[Congressional Record Volume 163, Number 156 (Thursday, September 28, 2017)]
[Senate]
[Pages S6225-S6227]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. CARDIN (for himself, Mr. Blunt, and Mr. Nelson):
S. 1890. A bill to improve the understanding of, and promote access
to treatment for, chronic kidney disease, and for other purposes; to
the Committee on Finance.
Mr. CARDIN. Mr. President, I rise in support of the bipartisan
Chronic Kidney Disease Improvement in Research and Treatment Act of
2017, which I am introducing with Senators Blunt and Nelson today. This
legislation seeks to make a real difference in the lives of Americans
suffering from kidney disease and end-stage renal disease.
Kidney disease is the 9th leading cause of death in the United
States, and unfortunately, more than 1 in 10 Americans today suffer
from some form of kidney disease. More than 661,000 Americans are
living with kidney failure or end-stage renal disease, which is an
irreversible condition that can be fatal without a kidney transplant or
life-sustaining dialysis. Of these, 468,000 patients in our Country
rely on life-sustaining dialysis care to survive and roughly 193,000
live with a functioning kidney transplant.
This legislation seeks to promote research, expand patient choice,
and improve care coordination for these hundreds of thousands of
patients. Specifically, it would identify payment disincentives that
create barriers to kidney transplants. The bill would require the
Government Accountability Office (GAO) to submit a comprehensive report
on how and to what extent palliative care is utilized in treating
individuals with advanced kidney disease and the effect of palliative
care on the quality of life and treatment outcomes of individuals with
ESRD. It would also direct the Department of Health and Human Services
(HHS) to evaluate and report on the biological, social, and behavioral
factors related to kidney disease and efforts to slow the progression
of disease in minority populations disproportionately affected by this
disease.
This legislation would improve access to pre-dialysis kidney
education programs to better manage patients' kidney disease and even
prevent kidney failure in some cases. Nephrologists and other health
professionals would be incentivized to work in underserved rural and
urban areas, and current payment policies would be modified to
encourage home dialysis, which is not incentivized under the current
Medicare payment structure. Patients with acute kidney injury would
also be allowed to receive treatments through dialysis providers,
therefore reducing costs associated with care provided in the more
expensive hospital outpatient setting. Perhaps most importantly, our
legislation would guarantee access to Medigap policies to all ESRD
Medicare beneficiaries, regardless of age. Currently, Medicare patients
under 65, whether disabled or ESRD beneficiaries do not have access to
Medigap plans, even though Medicare is their primary insurance.
Lastly, the bill would expand the options for patients by allowing
individuals diagnosed with kidney failure to enroll in the Medicare
Advantage program starting in plan year 2020 and reauthorizing on a
permanent basis the Medicare Advantage Special Needs Plan for patients
with kidney failure.
I urge my colleagues to join me, Senator Blunt and Senator Nelson in
supporting the Chronic Kidney Disease Improvement in Research and
Treatment Act of 2017, which will improve the care of patients who
suffer from kidney disease and end-stage renal disease.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 1890
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 ``Chronic Kidney Disease
Improvement in Research and Treatment Act of 2017''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--IMPROVING PATIENT LIVES AND QUALITY OF CARE THROUGH RESEARCH
AND INNOVATION
Sec. 101. Improving patient lives and quality of care through research
and innovation.
Sec. 102. Enhancing care through new technologies.
Sec. 103. Understanding current utilization of palliative care
services.
Sec. 104. Understanding the progression of kidney disease and treatment
of kidney failure in minority populations.
TITLE II--EMPOWER PATIENT DECISION MAKING AND CHOICE
Sec. 201. Providing individuals with kidney failure access to managed
care.
Sec. 202. Medigap coverage for beneficiaries with end-stage renal
disease.
Sec. 203. Promoting access to home dialysis treatments.
TITLE III--IMPROVING PATIENT CARE AND ENSURING QUALITY OUTCOMES
Sec. 301. Maintain an economically stable dialysis infrastructure.
Sec. 302. Improve patient decision making and transparency by
consolidating and modernizing quality programs.
