1.Short title; table of
contents
(a)This Act may be cited as the Kidney Disease Equitable Access, Prevention, and Research
Act of 2012
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—Providing equitable access to care for individuals with
kidney disease
Sec. 101. Improving access to care through improvements in the
initial survey process for renal dialysis facilities.
Sec. 102. Providing choice in primary insurer.
Sec. 103. Protecting individuals with kidney failure from
unfair practices.
TITLE II—Supporting research to improve access to high quality
kidney care
Sec. 201. Understanding the progression of kidney disease in
minority populations.
Sec. 202. Recommendations on dialysis quality and care
management research gaps.
Sec. 203. GAO study on transportation barriers to access kidney
care.
TITLE III—Improving access to preventive care for individuals
with kidney disease
Sec. 301. Improving access to medicare kidney disease
education.
<enum>I</enum><header>Providing
equitable access to care for individuals with kidney disease</header>
<section id="HAAA84873C10349AEBE4C986E869CC975"><enum>101.</enum><header>Improving
access to care through improvements in the initial survey process 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="HB4DD1CFB1690404FB331BE32207652D2"><enum>(1)</enum><text>by redesignating
subsection (e) as subsection (f);</text>
</paragraph><paragraph id="H1540D543254F465ABBAA0A2875B56046"><enum>(2)</enum><text>by inserting after
subsection (d) the following new subsection:</text>
<quoted-block id="H5125B17A0CD84F1BAB8319F7ADD9DA8F" style="OLC">
<subsection id="HCE8ED1F3BD984906A02E97330B1A7086"><enum>(e)</enum><paragraph commented="no" display-inline="yes-display-inline" id="HCB1D46D7980F4532A2D95D5B15117EF4"><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 section if it requests such a
waiver.</text>
</paragraph><paragraph id="H35DC7613930E495BAFCDAF4C92AD69AE" 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>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="H2875ED14D74F44CA95EB2EB6BBBBA247"><enum>(3)</enum><text>in subsection (f),
as so redesignated—</text>
<subparagraph id="HB3E39ED1889944A781A1997441ACF78C"><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="H19507D3283E44A7D8EE11CC6EFDB4440"><enum>(B)</enum><text>by adding at the
end the following:</text>
<quoted-block id="H45555F2202714D33A55C9066C933AA9B" style="OLC">
<paragraph id="H49A2870080734EC7AE2CB82EAED25077" 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 being equal to 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="H86BA42A0401348D9992F6256FE2B8224" 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="H5F6B86B10D424BA4B23B85EC97DA25CA"><enum>102.</enum><header>Providing
choice in primary insurer</header>
<subsection id="H509D9B4493D34F47ACCEED93E01C2C2F"><enum>(a)</enum><header>Providing for
patient choice</header>
<paragraph id="H73E557BF6245434BA82397F857DB1123"><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="H283DB4C69CD241DD9BBA4E0CADB96A04"><enum>(A)</enum><text>in the last
sentence, by inserting <quote>and before January 1, 2013,</quote> after
<quote>prior to such date)</quote>; and</text>
</subparagraph><subparagraph id="H5BAC35F95AF5483C9F952EEA2F07ED0B"><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, 2013 (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="H7D8008CE39AB4A16B0E15A50BE37F948"><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="HC4F050B9D78B4613B07692796FFD0960"><enum>(b)</enum><header>Providing
equitable access to insurance for individuals with kidney
failure</header><text>The Secretary of Health and Human Services shall clarify
upon enactment of this Act that the Medicare Secondary Payer rules set forth in
section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as
amended by this Act, apply to qualified health plans established under section
1311(b)(1)(B) of Public Law 111–148 (42 U.S.C. 13031(b)(1)(B)).</text>
