1.Short title; table of
contents
(a)This Act may be cited
as the Improving Care for Kidney Patients Act of
2010
.
(b)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.
<enum>I</enum><header>Improving Patient
Care</header>
<section id="H0E443A2642374A93B77EC843191AAC7A"><enum>101.</enum><header>Improvement of
pre-dialysis care for Medicaid beneficiaries</header>
<subsection id="HD9A724387DC3440585BE9FE87C2179B9"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">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: <quote>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</quote>.</text>
</subsection><subsection id="HCD8D096948A349CFAEBDDD7A772DB697"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) apply to fistulas and
grafts placed on or after January 1, 2011.</text>
</subsection></section><section id="H64F4E76B606947448675A64E76BD76A7"><enum>102.</enum><header>Study the
progression kidney disease in minority populations</header><text display-inline="no-display-inline">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—</text>
<paragraph id="HFD576694B44543C397DBADC49BAB03F0"><enum>(1)</enum><text>the social,
behavioral, and biological factors leading to kidney disease; and</text>
</paragraph><paragraph id="HCEBB76FAA2C2424CB066B416F0D8F69E"><enum>(2)</enum><text>efforts to slow
the progression of kidney disease in minority populations that are
disproportionately affected by such disease.</text>
</paragraph></section><section id="H6D93EA5CA9E345DBABFA2AE2836BCF71"><enum>103.</enum><header>AHRQ
recommendations on dialysis quality and care management research
gaps</header><text display-inline="no-display-inline">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.</text>
</section><section id="H82DDD075865649DBAA9F068A47A4A74D"><enum>104.</enum><header>Kidney disease
screening</header>
<subsection id="H19394684F1C0498EB9D3A8A2CD320864"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1128B(b)(3)
of the Social Security Act (42 U.S.C. 1320a–7b(b)(3)) is amended—</text>
<paragraph id="H00B38A2827DD4335BFEE7602D1B1592D"><enum>(1)</enum><text>by striking
<quote>and</quote> at the end of subparagraph (I);</text>
</paragraph><paragraph id="HBAF660599CB846DDBF8DC5C298C52A0D"><enum>(2)</enum><text>in subparagraph
(J), by moving the indentation 2 ems to the left and by striking the period at
the end and inserting <quote>; and</quote>; and</text>
</paragraph><paragraph id="H86D43D586D1E4C24B50D8BD6E4C0E246"><enum>(3)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H8BB78F74469A401F9D92CC56C8047219" style="OLC">
<subparagraph id="H99A77B1326F64C999ED81EE7C767CA1D"><enum>(K)</enum><text>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—</text>
<clause id="H314AA3F8C0DE4B04A52AEB849E6020AF"><enum>(i)</enum><text>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;</text>
</clause><clause id="HF086CE4CF358430EB9C0B9E9A98F9132"><enum>(ii)</enum><text>individuals
receiving the screening are referred to their own health care
practitioner;</text>
</clause><clause id="H706C13D250FE45AA9F0B8FD1CFA9C637"><enum>(iii)</enum><text>no special
discounts or waivers are available for any follow-up services; and</text>
</clause><clause id="H0EBAE04B96984B2C85F2288B4B0852D6"><enum>(iv)</enum><text display-inline="yes-display-inline">the facility does not bill for the
screening to any Federal or State health care program or to any other third
party
payor.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HF38E204195504E189B87822FBDBD980A"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by subsection (a) shall apply to waivers
occurring after the date of the enactment of this Act.</text>
</subsection></section><section id="H9E5A3FC1EFF14D299CCD318C36579F09"><enum>105.</enum><header>Kidney disease
education in hospitals</header>
<subsection id="H759B93E812EB4F688705A6876714BF63"><enum>(a)</enum><header>In
general</header><text>Section 1861(e)(6) of the Social Security Act (42 U.S.C.
