117 S1971 IS: Chronic Kidney Disease Improvement in Research and Treatment Act of 2021
U.S. Senate
2021-06-08
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EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents(a)This Act may be cited as the Chronic Kidney Disease Improvement in Research and Treatment Act of 2021
.(b)The table of contents for this Act is as follows:Sec. 1. Short title; table of contents.TITLE I—Increasing awareness, expanding preventive services, and improving care coordinationSec. 101. Expanding Medicare annual wellness benefit to include kidney disease screening.Sec. 102. Increasing access to Medicare kidney disease education benefit.Sec. 103. Improving patient lives and quality of care through research and innovation.Sec. 104. Understanding the progression of kidney disease and treatment of kidney failure in minority populations.TITLE II—Creating an economically stable dialysis infrastructure and incentivizing innovationSec. 201. Refining the end-stage renal disease payment system to improve accuracy in payment and support therapies.TITLE III—Increasing patient access to quality performance by improving the accuracy and transparency of end-stage renal disease quality programsSec. 301. Improving patient decision making and transparency by consolidating and modernizing quality programs.TITLE IV—Empowering patientsSec. 401. Medigap coverage for beneficiaries with end-stage renal disease.Sec. 402. Network adequacy requirements for dialysis services.<enum>I</enum><header>Increasing awareness, expanding preventive services, and improving care coordination</header><section id="id3df38f21b46841a7ae31a89ea05522b9"><enum>101.</enum><header>Expanding Medicare annual wellness benefit to include kidney disease screening</header><subsection id="id986C36D8EC3F4BAD9BCCD214156F48B9"><enum>(a)</enum><header>In general</header><text>Section 1861(ww)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(ww)(2)</external-xref>) is amended—</text><paragraph id="id4F84D2CBCFD1427DADF0A6920E913A30"><enum>(1)</enum><text>by redesignating subparagraph (O) as subparagraph (P); and</text></paragraph><paragraph id="id4B180066F71849EDB7C55B116A8DDD3D"><enum>(2)</enum><text>by inserting after subparagraph (N) the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id1DA4AB9B1EE147CAB0104FEA8314DD43"><subparagraph id="idADA513CF79FF46EABB6080417C7DFCD8"><enum>(O)</enum><text>Chronic kidney disease screening as defined by the Secretary.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id4ECE62E5DA504EC0ACE8DC96C95B26FC" commented="no"><enum>(b)</enum><header>Effective date</header><text>The amendments made by this section apply to items and services furnished on or after January 1, 2022.</text></subsection></section><section id="idBA003F7B90D748929B4902A661527E53"><enum>102.</enum><header>Increasing access to Medicare kidney disease education benefit</header><subsection id="id9b7a47a957a24d4980f4167b46fadbe3"><enum>(a)</enum><header>In general</header><text>Section 1861(ggg) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(ggg)</external-xref>) is amended—</text><paragraph id="ide5ddb20389fe4769a62538a06e532e04"><enum>(1)</enum><text>in paragraph (1)—</text><subparagraph id="idb47def8b766a482089a5717903fc3629"><enum>(A)</enum><text>in subparagraph (A), by inserting <quote>or stage V</quote> after <quote>stage IV</quote>; and</text></subparagraph><subparagraph id="id19c0a029a0dc4bd8ac38cf64907691b7"><enum>(B)</enum><text>in subparagraph (B), by inserting <quote>or of a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)) assisting in the treatment of the individual's kidney condition</quote> after <quote>kidney condition</quote>; and</text></subparagraph></paragraph><paragraph id="ide6815f17e0ba4ac1b87ebb8001c3f55d"><enum>(2)</enum><text>in paragraph (2)—</text><subparagraph id="idbdc6d8d84aa84d7a9cf31b7dcfb01bde"><enum>(A)</enum><text>by striking subparagraph (B); and</text></subparagraph><subparagraph id="id376367a0567542158497bfe809a7930d"><enum>(B)</enum><text>in subparagraph (A)—</text><clause id="idfa848a7c58da4490a66590a42ebaef00"><enum>(i)</enum><text>by striking <quote>(A)</quote> after <quote>(2)</quote>;</text></clause><clause id="id509e17e912e94675bff7486076ae7101"><enum>(ii)</enum><text>by striking <quote>and</quote> at the end of clause (i);</text></clause><clause id="idd3ddc3f609a643a69da77160bc5bd755"><enum>(iii)</enum><text>by striking the period at the end of clause (ii) and inserting <quote>; and</quote>;</text></clause><clause id="id4b0fc2423e714b7ba3cb64ca7b5a4118"><enum>(iv)</enum><text>by redesignating clauses (i) and (ii) as subparagraphs (A) and (B), respectively; and</text></clause><clause id="idd00db5099a7f428e88127fae0009aa9e"><enum>(v)</enum><text>by