[Congressional Record Volume 148, Number 61 (Tuesday, May 14, 2002)]
[Extensions of Remarks]
[Pages E802-E803]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   INTRODUCTION OF THE MEDICARE CHRONIC KIDNEY DISEASE MANAGEMENT ACT

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Tuesday, May 14, 2002

  Mr. STARK. Mr. Speaker, I rise today to introduce the Medicare 
Chronic Kidney Disease Management Act. My bill would expand Medicare 
eligibility for uninsured patients with chronic kidney disease before 
their condition advances to End-Stage status. The bill would provide 
access to healthcare and most importantly disease management and End 
Stage Renal Disease-prevention services (ESRD). It would improve the 
quality of life for those suffering from kidney disease and could 
provide real savings for the Medicare program by helping chronic kidney 
disease patients avoid or delay the costly dialysis treatments and 
kidney transplants associated with the end stage status of the disease.
  ESRD patients are the only group eligible for Medicare enrollment due 
to their medical diagnosis. ESRD is characterized by a permanent loss 
of kidney function, which results in the need for weekly dialysis 
treatments to cleanse impurities from the blood. ESRD patients are 
subject to a 30-month waiting period following diagnosis before 
Medicare benefits begin, which leads to further deterioration of health 
prior to being able to access care under Medicare. The decline in 
health that occurs during this waiting period reinforces the need for 
disease management interventions to preserve maximum health and delay 
advancement of the illness. It is known that early diagnosis and 
treatment of kidney disease can prevent certain future complications 
including progression to end stage status and development of heart 
disease, a common outcome of kidney disease. By allowing this 
vulnerable population to access care during the 2 years prior to 
qualifying for Medicare due to an End Stage Renal Disease diagnosis, 
this bill wisely and appropriately addresses a critical unmet health 
need.
  Under the Medicare Chronic Kidney Disease Management Act, uninsured, 
pre-ESRD chronic kidney disease patients would be eligible for full 
Medicare coverage and ESRD prevention services. To be eligible, a 
physician would need to certify a chronic kidney disease patient as 
likely to need dialysis or a transplant in the next two years under 
accepted clinical standards. Individuals eligible under the bill would 
pay Medicare Part B premiums. Disease management and ESRD-prevention 
services provided by this legislation include counseling on treatment 
options, the viability of a kidney transplant, disease management, and 
nutrition. These new services would also be available to current 
Medicare enrollees who become diagnosed with chronic kidney disease.
  Today, more than 300,000 people receive dialysis. By 2010, it is 
expected that 650,000 individuals will be receiving weekly dialysis 
treatment. In 2001, Medicare spent $14.4 billion to care for ESRD 
patients, which averages more than $20,000 per member, which far 
exceeds the average 2001 Medicare expenditure for non-ESRD 
beneficiaries, $6000.
  The National Kidney Foundation, who has endorsed this bill, estimates 
that 20 million

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Americans have kidney disease. Many of these Americans do not know they 
suffer from this condition and therefore do not take advantage of 
beneficial prevention measures. In February 2002, the National Kidney 
Foundation called for earlier screening for kidney disease in reaction 
to the near doubling of the illness in the U.S. in the last decade. 
Their screening campaign focuses on those at high risk for developing 
chronic kidney disease including people with diabetes, high blood 
pressure, a family history of the disease, older Americans, African 
Americans, Asian and Pacific Islanders, American Indians, and 
Hispanics.
  Expanded prevention services for chronic kidney disease patients are 
long overdue. The preventive measures in this bill will minimize the 
damaging impact of this chronic illness and allow Medicare to slow the 
growth of the ESRD population. I urge my colleagues to join me in 
supporting the Medicare Chronic Kidney Disease Management Act so we can 
make these vital improvements to the Medicare program for those who 
suffer from chronic kidney disease.

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