1395x(e)(6)) is amended—</text>
<paragraph id="HD9706E72F4964A1997D2FE8BF20090BE"><enum>(1)</enum><text>by striking
<quote>and (B)</quote> and inserting <quote>, (B)</quote>; and</text>
</paragraph><paragraph id="HC8E506C1828A406F819544A3569FA2A3"><enum>(2)</enum><text>by inserting
before the semicolon at the end the following: <quote>, 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</quote>.</text>
</paragraph></subsection><subsection id="H16DD71F679DA481C90B7EADC86A5F5D5"><enum>(b)</enum><header>Technical
assistance</header><text>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).</text>
</subsection><subsection id="H87AFD8BA86AB4C1181452979E8BDEBFE"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by subsection (a) shall take effect 1
year after the date of the enactment of this Act.</text>
</subsection></section><section id="HD878BAD05CF841AD8FBC7FE02DF925EA"><enum>106.</enum><header>Increasing
access to medicare kidney disease education benefit</header>
<subsection id="H1DF4496862A54A58AE3CA3BFEBC9EA31"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1861(ggg)(2)
of the Social Security Act (42 U.S.C. 1395x(ggg)(2)) is amended—</text>
<paragraph id="H08DEA3B623D6466AA83CD3540F69DE30"><enum>(1)</enum><text>by striking
subparagraph (B); and</text>
</paragraph><paragraph id="H357EF0D1447C4A16B5A40326E7D37D1F"><enum>(2)</enum><text>in subparagraph
(A)—</text>
<subparagraph id="H9B542E62C22E4602A52B605B787768A3"><enum>(A)</enum><text>by striking
<quote>(A)</quote> after <quote>(2)</quote>;</text>
</subparagraph><subparagraph id="H90F3689DE8C24C3FA5238E63B0F5695A"><enum>(B)</enum><text>by striking
<quote>and</quote> at the end of clause (i);</text>
</subparagraph><subparagraph id="H0A9A30B912244471B061500B7C9093DA"><enum>(C)</enum><text>by striking the
period at the end of clause (ii) and inserting <quote>; and</quote>;</text>
</subparagraph><subparagraph id="HE1B76837844845C29BA3548B6E7F743E"><enum>(D)</enum><text>by redesignating
clauses (i) and (ii) as subparagraphs (A) and (B), respectively; and</text>
</subparagraph><subparagraph id="H68412338ED954E56B492E54872B7BCC3"><enum>(E)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="HC26CCDB5F3C643D1ADF80A32E2226936" style="OLC">
<subparagraph id="HFCC7636E731F4A9F8E8DE7A79A591E9D" indent="up1"><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 id="HEB9F6C9311BE466CAA275940E8FE0108"><enum>(i)</enum><text>provide the services described in
paragraph (1); and</text>
</clause><clause id="HEC38B9C7402F4161A96E1C64A6346419"><enum>(ii)</enum><text display-inline="yes-display-inline">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)).</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="HD065190655E240A5AA9DFC4B09489FD1"><enum>(b)</enum><header>Payment to renal
dialysis facilities</header><text display-inline="yes-display-inline">Section
1881(b) of such 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="H1D4C3CAB24394308BEB8C9E2B8E2CA0D" style="traditional">
<paragraph id="H4E78E0DFEF7F4DBA84B2FCEBEA5B18F6"><enum>(15)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H698DBE4D0E8C46E0A44DAC4D43925DBE"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section apply to kidney disease
education services furnished on or after January 1, 2011.</text>
</subsection></section><section id="H890D529C7E5340029D1C73BF97B12F79"><enum>107.</enum><header>Kidney disease
accountable care organizations (ACOs)</header><text display-inline="no-display-inline">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—</text>
<paragraph id="HDCE5E776DB124DFBB5077045DA50820A"><enum>(1)</enum><text>by redesignating
subparagraph (E) as subparagraph (F); and</text>
</paragraph><paragraph id="H84AF3144774E413DB7E229DDF134B8DE"><enum>(2)</enum><text>by inserting after