adding at the end the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idbdf46d5ef7824d12877f7f6046014aa8"><subparagraph id="id7fec8168e14a47258d20470f18eab85b"><enum>(C)</enum><text>a renal dialysis facility subject to the requirements of section 1881(b)(1) with personnel who—</text><clause id="id45cf2429e9f44bf19e644921c73b9ae4"><enum>(i)</enum><text>provide the services described in paragraph (1); and</text></clause><clause id="id18693a06f6e043babe5316a783a52c65"><enum>(ii)</enum><text>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></clause></subparagraph></paragraph></subsection><subsection id="id863837a0ddeb4da2b513198c8e17c810"><enum>(b)</enum><header>Payment to renal dialysis facilities</header><text>Section 1881(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)</external-xref>) is amended by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id707c8e307cd64019a8502a4687d692c8"><paragraph id="id1e63731d2b604075add4b4db11007c99"><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="iddc45981fcc1241778f194d60745bf1b0"><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, 2022.</text></subsection></section><section id="id6F492355AD61435096DB096795863A62"><enum>103.</enum><header>Improving patient lives and quality of care through research and innovation</header><subsection id="idF2F586F07A874A89B35362034A2F30A1"><enum>(a)</enum><header>Study</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services (in this section referred to as the <quote>Secretary</quote>) shall conduct a study on increasing kidney transplantation rates. Such study shall include an analysis of each of the following:</text><paragraph id="id1d81d4be938e4c9ebdd1a0e3280ee4bd"><enum>(1)</enum><text>Any disincentives in the payment systems under the Medicare program under title XVIII of the Social Security Act that create barriers to kidney transplants and post-transplant care for beneficiaries with end-stage renal disease.</text></paragraph><paragraph id="id4ef7059758c140a1b2d1887ca6b24f39"><enum>(2)</enum><text>The practices used by States with higher than average donation rates and whether those practices and policies could be successfully utilized in other States.</text></paragraph><paragraph id="id88d0a806a4bd4977afb25c71d551a648"><enum>(3)</enum><text>Practices and policies that could increase deceased donation rates of minority populations.</text></paragraph><paragraph id="id27874929c6ec4bb6a41c67e01d5d2846"><enum>(4)</enum><text>Whether cultural and policy barriers exist to increasing living donation rates, including an examination of how to better facilitate chained donations.</text></paragraph><paragraph id="id64B4524C0A8A4319943EC217FE99B834"><enum>(5)</enum><text>Other areas determined appropriate by the Secretary.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id52531F58EDF64943AC8D3DB6DCA32E04"><enum>(b)</enum><header>Report</header><text>Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a), together with such recommendations as the Secretary determines to be appropriate.</text></subsection></section><section id="ideaaeed60ca124ec0aef75413a16f600e"><enum>104.</enum><header>Understanding the progression of kidney disease and treatment of kidney failure in minority
populations</header><subsection id="id08E3BB510DC04CDC8CE4252E88AE236B"><enum>(a)</enum><header>Study</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services (in this section referred to as the <quote>Secretary</quote>) shall conduct a study on—</text><paragraph id="id9dfb4f85dc1e48318a1f589792a439c0"><enum>(1)</enum><text>the social, behavioral, and biological factors leading to kidney disease;</text></paragraph><paragraph id="id4293422daa114d74b2f08aa267f8fef6"><enum>(2)</enum><text>efforts to slow the progression of kidney disease in minority populations that are disproportionately affected by such disease; and</text></paragraph><paragraph id="id9e57d3d5ecbb4d5fab681335f859514c"><enum>(3)</enum><text>treatment patterns associated with providing care, under the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and through private health insurance, to minority populations that are disproportionately affected by kidney failure.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id22F1C29C6E274FC99351E1E992E36193"><enum>(b)</enum><header>Report</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a), together with such recommendations as the Secretary determines to be appropriate.</text></subsection></section><enum>II</enum><header>Creating an economically stable dialysis infrastructure and incentivizing innovation</header><section id="iddeba14b064ee4129a1bd2340222f2763"><enum>201.