</subsection></section><section id="H734EA499B4AF49D8953C6F79762B08FD"><enum>103.</enum><header>Protecting
individuals with kidney failure from unfair practices</header>
<subsection id="H86C0C1E689D1417C9CD4BBECA9FB91DD"><enum>(a)</enum><header>In
general</header><text>Section 1862(b)(1)(C)(ii) of the Social Security Act (42
U.S.C. 1395y(b)(1)(C)(ii)) is amended to read as follows:</text>
<quoted-block id="H47EBC9A1967C468296D45A25ABA75BE4" style="OLC">
<clause id="HB54BD16B4C2B458CBD121343F8E19E68"><enum>(ii)</enum><text>may not
differentiate in the benefits it provides between individuals having end stage
renal disease and other individuals covered by such plan or issuer on the basis
of the existence of end stage renal disease, the need for renal dialysis, or in
any other manner, and such plan—</text>
<subclause id="H73B11B208CA84FC3AC7E4A596DAAE53F"><enum>(I)</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 in rates paid for out-of-network benefits for such services;</text>
</subclause><subclause id="H76DED9C03A27427C8CF12B644F191D3A"><enum>(II)</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 the dialysis services network of the plan or issuer;</text>
</subclause><subclause id="H21C5375B13F6462B87B6736F16CE6F99"><enum>(III)</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>
</subclause><subclause id="HB838299B8D194D1ABCA636BBCC0D6254"><enum>(IV)</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 for which payment
may be made pursuant to section 1881(b)(1);</text>
</subclause><subclause id="H1507D6136CF548AAA7617DA16076EEBE"><enum>(V)</enum><text>may not require
assignment of benefits for such services;</text>
</subclause><subclause id="H1EADF0B0CCFC4D48A5FF9BD5B442B0AC"><enum>(VI)</enum><text>shall ensure that
out-of-pocket payments for such services apply to the medicare part C
out-of-pocket maximums and not treated as routine for purposes of calculating
beneficiary copayments;</text>
</subclause><subclause id="H831F3A799E6A46B2973453AEAA13E7D4"><enum>(VII)</enum><text>may not deny or
limit coverage for patients for such services if premiums, copayments, or other
payments are made by third parties on their behalf; and</text>
</subclause><subclause id="H04A6C7392D174E5D8A693B4AC4B55A31"><enum>(VIII)</enum><text>shall meet
minimum network adequacy standards specified by the Secretary with respect to
such
services;</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H3CD8C20914DC4806AAD18E1578663141"><enum>(b)</enum><header>Effective
Date</header><text>The amendment made by subsection (a) shall apply to group
health plans as of January 1, 2014.</text>
</subsection></section><enum>II</enum><header>Supporting
research to improve access to high quality kidney care</header>
<section id="H222E3E2295F04266A3751BE96BFBD0C0"><enum>201.</enum><header>Understanding
the progression of 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 shall
complete a study (and submit a report to Congress) on—</text>
<paragraph id="HB3B155C60EB34C2C9B93A1D2A0A5BBC7"><enum>(1)</enum><text>the social,
behavioral, and biological factors leading to kidney disease; and</text>
</paragraph><paragraph id="H3D6C0E3176954C39987BACFB03BE4072"><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="HD5634C2EA79D445A9B3763F60BC936BA"><enum>202.</enum><header>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 shall submit
to Congress a report regarding the research gaps with respect to the
development of quality metrics and care management metrics for patients with
end-stage renal disease, including pediatric and home dialysis patients. Such
report shall include recommendations about undertaking research to fill such
gaps and prioritizing such research.</text>
</section><section id="H2AE0A2BE874849D88AF534496D72E0F8"><enum>203.</enum><header>GAO study on
transportation barriers to access kidney care</header>
<subsection id="H30CF29FD46774A118C85F3EF13D66183"><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="H00E5C73769534DF990AFADBB2800B595"><enum>(b)</enum><header>Specific Matters
