[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3893 Introduced in House (IH)]

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117th CONGRESS
  1st Session
                                H. R. 3893

   To improve kidney disease research, prevention, surveillance, and 
      treatment in minority populations and rural and underserved 
                  communities, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 15, 2021

   Ms. Blunt Rochester (for herself and Mr. Wenstrup) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
   To improve kidney disease research, prevention, surveillance, and 
      treatment in minority populations and rural and underserved 
                  communities, 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.

    This Act may be cited as the ``Coordination, Accountability, 
Research, and Equity for All Kidneys Act of 2021'' or the ``CARE for 
All Kidneys Act of 2021''.

SEC. 2. KIDNEY DISEASE RESEARCH IN MINORITY POPULATIONS AND RURAL AND 
              UNDERSERVED COMMUNITIES.

    (a) In General.--The Director of the National Institutes of Health 
shall expand, intensify, and support ongoing research and other 
activities with respect to kidney disease in minority populations and 
rural and underserved communities.
    (b) Consultation.--The Director of the National Institutes of 
Health shall carry out subsection (a) in consultation with the 
Administrator of the Centers for Medicare & Medicaid Services, working 
with personnel of the Centers who are responsible for chronic care 
management activities and have expertise in kidney care.
    (c) Research.--
            (1) Description.--Research under subsection (a) shall 
        include investigation into--
                    (A) the causes of kidney disease, including 
                socioeconomic, geographic, clinical, environmental, 
                genetic, racial, ethnic, and other factors that may 
                contribute to increased rates of kidney disease in 
                minority populations and rural and underserved 
                communities; and
                    (B) the causes of increased incidence of kidney 
                disease complications in minority populations and rural 
                and underserved communities, and possible clinical and 
                nonclinical (such as food security, housing, and access 
                to coverage) interventions to decrease such incidence.
            (2) Inclusion of participants.--In conducting and 
        supporting research described in subsection (a), the Director 
        of the National Institutes of Health shall seek to include 
        participants from minority populations and rural and 
        underserved communities as study subjects in clinical trials.
    (d) Report.--
            (1) In general.--Not later than 6 months after the date of 
        enactment of this section, the Secretary of Health and Human 
        Services shall prepare and submit to the Congress a report on 
        Federal research and public health activities with respect to 
        kidney disease in minority populations and rural and 
        underserved communities.
            (2) Contents.--The report under paragraph (1) shall at 
        minimum address each of the following:
                    (A) Research on kidney disease in minority 
                populations and rural and underserved communities, 
                including such research on--
                            (i) socioeconomic, geographic, clinical, 
                        environmental, genetic, racial, ethnic, and 
                        other factors (such as food security, housing, 
                        and access to coverage) that may contribute to 
                        increased rates of kidney disease in minority 
                        populations and rural and underserved 
                        communities; and
                            (ii) prevention and complications among 
                        individuals within these populations and 
                        communities who have already developed kidney 
                        disease.
                    (B) Surveillance and data collection on kidney 
                disease in minority populations and rural and 
                underserved communities, including with respect to--
                            (i) efforts to better determine the 
                        prevalence of kidney disease among Black, 
                        Hispanic/Latino, and Asian-American and Pacific 
                        Islander subgroups; and
                            (ii) efforts to coordinate data collection 
                        on the American Indian population.
                    (C) Community-based interventions to address kidney 
                disease targeting minority populations and rural and 
                underserved communities, including--
                            (i) the evidence base for such 
                        interventions;
                            (ii) the cultural appropriateness of such 
                        interventions; and
                            (iii) efforts to educate the public on the 
                        causes of kidney disease, the importance of 
                        maintaining kidney health, and actions 
                        individuals can take to avoid kidney disease.
                    (D) Education and training programs for health 
                professionals (including community health workers) on 
                the prevention and management of kidney disease and its 
                related complications that is supported by the Health 
                Resources and Services Administration, including such 
                programs supported by the Bureau of Health Workforce, 
                the Bureau of Primary Health Care, and the Healthcare 
                Systems Bureau.

SEC. 3. KIDNEY DISEASE ACTION PLAN.