</enum><header>Refining the end-stage renal disease payment system to improve accuracy in payment and support therapies</header><subsection id="id2998619d50b94d9389b339929d8beafd"><enum>(a)</enum><header>In general</header><text>Section 1881(b)(14) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(14)</external-xref>) is amended—</text><paragraph id="idc0691664c0594ba782bb8c662983874d"><enum>(1)</enum><text>in subparagraph (D), in the matter preceding clause (i), by striking <quote>Such system</quote> and inserting <quote>Subject to subparagraph (J), such system</quote>; and</text></paragraph><paragraph id="id9adb2a457770411eb1ab56520ce171d0"><enum>(2)</enum><text>by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id4938a5b49ce94da68e043e3005ae302c"><subparagraph id="id6c2f8064de1e44c8854cd46afbbb0fe3"><enum>(J)</enum><text>For payment for renal dialysis services furnished on or after January 1, 2024, under the system under this paragraph—</text><clause id="idcba527044509479286c99e1d82f480d3"><enum>(i)</enum><text>the payment adjustment described in clause (i) of subparagraph (D)—</text><subclause id="idf1709da994674b4fb53a9158e15e6efb"><enum>(I)</enum><text>shall not take into account comorbidities; and</text></subclause><subclause id="id9af2419501d249b58a299fd3761e94db"><enum>(II)</enum><text>shall take into account age for purposes of distinguishing between individuals who are under 18 years of age and those who are 18 years of age and older but shall not include any other adjustment for age for patients 18 years of age and older;</text></subclause></clause><clause id="ida64976404b15419aba84729241a16e11"><enum>(ii)</enum><text>the Secretary shall reassess any adjustments related to patient weight under such clause;</text></clause><clause id="iddf3bdad4ead74f4690212cd6e4fd63b4"><enum>(iii)</enum><text>the payment adjustment described in clause (ii) of such subparagraph shall not be included; and</text></clause><clause id="id74b1ba4960e845329207efafe7b2ecfc"><enum>(iv)</enum><text>take into account reasonable costs for determining the payment rate consistent with paragraph (2)(B).</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="idc2f12d6bc7c641919c95bd674bacca59"><enum>(b)</enum><header>Inclusion of network fee as an allowable cost</header><text>Section 1881(b)(14) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(14)</external-xref>), as amended by subsection (a), is amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id8108371a2c6044a1aa41f30fefe54e23"><subparagraph id="idb5ad429d70e7483782e3e422f91b2d1c"><enum>(K)</enum><text>Not later than January 1, 2022, the Secretary shall amend the ESRD facility cost report to include the per treatment network fee (as described in paragraph (7)) as an allowable cost or offset to revenue.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" id="ide87cccaabbc441abae799eecd7a54890"><enum>(c)</enum><header>Determination of productivity adjustment</header><text>Section 1886(b)(3)(B)(xi) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(b)(3)(B)(xi)</external-xref>) is amended—</text><paragraph id="id74018d4cbb1543a2962264cfd7654221"><enum>(1)</enum><text>in subclause (I), by striking <quote>For 2012</quote> and inserting <quote>Subject to subclause (IV), for 2012</quote>; and</text></paragraph><paragraph id="idd98f8e7203a047afa451732a1828fa20"><enum>(2)</enum><text>by adding at the end, the following new subclause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id6e68fb23f42445f6b2cdc8fb8b23a698"><subclause id="idc7f5054cec574f1489fb9cfc290b6877"><enum>(IV)</enum><text>For each of 2022 through 2025, the productivity adjustment described in subclause (II) shall be zero for a payment system in any year in which the Medicare Payment Advisory Commission estimates that payments under this title pursuant to such payment system, on an aggregate national basis, exceed costs, on an aggregate national basis, by 3.0 percent or less.</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" id="idbb6aa105904e421eb0253bd6bd564816"><enum>(d)</enum><header>Payment for new and innovative drugs and biologicals that are renal dialysis services</header><text>Section 1881(b)(14) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(b)(14)</external-xref>), as amended by subsections (a) and (b), is amended by adding the following new subparagraph—</text><quoted-block style="OLC" display-inline="no-display-inline" id="id57b5723de1d84987a5ad9e93adedda85"><subparagraph id="idf2f89de16ed3469894accaade77c55e1"><enum>(L)</enum><header>Payment for new and innovative drugs, biologicals, and devices that are renal dialysis services</header><clause id="id1c9de143a21e4c8b800db589a80aff1f"><enum>(i)</enum><header>In general</header><text>For drugs or biologicals determined to be within a functional category, the Secretary, in consultation with stakeholders, shall ensure that the single payment amount is adequate to cover the cost of new innovative drugs or biologicals and increase the single payment amount if the Secretary determines such payment amount is not adequate to cover such cost. In carrying out the preceding sentence, the Secretary shall use the cost and utilization data collected during the three-year transitional payment period, as otherwise described in the final regulation published on November 14, 2018 (83 Fed. Reg. 56922 et seq.).