subparagraph (D) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H60221C780BF44755994E189A012ABC02" style="OLC">
<subparagraph id="H0CA19E9072984AD7ACAD6D6AA839FAC8"><enum>(E)</enum><text display-inline="yes-display-inline">A group consisting of dialysis facilities,
nephrologists, and other providers of services and suppliers that treat
patients with kidney disease.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="H95CA0283C64340DBB3C3D6E437E8C489"><enum>108.</enum><header>Coordination of
care between hospitals and renal dialysis facilities</header>
<subsection id="HF6E193F6171B4023910EC50356ECDD7E"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">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:</text>
<quoted-block id="HD465769BA48B459B8FB42014E9E32F26" style="OLC">
<subparagraph id="H3682312CCA9440C5B0B282D80F3A0B5E"><enum>(I)</enum><text>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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H6B4E3848CF3F4685A093B9072B7353DE"><enum>(b)</enum><header>Deadline</header><text>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.</text>
</subsection></section><section id="H3613A6DA51DF4BA596EB27F3C6FAD3DA"><enum>109.</enum><header>Clarification
of coverage of certain occulsive dressings</header>
<subsection id="H61208C80E4194E3588C2EB70EE73C5D4"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">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: <quote>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)</quote>.</text>
</subsection><subsection id="H4569340B6E124F5086FCBCEAB23C9155"><enum>(b)</enum><header>Exclusion from
ESRD bundled payment rate</header><text>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: <quote>or occlusive dressings
described in section 1861(s)(5)</quote>.</text>
</subsection><subsection id="H9668D82BE1EF40899A39AB26CBE6C070"><enum>(c)</enum><header>Payment under
surgical dressing provisions</header><text>Section 1834(i)(1) of such Act (42
U.S.C. 1395m(i)(1)) is amended by inserting <quote>, including specialized
occlusive dressings described in such section</quote> after
<quote>1861(s)(5)</quote>.</text>
</subsection><subsection id="H72C65046784D4BE1939AF957D6E388B5"><enum>(d)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to dressings
furnished on or after January 1, 2011.</text>
</subsection></section><enum>II</enum><header>Providing Access
to Patients in Need of Dialysis Treatment</header>
<section id="H54D224F7C52B4B248411785EAFCD0688"><enum>201.</enum><header>Survey
requirements for renal dialysis facilities</header><text display-inline="no-display-inline">Section 1864 of the Social Security Act (42
U.S.C. 1395aa) is amended—</text>
<paragraph id="H78C98D9FA53645EBA42BF91FAF2A7E5A"><enum>(1)</enum><text>by redesignating
subsection (e) as subsection (f) and by inserting after subsection (d) the
following new subsection:</text>
<quoted-block id="H22D801E03BC24F81B35790C3FFB1487B" style="OLC">
<subsection id="HF1A3C4F470F647A4891752D4B7F19240"><enum>(e)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H53877832A5BA4EAD9BEDF0EA1D3447A5"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="H8188B067D2914E83B32FB180A8155043" indent="up1"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><after-quoted-block>;</after-quoted-block></quoted-block>
</paragraph><paragraph id="HD86A1F221D4F45F6AD5765A916E02C68"><enum>(2)</enum><text>in subsection (f),
as so redesignated—</text>
<subparagraph id="H7DCB775B4F2A4D78AC10741B177811B3"><enum>(A)</enum><text>by striking
<quote>Notwithstanding any other provision of law,</quote> and inserting
<quote>(1) Notwithstanding any other provision of law and except as provided in
paragraph (2)</quote>; and</text>