    (a) In General.--The Assistant Secretary for Health of the 
Department of Health and Human Services shall conduct, support, and 
expand public health strategies, prevention, diagnosis, surveillance, 
and public and professional awareness activities regarding kidney 
disease.
    (b) National Action Plan.--
            (1) Development.--Not later than 2 years after the date of 
        the enactment of this Act, the Assistant Secretary for Health 
        of the Department of Health and Human Services shall develop a 
        national action plan to address kidney disease in the United 
        States with participation from patients, caregivers, health 
        professionals, patient advocacy organizations, researchers, 
        providers, public health professionals, and other stakeholders.
            (2) Contents.--At a minimum, such plan shall include 
        recommendations for--
                    (A) public health interventions for the purpose of 
                implementation of the national plan;
                    (B) biomedical, health services, and public health 
                research on kidney disease; and
                    (C) inclusion of kidney disease in the health data 
                collections of all Federal agencies.
    (c) Kidney Disease Prevention Programs.--At the conclusion of the 
development of the national action plan under subsection (b), the 
Director of the National Institute of Diabetes and Digestive and Kidney 
Disease shall conduct public education and awareness activities with 
patient and professional organizations to stimulate earlier diagnosis 
and improve patient outcomes from treatment of kidney disease. To the 
extent known and relevant, such public education and awareness 
activities shall reflect differences in kidney disease by cause (such 
as hypertension, diabetes, and polycystic kidney disease) and include a 
focus on outreach to undiagnosed and, as appropriate, minority 
populations and rural and underserved communities.
    (d) Grants for Reducing Burden of Kidney Disease.--Beginning not 
later than 2 years after the date of enactment of this Act, the 
Director of the Centers for Disease Control and Prevention shall 
supplement and expand upon the activities of the National Institute of 
Diabetes and Digestive and Kidney Disease by making grants to nonprofit 
organizations, State and local jurisdictions, and Indian Tribes for the 
purpose of reducing the burden of kidney disease, especially in 
disproportionately impacted communities, through public health 
interventions and related activities.
    (e) Development of Best Practices for Diagnosis and Management of 
Kidney Disease.--Beginning not later than 2 years after the date of 
enactment of this Act, the Assistant Secretary for Health of the 
Department of Health and Human Services shall--
            (1) in coordination with the Centers for Disease Control 
        and Prevention, the Indian Health Service, the Health Resources 
        and Services Administration, the Department of Veterans 
        Affairs, dialysis providers, nephrologists, medical societies, 
        and nursing groups, develop pilot programs to demonstrate best 
        practices for the diagnosis and management of kidney disease; 
        and
            (2) design such pilot programs and best practices for use 
        by--
                    (A) general practitioners, family physicians, 
                internal medicine practitioners, nurse practitioners, 
                and physician assistants in private practice; and
                    (B) Federally qualified health centers, Indian 
                reservations, prisons, community health centers, and 
                other primary care settings.
    (f) Data Collection.--Not later than 180 days after the date of 
enactment of this Act, the Director of the National Institute of 
Diabetes and Digestive and Kidney Disease and the Director of the 
Centers for Disease Control and Prevention, acting jointly, shall 
assess the depth and quality of information on kidney disease that is 
collected in surveys and population studies conducted by the Centers 
for Disease Control and Prevention, including whether there are 
additional opportunities for information to be collected in the 
National Health and Nutrition Examination Survey, the National Health 
Interview Survey, and the Behavioral Risk Factors Surveillance System 
surveys. The Director of the National Institute of Diabetes and 
Digestive and Kidney Disease shall include the results of such 
assessment in the national action plan under subsection (b).
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            (1) $1,000,000 for fiscal year 2022;
            (2) $1,000,000 for fiscal year 2023;
            (3) $1,000,000 for fiscal year 2024;
            (4) $1,000,000 for fiscal year 2025; and
            (5) $1,000,000 for fiscal year 2026.

SEC. 4. REPORT ON END-STAGE RENAL DISEASE (ESRD) TREATMENT CHOICES 
              (ETC) MODEL.

    The Assistant Secretary for Health of the Department of Health and 
Human Services shall--
            (1) annually provide to the Congress a report on how the 
        end-stage renal disease treatment choices model has affected 
        minority populations and rural and underserved communities; and
            (2) in each such report, include the number and percentage 
        of people in home dialysis categorized by race, ethnicity, 
        gender, geographic location, and age.

SEC. 5. INCREASING KIDNEY TRANSPLANTS IN MINORITY, RURAL, AND 
              UNDERSERVED COMMUNITIES.