</text></clause><clause id="id150bb96a5eac462882ae5b0bf13ab7d7"><enum>(ii)</enum><header>Money to follow the patient</header><text>The Secretary, through notice and comment rulemaking, shall implement a policy for any drug or biological that is not provided to the <quote>average</quote> patient that results in the amount by which the single payment amount is increased pursuant to this subparagraph shall be paid only when a provider or renal dialysis facility has demonstrated that it has administered the drug or biological to a patient.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id3ebb4c59e620412c9037a8f8556d9934"><enum>(e)</enum><header>New devices and other technologies</header><text>As part of the promulgation of the annual rule for the Medicare end-stage renal disease prospective payment system under section 1881(b)(14) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(14)</external-xref>) for calendar year 2022, and in consultation with stakeholders, the Secretary shall ensure that the single payment amount is adequate to cover the cost of the new innovative device or other technology with substantial clinical improvement and increase the single payment amount if the Secretary determines such payment amount is not adequate to cover such cost. In carrying out the preceding sentence, the Secretary shall use the cost and utilization data collected during a three-year transitional payment period, as otherwise described in the final regulation published on November 9, 2020 (85 Fed. Reg. 71398 et seq.). </text></subsection></section><enum>III</enum><header>Increasing patient access to quality performance by improving the accuracy and transparency of end-stage renal disease quality programs</header><section id="id2ceb0c9d9f374f9489391767b2c85e6c"><enum>301.</enum><header>Improving patient decision making and transparency by consolidating and modernizing quality
programs</header><subsection id="id6d4dafd185864e5d982096ab9bd678d3"><enum>(a)</enum><header>Measures</header><text>Section 1881(h)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(h)(2)</external-xref>) is amended—</text><paragraph id="id6335359b0a854e6b981ab68e8965b927"><enum>(1)</enum><text>by striking subparagraph (A) and inserting the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idFCEACB2B09394342B01242A4E7805CDC"><subparagraph id="idC62DAAC69F9D4DB7AFB6F16D6568338B"><enum>(A)</enum><text>The measures specified under this paragraph with respect to the year involved shall be selected by the Secretary in consultation with stakeholders to promote improvement in beneficiary outcomes and shared decision-making with beneficiaries and their caregivers. When selecting measures specified under this paragraph, the Secretary shall take into account clinical gaps in care, underutilization that may lead to beneficiary harm, patient safety, and outcomes.</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></paragraph><paragraph id="id97F0ED72799C47A8B35BB9455D6845F1"><enum>(2)</enum><text>in subparagraph (B)(i), by striking <quote>subparagraph (A)(iv)</quote> and inserting <quote>subparagraph (A)</quote>;</text></paragraph><paragraph id="id06992EA252ED442BB57E5FC49D9E2969"><enum>(3)</enum><text>by striking subparagraph (E); and</text></paragraph><paragraph id="id06cee6751d1c4caaa1eac4c7db207b36"><enum>(4)</enum><text>by adding at the end the following new subparagraphs:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id4F84313F4BD044139E3A67E1792FFD53"><subparagraph id="idf8a510117651478795667ae75d9af4c0"><enum>(E)</enum><header>Weighting limitation</header><text>No single measure specified by the Secretary or individual measure within a composite measure so specified may be weighted less than 10 percent of the total performance score.</text></subparagraph><subparagraph id="idb44dd259331d44bb822bfeefa60a6b4c"><enum>(F)</enum><header>Statistically valid and reliable</header><text>In specifying measures under subparagraph (A), the Secretary shall only specify measures that have been shown to be statistically valid and reliable through testing.