</subparagraph><subparagraph id="H0524C91F470A44A88D39CAB1C77E8190"><enum>(B)</enum><text>by adding at the
end the following:</text>
<quoted-block id="HDEBB2D91FEFD40C499F29C6E50A67B1A" style="OLC">
<paragraph id="H40C79A6E08B64197990641319898DCE0" indent="up1"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph id="HE770B704280E49D6A4892BFEA8FA652A" indent="up1"><enum>(3)</enum><text>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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></section><section id="H40C15F966BE542F9BBCD2A06A8C52A21"><enum>202.</enum><header>GAO study on
transportation barriers to accessing kidney care</header>
<subsection id="HE79512A3B8A1445FBC93B329026E0765"><enum>(a)</enum><header>In
general</header><text>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.</text>
</subsection><subsection id="HA7C306F2ABE04816AA19228B06C89489"><enum>(b)</enum><header>Specific matters
evaluated</header><text>In conducting the evaluation under subsection (a), the
Comptroller General shall examine—</text>
<paragraph id="HE9532E380D354A868A9D6C314DAAEA18"><enum>(1)</enum><text>the costs
associated with providing dialysis services;</text>
</paragraph><paragraph id="H42481AB88F8C4B299F2C4E2FF8131FC8"><enum>(2)</enum><text>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</text>
</paragraph><paragraph id="H9FFE2573E98341EEBD34F4B9E10D542F"><enum>(3)</enum><text>the potential
sources of providing dialysis patients with such transportation
services.</text>
</paragraph></subsection><subsection id="HF0FED28FD0CF4CBAAD0909AB7CEC6757"><enum>(c)</enum><header>Report</header><text>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.</text>
</subsection></section><section id="HF5CDD8DD0C3244B692783473280CACC9"><enum>203.</enum><header>Vascular access
care service sites</header><text display-inline="no-display-inline">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.</text>
</section><enum>III</enum><header>Eliminating
Inequities for Patients with Kidney Failure</header>
<section id="H172920649C05492A8D79C4E66E125195"><enum>301.</enum><header>Patient choice
of primary insurer</header>
<subsection id="H6DB925DC4CEB4FD289287E05BAE9478C"><enum>(a)</enum><header>Providing
patient choice in medicare</header>
<paragraph id="H2D1B8129648D463EB1C0B46D283C80FD"><enum>(1)</enum><header>In
general</header><text>Section 1862(b)(1)(C) of the Social Security Act (42
U.S.C. 1395y(b)(1)(C)) is amended—</text>
<subparagraph id="HE4B1A48BD9BA4B66BED16106C6E102A2"><enum>(A)</enum><text>in the last
sentence, by inserting <quote>and before January 1, 2011</quote> after
<quote>prior to such date)</quote>; and</text>
</subparagraph><subparagraph id="H76BBBDA9FB7C4B4B8ABDB2E9B5E17A95"><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, 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 <quote>42-month</quote> for <quote>12-month
</quote>each place it appears in the first sentence.</quote>.</text>
</subparagraph></paragraph><paragraph id="H26A1CD13831A497E95F8BDEDE00F0E87"><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="HE6CEB70198294A968959D61166F5237B"><enum>(b)</enum><header>Application of
rules to qualified health plans and individual health insurance
coverage</header><text>Such section is further amended, in the matter before
clause (i), by inserting after <quote>subparagraph (A)(v))</quote> the
following: <quote>, 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)</quote>.</text>
</subsection></section><section id="H6C6AEB90CAE24231AFA504364BE93048"><enum>302.</enum><header>Access to
medigap policies</header>
<subsection id="H195C041ACF7E4F5D8039DD62A1230F73"><enum>(a)</enum><header>In
general</header><text>Section 1882(s) of the Social Security Act (42 U.S.C.