Evaluated</header><text>In conducting the evaluation under subsection (a), the
Comptroller General shall examine—</text>
<paragraph id="HF7D88FE2B9B446AE83E4B9870AAF1060"><enum>(1)</enum><text>the costs
associated with providing dialysis services;</text>
</paragraph><paragraph id="H2B85C5EEDCAE40A5BBF4CABAA641BAB9"><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="HF8F80360060F4165BAA349503B257539"><enum>(3)</enum><text>the potential
sources of providing dialysis patients with such transportation
services.</text>
</paragraph></subsection><subsection id="H5728307250CF4D8996514F89119A8B48"><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><enum>III</enum><header>Improving access
to preventive care for individuals with kidney disease</header>
<section id="H4A352C1B232B4134A3FB25334207147D"><enum>301.</enum><header>Improving
access to medicare kidney disease education</header>
<subsection display-inline="no-display-inline" id="H79C1249A8D5140A2894DA6C0D8A0D6C1"><enum>(a)</enum><header>In
general</header><text>Section 1861(ggg)(2) of the Social Security Act (42
U.S.C. 1395x(ggg)(2)) is amended—</text>
<paragraph id="H4C2C3E7449AC46C385B86ACDCA8590F0"><enum>(1)</enum><text>by striking
subparagraph (B); and</text>
</paragraph><paragraph id="H4E2056926EF944B086B043F08C289DC6"><enum>(2)</enum><text>in subparagraph
(A)—</text>
<subparagraph id="H5765BC79D6D44721970BD2199C8D8274"><enum>(A)</enum><text>by striking
<quote>(A)</quote> after <quote>(2)</quote>;</text>
</subparagraph><subparagraph id="H7B1067B0A2EA45069807B630F35D3D08"><enum>(B)</enum><text>by striking
<quote>and</quote> at the end of clause (i);</text>
</subparagraph><subparagraph id="H20F59865A0E04E30BC37A252C40E9660"><enum>(C)</enum><text>by striking the
period at the end of clause (ii) and inserting <quote>; and</quote>;</text>
</subparagraph><subparagraph id="H0095E31EF298443498291EC2F80A07F0"><enum>(D)</enum><text>by redesignating
clauses (i) and (ii) as subparagraphs (A) and (B), respectively; and</text>
</subparagraph><subparagraph id="H6540BEFEF0204CFA83E36D70F640C5D3"><enum>(E)</enum><text>by adding at the
end the following:</text>
<quoted-block id="HD974E84F98364B54B976267F4F6006B3" style="OLC">
<subparagraph id="H00F309DDECCE4730AF0BCD50AEFF8E6E"><enum>(C)</enum><text>a renal dialysis
facility subject to the requirements of section 1881(b)(1) with
personnel—</text>
<clause id="H0BC9D74416754F6FAD65885B3DB6E415"><enum>(i)</enum><text>who provide the
services described in paragraph (1); and</text>
</clause><clause id="H281F033CB25B4227A552F0F9B613C13D"><enum>(ii)</enum><text>that include 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="H8DF1DDA480CD4EB19E8D8440D0530F45"><enum>(b)</enum><header>Payment to Renal
Dialysis Facilities</header><text>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 id="H85A48363C84B4E1D81CB544093CE4E2B" style="OLC">
<paragraph id="HA0655D30255A467B94CEC0BFAF7D5F7E" indent="up1"><enum>(15)</enum><text>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="HB347AD29ABE540BC986A177DAF31B6A6"><enum>(c)</enum><header>Providing
education services to individuals with kidney failure</header><text>Section
1861(ggg)(1)(A) of the Social Security Act (42 U.S.C. 1395x(ggg)(1)(A)) is
amended—</text>
<paragraph id="H4655EB3CD1224700ADD480562A5974CE"><enum>(1)</enum><text>by inserting
<quote>or stage V</quote> after <quote>stage IV</quote>; and</text>
</paragraph><paragraph id="H6DA9BC6DFBF84F9194FE3E015B0284D7"><enum>(2)</enum><text>by inserting
<quote>and who is not receiving dialysis services</quote> after <quote>chronic
kidney disease</quote>.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HA0911AF5A6B24BA5B64BDBFCB1AA3372"><enum>(d)</enum><header>Effective
Date</header><text>The amendments made by this section apply to kidney disease
education services furnished on or after January 1, 2013.</text>
</subsection></section>