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="idfb32bdf7d9c94759b65de65442c149ac"><enum>(b)</enum><header>Endorsement</header><text>Section 1881(h)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(h)(2)(B)</external-xref>) is amended—</text><paragraph id="id40e0e198067d438f806bd71c57a533a7"><enum>(1)</enum><text>in clause (ii), by adding at the end the following new sentence: <quote>The exception under the preceding sentence shall not apply to a measure that the entity with a contract under section 1890(a) (or a similar entity) considered but failed to endorse.</quote>; and</text></paragraph><paragraph id="id154065641ef64c539d368cc59a6d5b64"><enum>(2)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idbcb39e1cead147218cdee250d3ef2b22"><clause id="id545eff331be94b82a289dee8f6a90db6"><enum>(iii)</enum><header>Composite measures</header><text>Clauses (i) and (ii) shall apply to composite measures in the same manner as such clauses apply to individual measures.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id2636f58faec14981b8035ffa89495e55"><enum>(c)</enum><header>Requirements for dialysis facility compare star rating program</header><text>Section 1881(h)(6) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(h)(6)</external-xref>) is amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id815957dc92ac4a05b99a8c18aa188a7e"><subparagraph id="id3df100ff718b4d35b5df03b0b94a375b"><enum>(E)</enum><header>Requirements for any dialysis facility compare star rating program</header><text>To the extent that the Secretary maintains a dialysis facility compare star rating program, under such a program the Secretary—</text><clause id="id8d08bcd7913840dfbc51cad56e7d3e83"><enum>(i)</enum><text>shall assign stars using the same methodology and total performance score results from the quality incentive program under this subsection;</text></clause><clause id="idd2fb811c09604ae490f671516c540b69"><enum>(ii)</enum><text>shall determine the stars using the same methodology used under such quality incentive program; and</text></clause><clause id="id88e32fd0e1984192b657c4333eaf7883"><enum>(iii)</enum><text>shall not use a forced bell curve when determining the stars or rebaselining the stars.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id5a54e8e4d26149c28a7fcb8368889568"><enum>(d)</enum><header>Incentive payments</header><text>Section 1881(h)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(h)(1)</external-xref>) is amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id6eb846ca53a9483285b70995af33719a"><subparagraph id="idb8344ddec950408894fbc97579ca7f0a"><enum>(D)</enum><header>Incentive payments</header><clause id="id1338e28575904a9ebafe0b94e198ac9b"><enum>(i)</enum><header>In general</header><text>In the case of a provider of services or a renal dialysis facility that the Secretary determines exceeds the attainment performance standards under paragraph (4) with respect to a year, the Secretary may make a bonus payment to the provider or facility (pursuant to a process established by the Secretary).</text></clause><clause id="idc2267ee9f4ef41c0975e8fc2572d8729"><enum>(ii)</enum><header>Funding</header><text>The total amount of bonus payments under clause (i) in a year shall be equal to the total amount of reduced payments in a year under subparagraph (A).</text></clause><clause id="idfbbfb7c0643f4e23be21a131ae7c1c78"><enum>(iii)</enum><header>No effect in subsequent years</header><text>The provisions of subparagraph (C) shall apply to a bonus payment under this subparagraph in the same manner subparagraph (C) applies to a reduction under such subparagraph.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id3009ce2719ad4f5195eb39fe41014e38"><enum>(e)</enum><header>Effective date</header><text>The amendments made by this section shall apply to items and services furnished on or after January 1, 2022.</text></subsection></section><enum>IV</enum><header>Empowering patients</header><section id="idf4b220c886f046d6b5ce53b18e6d8531"><enum>401.</enum><header>Medigap coverage for beneficiaries with end-stage renal disease</header><subsection id="id5ca22bdbd2484ad2aad447813ecdc875"><enum>(a)</enum><header>Guaranteed availability of Medigap policies to all ESRD Medicare beneficiaries</header><paragraph id="idb569e3015b844ccbab24898441a391ae"><enum>(1)</enum><header>In general</header><text>Section 1882(s) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ss">42 U.S.C. 1395ss(s)</external-xref>) is amended—</text><subparagraph id="id9fe3b218cdaf42f6b12cffeb5c03b289"><enum>(A)</enum><text>in paragraph (2)—</text><clause id="idbf637790b7454562ab7c3f0e9b782ba7"><enum>(i)</enum><text>in subparagraph (A), by striking <quote>is 65</quote> and all that follows through the period and inserting the following: “is—</text><quoted-block style="OLC" display-inline="no-display-inline" id="id6b7b7adcb5714247bf3dbf00bcd56f10"><clause id="ided63cd965145454884df00ca21f371c4" indent="up2"><enum>(i)</enum><text>65 years of age or older and is enrolled for benefits under part B; or</text></clause><clause id="id4c5835fab16443e3a0f8d2c1f245b38a" indent="up2"><enum>(ii)</enum><text>entitled to benefits under 226A(b) and is enrolled for benefits under part B.