    (a) In General.--The Director of the National Institutes of Health 
shall expand, intensify, and support ongoing research and other 
activities with respect to kidney transplants in minority populations 
and rural and underserved communities.
    (b) Consultation.--The Director of the National Institutes of 
Health shall carry out this section in consultation with the 
Administrator of the Centers for Medicare & Medicaid Services, working 
with personnel of the Centers who are responsible for chronic care 
management activities and have expertise in kidney care.
    (c) Research.--Research under subsection (a) shall include 
investigation into--
            (1) the causes of lower rates of kidney transplants in 
        minority, rural, and underserved communities, including 
        socioeconomic, geographic, clinical, environmental, genetic, 
        racial, ethnic, and other factors that may contribute to lower 
        rates of kidney transplants in minority populations and rural 
        and underserved communities; and
            (2) possible interventions to increase kidney transplants.
    (d) Report; Comprehensive Plan.--
            (1) In general.--The Secretary of Health and Human Services 
        shall--
                    (A) prepare and submit to the Congress, not later 
                than 6 months after the date of enactment of this 
                section, a report on Federal research and public health 
                activities with respect to kidney transplants as a 
                treatment for end-stage renal disease in minority 
                populations and rural and underserved communities; and
                    (B) develop and submit to the Congress, not later 
                than 1 year after the date of enactment of this 
                section, an effective and comprehensive Federal plan 
                (including all appropriate Federal health programs) to 
                increase the number of kidney transplants in minority 
                populations and rural and underserved communities.
            (2) Contents.--The report under paragraph (1)(A) shall at 
        minimum address each of the following:
                    (A) Research on kidney transplants in minority 
                populations and rural and underserved communities, 
                including such research on financial, insurance 
                coverage, genetic, behavioral, and environmental 
                factors.
                    (B) Surveillance and data collection on kidney 
                transplants in minority populations and rural and 
                underserved communities, including with respect to--
                            (i) efforts to increase kidney transplants 
                        among Black, Hispanic/Latino, Asian-American, 
                        and Pacific Islander subgroups with end-stage 
                        renal disease; and
                            (ii) efforts to increase kidney transplants 
                        in the American Indian population.
                    (C) Community-based efforts to increase kidney 
                transplants targeting minority populations and rural 
                and underserved communities, including--
                            (i) the evidence base for such increases;
                            (ii) the cultural appropriateness of such 
                        increases; and
                            (iii) efforts to educate the public on the 
                        kidney transplants.
                    (D) Education and training programs for health 
                professionals (including community health workers) on 
                kidney transplants that are supported by the Health 
                Resources and Services Administration, including such 
                programs supported by the Bureau of Health Workforce, 
                the Bureau of Primary Health Care, and the Healthcare 
                Systems Bureau.

SEC. 6. ENVIRONMENTAL AND OCCUPATIONAL HEALTH PROGRAMS.

    The Director of the Centers for Disease Control and Prevention 
shall--
            (1) support research into the environmental and 
        occupational causes and biological mechanisms that contribute 
        to kidney disease; and
            (2) develop and disseminate public health interventions 
        that will lessen the impact of environmental and occupational 
        causes of kidney disease.

SEC. 7. UNDERSTANDING THE TREATMENT PATTERNS ASSOCIATED WITH PROVIDING 
              CARE AND TREATMENT OF KIDNEY FAILURE IN MINORITY 
              POPULATIONS AND RURAL AND UNDERSERVED COMMUNITIES.

    (a) Study.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall conduct a study on 
treatment patterns associated with providing care, under the Medicare 
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 
et seq.), and through private health insurance, to minority 
populations, and rural and underserved communities, that are 
disproportionately affected by kidney failure.
    (b) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Secretary shall submit to the Congress a report on the 
study conducted under subsection (a), together with such 
recommendations as the Secretary determines to be appropriate.

SEC. 8. IMPROVING ACCESS IN UNDERSERVED AREAS.

    (a) Definition of Primary Care Services.--Section 331(a)(3)(D) of 
the Public Health Service Act (42 U.S.C. 254d(a)(3)(D)) is amended by 
inserting ``renal dialysis,'' after ``dentistry,''.
    (b) National Health Service Corps Scholarship Program.--Section 
338A(a)(2) of the Public Health Service Act (42 U.S.C. 254l(a)(2)) is 
amended by inserting ``, which may include nephrology health 
professionals'' before the period at the end.
    (c) National Health Service Corps Loan Repayment Program.--Section 
338B(a)(2) of the Public Health Service Act (42 U.S.C. 254l-1(a)(2)) is 
amended by inserting ``, which may include nephrology health 
professionals'' before the period at the end.
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