Sec. 303. Increasing access to Medicare kidney disease education
benefit.
Sec. 304. Certification of new facilities.
Sec. 305. Improving access in under served areas.
TITLE I--IMPROVING PATIENT LIVES AND QUALITY OF CARE THROUGH RESEARCH
AND INNOVATION
SEC. 101. IMPROVING PATIENT LIVES AND QUALITY OF CARE THROUGH
RESEARCH AND INNOVATION.
(a) Study.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall conduct
a study on increasing kidney transplantation rates. Such
study shall include an analysis of each of the following:
(1) 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.
(2) The practices used by States with higher than average
donation rates and whether those practices and policies could
be successfully utilized in other States.
(3) Practices and policies that could increase deceased
donation rates of minority populations.
(4) Whether cultural and policy barriers exist to
increasing living donation rates, including an examination of
how to better facilitate chained donations.
(5) Other areas determined appropriate by the Secretary.
(b) Report.--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.
SEC. 102. ENHANCING CARE THROUGH NEW TECHNOLOGIES.
(a) Agreement With National Academy of Sciences.--The
Secretary of Health and Human Services shall seek to enter
into an agreement with the National Academy of Sciences
within six months of the date of the enactment of this Act
under which the National Academy of Sciences will conduct a
study on the design of payments for renal dialysis services
under the Medicare program
[[Page S6226]]
under title XVIII of the Social Security Act, including an
analysis of whether adjustments to such payments are needed
to allow for the incorporation of new technologies and
therapies.
(b) Contents.--In conducting the study under subsection
(a), the National Academy of Sciences shall evaluate the
current payment system for renal dialysis services under the
Medicare program, identify barriers to adopting innovative
items, services, and therapies, and make recommendations as
to how to eliminate such barriers.
SEC. 103. UNDERSTANDING CURRENT UTILIZATION OF PALLIATIVE
CARE SERVICES.
(a) Study.--
(1) In general.--The Comptroller General of the United
States (in this section referred to as the ``Comptroller
General'') shall conduct a study on the utilization of
palliative care in treating individuals with advanced kidney
disease, from stage 4 through stage 5, including individuals
with kidney failure on dialysis through any progression of
the disease. Such study shall include an analysis of--
(A) how palliative care can be utilized to improve the
quality of life of those with kidney disease and facilitate
care tailored to their individual goals and values;
(B) the successful use of palliative care in the care of
patients with other chronic diseases and serious illnesses;
(C) the utilization of palliative care at any point in an
illness, including when used at the same time as curative
treatment; and
(D) other areas determined appropriate by the Comptroller
General.
(2) Definition of palliative care.--In this section, the
term ``palliative care'' means patient and family centered
care that optimizes quality of life by anticipating,
preventing, and treating suffering. Such term includes care
that is furnished throughout the continuum of the illness
that addresses physical, intellectual, emotional, social, and
spiritual needs and that facilitates patient autonomy, access
to information and choice.
(b) Report.--Not later than 1 year after the date of the
enactment of this Act, the Comptroller General shall submit
to the Congress a report on the study conducted under
subsection (a), together with such recommendations as the
Comptroller General determines to be appropriate.
SEC. 104. UNDERSTANDING THE PROGRESSION OF KIDNEY DISEASE AND
TREATMENT OF KIDNEY FAILURE IN MINORITY
POPULATIONS.
(a) Study.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall conduct
a study on--
(1) the social, behavioral, and biological factors leading
to kidney disease;
(2) efforts to slow the progression of kidney disease in
minority populations that are disproportionately affected by
such disease; and
(3) 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.
(b) Report.--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.
TITLE II--EMPOWER PATIENT DECISION MAKING AND CHOICE
SEC. 201. PROVIDING INDIVIDUALS WITH KIDNEY FAILURE ACCESS TO
MANAGED CARE.
