

SEC. 203. VASCULAR ACCESS CARE SERVICE SITES.

    Not later than 1 year after the date of the enactment of this Act, 
the Secretary of Health and Human Services shall report and provide 
recommendations to the Congress on the benefits of recognizing dialysis 
vascular and peritoneal dialysis access care service sites for purposes 
of receiving reimbursement under the Medicare program.

   TITLE III--ELIMINATING INEQUITIES FOR PATIENTS WITH KIDNEY FAILURE

SEC. 301. PATIENT CHOICE OF PRIMARY INSURER.

    (a) Providing Patient Choice in Medicare.--
            (1) In general.--Section 1862(b)(1)(C) of the Social 
        Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended--
                    (A) in the last sentence, by inserting ``and before 
                January 1, 2011'' after ``prior to such date)''; and
                    (B) by adding at the end the following new 
                sentence: ``Effective for items and services furnished 
                on or after January 1, 2011 (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 `42-month' for `12-month 'each place it 
                appears in the first sentence.''.
            (2) Effective date.--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).
    (b) Application of Rules to Qualified Health Plans and Individual 
Health Insurance Coverage.--Such section is further amended, in the 
matter before clause (i), by inserting after ``subparagraph (A)(v))'' 
the following: ``, a qualified health plan established pursuant to or 
governed by subtitle D of title I of the Patient Protection and 
Affordable Care Act, or any individual health insurance coverage (as 
defined in section 2791(b)(5) of the Public Health Service Act, 
excluding excepted coverage under subsection (c) of such section)''.

SEC. 302. ACCESS TO MEDIGAP POLICIES.

    (a) In General.--Section 1882(s) of the Social Security Act (42 
U.S.C. 1395ss(s)) is amended--
            (1) in paragraph (2)(A), by inserting ``, or is eligible 
        for hospital insurance benefits under part A on the basis of 
        sections 226(b) or 226A'' after ``65 years of age or older'';
            (2) in paragraph (2)(D), by striking ``the 6-month period 
        described in subparagraph (A) to an individual who is 65 years 
        of age or older as of the date of issuance and'' and inserting 
        ``a 6-month period described in subparagraph (A) to an 
        individual''; and
            (3) in paragraph (3)(B)(vi), by striking ``at age 65''.
    (b) Effective Date.--
            (1) In general.--The amendments made by subsection (a) 
        shall take effect as of the date of the enactment of this Act.
            (2) Transition.--
                    (A) No medicare supplemental policy of an issuer 
                shall be deemed to meet the standards in subsection (c) 
                of section 1882 of the Social Security Act (42 U.S.C. 
                1395ss) unless the issuer permits each individual 
                described in subparagraph (B), during the 6-month 
                period beginning on the first day of the first month 
                beginning after the date of the enactment of this Act, 
                to be enrolled under a medicare supplemental policy in 
                accordance with subsection (s) of such section, as 
                amended by subsection (a), applied as if the individual 
                were first enrolled under part B of title XVIII of the 
                Social Security Act as of the first day of such first 
                month.
                    (B) For purposes of subparagraph (A), an individual 
                described in this subparagraph is an individual who, as 
                of the first day of the first month beginning after the 
                date of the enactment of this Act--
                            (i) is under 65 years of age;
                            (ii) is enrolled under part B of title 
                        XVIII of the Social Security Act; and
                            (iii) is not enrolled in a medicare 
                        supplemental policy.

SEC. 303. PROTECTING INDIVIDUALS WITH KIDNEY FAILURE FROM UNFAIR 
              PRACTICES UNDER HEALTH CARE REFORM.

    (a) In General.--Section 2719A of the Public Health Service Act (42 
U.S.C. 300gg-19a), as added by section 10101(h) of the Patient 
Protection and Affordable Care Act (Public Law 111-148), is amended by 
adding at the end the following new subsection:
    ``(e) Access for Patients With Kidney Failure.--
            ``(1) In general.--In the case of an individual who is a 
        participant, beneficiary, or enrollee under a group health 
        plan, or health insurance coverage offered by a health 
        insurance issuer in the group or individual market and who has 
        kidney failure, the plan or issuer may only impose restrictions 
        with respect to treatment for kidney failure if the 
        restrictions are reasonable and assure adequate access to out-
        of-network providers consistent with this subsection.
            ``(2) Specific requirements.--In carrying out paragraph 
        (1), a plan or issuer--
                    ``(A) may not set out-of-network rates through 
                unilateral rate setting or other mechanisms that 
                restrict or limit negotiations with providers and 
                facilities that furnish services to treat kidney 
                failure;
                    ``(B) shall provide adequate, advanced, written 
                notification to patients regarding changes to dialysis 
                service benefits, new restrictions on out-of-network 
                access, or reductions to rates paid for out-of-network 
                benefits for such services;
                    ``(C) shall allow patients to continue using their 
                existing provider or facility of such services for at 
                least 24 months following the date of notice of any 
                change by the plan or issuer in their dialysis services 
                network;
                    ``(D) shall hold patients harmless from provider 
                network changes with respect to such services if such 
                changes require unreasonable drive time or disrupt the 
                physician-patient relationship;
                    ``(E) may not restrict the duration or number of 
                dialysis sessions for patients, such as based on a 
                fixed number of treatments per week, to less than the 
                number permitted under the Medicare program under title 
                XVIII of the Social Security Act;
                    ``(F) may not penalize physicians for referring 
                patients to out-of-network providers or facilities for 
                such services;
                    ``(G) may not require assignment of benefits for 
                such services;
                    ``(H) shall ensure equity with respect to out-of-
                pocket payments for such services;
                    ``(I) may not deny or limit coverage for patients 
                for such services if premiums, co-payments, or other 
                payments are made by third parties on their behalf; and
                    ``(J) shall meet minimum network adequacy standards 
                specified by the Secretary with respect to such 
                services.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to plans and issuers as of January 1, 2014.
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