</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></clause><clause id="id7ca3e5f011fb43bfb8de1d2f56a9c6e0"><enum>(ii)</enum><text>in subparagraph (D), in the matter preceding clause (i), by inserting <quote>(or is entitled to benefits under 226A(b))</quote> after <quote>is 65 years of age or older</quote>; and</text></clause></subparagraph><subparagraph id="id638ae370e9ca418eacca87f890748168"><enum>(B)</enum><text>in paragraph (3)(B)—</text><clause id="id4a4b285453f249298de6dfe20cd903e6"><enum>(i)</enum><text>in clause (ii), by inserting <quote>(or is entitled to benefits under 226A(b))</quote> after <quote>is 65 years of age or older</quote>; and</text></clause><clause id="idc342ec7cf9054188939461fb3c3aa497"><enum>(ii)</enum><text>in clause (vi), by inserting <quote>(or under 226A(b))</quote> after <quote>at age 65</quote>.</text></clause></subparagraph></paragraph><paragraph id="id8d52a2a1944a464e85204bd256a998ea"><enum>(2)</enum><header>Effective date</header><text>The amendments made by paragraph (1) shall apply to Medicare supplemental policies effective on or after January 1, 2022.</text></paragraph></subsection><subsection id="idcef908c8f2104b1893e42012d873e9a9"><enum>(b)</enum><header>Additional enrollment period for certain individuals</header><paragraph id="idf780c850f0fe4cbea64005ebd5fde313"><enum>(1)</enum><header>One-time enrollment period</header><subparagraph id="id56fb2383fc5f4b0fba32c3de1f0eec50"><enum>(A)</enum><header>In general</header><text>In the case of an individual described in subparagraph (B), the Secretary of Health and Human Services shall establish a one-time enrollment period during which such an individual may enroll in any Medicare supplemental policy under section 1882 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ss">42 U.S.C. 1395ss</external-xref>) of the individual's choosing.</text></subparagraph><subparagraph id="id51b46f77f0e54e2a90e5eabc7014b45e"><enum>(B)</enum><header>Enrollment period</header><text>The enrollment period established under subparagraph (A) shall begin on January 1, 2023, and shall end June 30, 2023.</text></subparagraph></paragraph><paragraph id="id6ea13ac812d94553bd2e428b75885fa9"><enum>(2)</enum><header>Individual described</header><text>An individual described in this paragraph is an individual who—</text><subparagraph id="id66c7ad7fffbf4ef0b83d286074b026d5"><enum>(A)</enum><text>is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act under section 226A(b) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/426-1">42 U.S.C. 426–1</external-xref>);</text></subparagraph><subparagraph id="idadf6b9153dda4571ae3cc929ff69e2b9"><enum>(B)</enum><text>is enrolled for benefits under part B of such title XVIII; and</text></subparagraph><subparagraph id="ideff7c5cb08ee45e09067b2cc14dfd5a7"><enum>(C)</enum><text>would not, but for the provisions of, and amendments made by, subsection (a) be eligible for the guaranteed issue of a Medicare supplemental policy under paragraph (2) or (3) of section 1882(s) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ss">42 U.S.C. 1395ss(s)</external-xref>).</text></subparagraph></paragraph></subsection></section><section id="idC78126B810514355B51DDABCAA290AB1"><enum>402.</enum><header>Network adequacy standards for dialysis services</header><text display-inline="no-display-inline">Section 1852(d) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-22">42 U.S.C. 1395w–22(d)</external-xref>) is amended by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id8C687172F7E744A2A0AC4774129CCE41"><paragraph id="idEC67BC030F334092BA000D0B355255F4"><enum>(7)</enum><header>Network adequacy requirements for dialysis services</header><text>For plan year 2022 and subsequent plan years, the Secretary shall apply the network adequacy standards under this subsection with respect to access to dialysis services—</text><subparagraph id="id3B1B98DE1C56440B8A7DD87471A0ED1D"><enum>(A)</enum><text>using the time and distance standards in effect for plan year 2020; and</text></subparagraph><subparagraph id="idCD1772127DBE47F58CA11A7CA1CDF692"><enum>(B)</enum><text>without regard to the final rule titled <quote>Medicare Program; Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program</quote> (85 Fed. Reg. 33796).</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section>