[Congressional Record Volume 149, Number 172 (Sunday, November 23, 2003)]
[Extensions of Remarks]
[Page E2430]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 INTRODUCTION OF THE MEDICARE CHRONIC KIDNEY DISEASE MANAGEMENT ACT OF 
                                  2003

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Friday, November 21, 2003

  Mr. STARK. Mr. Speaker, I rise today to introduce the Medicare 
Chronic Kidney Disease Management Act of 2003. My bill would expand 
Medicare eligibility for uninsured patients with advanced chronic 
kidney disease before their condition progresses to end-stage renal 
disease (ESRD) status. The bill would provide access to healthcare and 
most importantly disease management and pre-ESRD educational and 
counseling services. It would improve the health and quality of life 
for those suffering from kidney disease and could provide real savings 
for the Medicare program by helping chronic kidney disease patients 
delay costly dialysis treatments and kidney transplants associated with 
the end stage status of the disease.
  ESRD patients are the only group of patients eligible for Medicare 
enrollment solely due to their medical diagnosis. ESRD is characterized 
by a permanent loss of kidney function, which results in the need for 
dialysis treatments or kidney transplantation in order to sustain life. 
Under current law, a physician must certify that an individual's kidney 
functions have deteriorated to end-stage status for a patient to be 
eligible for the Medicare ESRD program. Subsequently, there may be an 
additional waiting period of up to 3 months depending on the type of 
dialysis procedure chosen by the patient before the individual becomes 
eligible for benefits. Thus, benefits are only received after the 
cessation of adequate kidney functioning.
  The cost to the Federal Government for providing care to an ESRD 
patient is very high. The average per capita expense for all ESRD 
patients was $33,282 in 2000, approximately 8 times the annual cost of 
care for the average Medicare beneficiary. The annual cost for in-
center hemodialysis, the most frequent form of dialysis used, 
approaches $55,000.
  There has been a substantial amount of research within the past 
several years indicating that the provision of improved medical care 
and disease-related pre-ESRD educational and counseling services to 
advanced chronic kidney disease patients prior to their progressing to 
end-stage renal status has multiple positive effects. The provision of 
these pre-ESRD services slows down the progression toward ESRD status, 
decreases the occurrence and intensity of related diseases and 
decreases overall mortality rates. By allowing uninsured patients with 
advanced kidney disease to access care 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 pre-ESRD counseling and educational services. To 
be eligible, a physician would need to certify that a chronic kidney 
disease patient has reached a level of kidney functioning deterioration 
predictive of a need for dialysis or a transplant in the next 1\1/2\ 
years under a widely accepted clinical standard. Individuals eligible 
under the bill would pay Medicare Part B premiums. Pre-ESRD educational 
and counseling services provided by this legislation address treatment 
options, disease management, and nutrition. These new services would 
also be available to current Medicare enrollees who become diagnosed 
with chronic kidney disease.
  This bill also requests that the Secretary of Health and Human 
Services establish at least 2 demonstration projects in cooperation 
with recognized kidney patient organizations, to devise ways, or 
demonstrate means through which peer education procedures can slow 
progress to ESRD and improve outcomes for patients with this disease.
  Today, more than 300,000 individuals are covered under the Medicare 
ESRD program. By 2010, it is expected that this number will more than 
double. This bill, which is supported by the National Kidney 
Association and the American Association of Kidney Patients, will help 
minimize the damaging impact of this chronic illness and slow the 
growth of individuals suffering from ESRD. By delaying the need for 
either dialysis or transplantation, one can also anticipate substantial 
cost savings to the government. 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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