1395ss(s)) is amended—</text>
<paragraph id="H05D04BF306C8482F88AC8E54F5CAEFF8"><enum>(1)</enum><text>in paragraph
(2)(A), by inserting <quote>, or is eligible for hospital insurance benefits
under part A on the basis of sections 226(b) or 226A</quote> after <quote>65
years of age or older</quote>;</text>
</paragraph><paragraph id="HFB3A3A7017FA4841BE5C5A000950A175"><enum>(2)</enum><text>in paragraph
(2)(D), by striking <quote>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</quote> and inserting <quote>a 6-month period described in subparagraph (A)
to an individual</quote>; and</text>
</paragraph><paragraph id="H4A31A1D700924ED9922C4410787C9F19"><enum>(3)</enum><text>in paragraph
(3)(B)(vi), by striking <quote>at age 65</quote>.</text>
</paragraph></subsection><subsection id="H14269AA35D674CD5AA2E1574B9D8EFD8"><enum>(b)</enum><header>Effective
date</header>
<paragraph id="H23B8B5F9502243AABD5748DB590706F6"><enum>(1)</enum><header>In
general</header><text>The amendments made by subsection (a) shall take effect
as of the date of the enactment of this Act.</text>
</paragraph><paragraph id="HE376FC304EB24731AEBF66C100597A32"><enum>(2)</enum><header>Transition</header>
<subparagraph id="H6A1BC4920417409ABD2E705792FD4485"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph id="H34FFD4BE11EC40FD93D44ECCFEBB7898"><enum>(B)</enum><text display-inline="yes-display-inline">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—</text>
<clause id="H434A54965AE7430C84D5BA49AEDDB678"><enum>(i)</enum><text>is
under 65 years of age;</text>
</clause><clause id="H18EC1A8D8418471CB2E106780F53ABBF"><enum>(ii)</enum><text>is
enrolled under part B of title XVIII of the Social Security Act; and</text>
</clause><clause id="H29731CDC75CF423FA90DCBA140C66ABB"><enum>(iii)</enum><text>is
not enrolled in a medicare supplemental policy.</text>
</clause></subparagraph></paragraph></subsection></section><section id="H0A140BF719734D539B1E3330C8337424"><enum>303.</enum><header>Protecting
individuals with kidney failure from unfair practices under health care
reform</header>
<subsection id="H13181F6C53134A83BDA4895AA77FD443"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H35D7E44A282B4DD795ABE529A1A0A34C" style="OLC">
<subsection id="H4DCB4EE35C084EE0AE8BF39722930B47"><enum>(e)</enum><header>Access for
patients with kidney failure</header>
<paragraph id="H738AB9CF64734194B305290F70A5E5CF"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="HE248AED10EC34CCCB4CCAE2DCB20C774"><enum>(2)</enum><header>Specific
requirements</header><text>In carrying out paragraph (1), a plan or
issuer—</text>
<subparagraph display-inline="no-display-inline" id="HF2785E63EBE349E488657A5F8AAD380A"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="H7AC2A76E796C4DDD8CA13BB0B4C62261"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="H25FCFCBC80E84C53AC80A62DAE38AF71"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph id="H900BFBC731344B3CB270AE84F9E78702"><enum>(D)</enum><text>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;</text>
</subparagraph><subparagraph id="HDAF7139087F6471197D87169CA1F3230"><enum>(E)</enum><text>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;</text>
</subparagraph><subparagraph id="H40146C5128904DC4B43190C380AE7F0B"><enum>(F)</enum><text>may not penalize
physicians for referring patients to out-of-network providers or facilities for
such services;</text>
</subparagraph><subparagraph id="H69D272CF369A485091871A519FB5D221"><enum>(G)</enum><text>may not require
assignment of benefits for such services;</text>
</subparagraph><subparagraph id="HAAF7245AE91F421CB71EC055FFDB27D0"><enum>(H)</enum><text>shall ensure
equity with respect to out-of-pocket payments for such services;</text>
</subparagraph><subparagraph id="HDF262D4BE3894ED980634A4E643E026B"><enum>(I)</enum><text display-inline="yes-display-inline">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</text>
</subparagraph><subparagraph id="H41E80E750DE44708895A9F9BBC5F5713"><enum>(J)</enum><text display-inline="yes-display-inline">shall meet minimum network adequacy
standards specified by the Secretary with respect to such
services.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HA705B2275C5C4E4A9CC75E971759EC17"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to plans
and issuers as of January 1, 2014.</text>
</subsection></section>