(a) Permanent Extension of Medicare Advantage ESRD Special
Needs Plans Authority.--Section 1859(f)(1) of the Social
Security Act (42 U.S.C. 1395w-28(f)(1)) is amended by
inserting ``, in the case of a specialized MA plan for
special needs individuals who have not been determined to
have end stage renal disease,'' before ``for periods before
January 1, 2019''.
(b) Accelerated Access to Medicare Advantage.--Section
17006(a)(3) of the 21st Century Cures Act (Public Law 114-
255) is amended by striking ``2021'' and inserting ``2020.''
(c) Accelerated MedPAC Risk Adjustment Report.--Section
17006(f)(2)(A)(i)(II) of the 21st Century Cures Act (Public
Law 114-255) is amended by striking ``2020'' and inserting
``2019.''
SEC. 202. MEDIGAP COVERAGE FOR BENEFICIARIES WITH END-STAGE
RENAL DISEASE.
(a) Guaranteed Availability of Medigap Policies to All ESRD
Medicare Beneficiaries.--
(1) In general.--Section 1882(s) of the Social Security Act
(42 U.S.C. 1395ss(s)) is amended--
(A) in paragraph (2)--
(i) in subparagraph (A), by striking ``is 65'' and
inserting the following: ``is--
``(i) 65 years of age or older and is enrolled for benefits
under part B; or
``(ii) is entitled to benefits under 226A(b) and is
enrolled for benefits under part B.''; and
(ii) in subparagraph (D), in the matter preceding clause
(i), by inserting ``(or is entitled to benefits under
226A(b))'' after ``is 65 years of age or older''; and
(B) in paragraph (3)(B)--
(i) in clause (ii), by inserting ``(or is entitled to
benefits under 226A(b))'' after ``is 65 years of age or
older''; and
(ii) in clause (vi), by inserting ``(or under 226A(b))''
after ``at age 65''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to medicare supplemental policies effective on or
after January 1, 2020.
(b) Additional Enrollment Period for Certain Individuals.--
(1) One-time enrollment period.--
(A) In general.--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 (42
U.S.C. 1395ss) of the individual's choosing.
(B) Enrollment period.--The enrollment period established
under subparagraph (A) shall begin on January 1, 2020, and
shall end June 30, 2020.
(2) Individual described.--An individual described in this
paragraph is an individual who--
(A) is entitled to hospital insurance benefits under part A
of title XVIII of the Social Security Act under section
226A(b) of such Act (42 U.S.C. 426-1);
(B) is enrolled for benefits under part B of such title
XVIII; and
(C) 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 (42 U.S.C. 1395ss(s).
SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREATMENTS.
(a) In General.--Section 1881(b)(3) of the Social Security
Act (42 U.S.C. 1395rr(b)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively;
(2) in clause (ii), as redesignated by subparagraph (A),
strike ``on a comprehensive'' and insert ``subject to
subparagraph (B), on a comprehensive'';
(3) by striking ``With respect to'' and inserting ``(A)
With respect to''; and
(4) by adding at the end the following new subparagraph:
``(B) For purposes of subparagraph (A)(ii), an individual
determined to have end-stage renal disease receiving home
dialysis may choose to receive the monthly end-stage renal
disease-related visits furnished on or after January 1, 2018,
via telehealth if the individual receives a face-to-face
visit, without the use of telehealth, at least once every
three consecutive months.''.
(b) Originating Site Requirements.--
(1) In general.--Section 1834(m) of the Social Security Act
(42 U.S.C. 1395m(m)) is amended--
(A) in paragraph (4)(C)(ii), by adding at the end the
following new subclauses:
``(IX) A renal dialysis facility, but only for purposes of
section 1881(b)(3)(B).
``(X) The home of an individual, but only for purposes of
section 1881(b)(3)(B).''; and
(B) by adding at the end the following new paragraph:
``(5) Treatment of home dialysis monthly esrd-related
visit.--The geographic requirements described in paragraph
(4)(C)(i) shall not apply with respect to telehealth services
furnished on or after January 1, 2018, for purposes of
section 1881(b)(3)(B), at an originating site described in
subclause (VI), (IX), or (X) of paragraph (4)(C)(ii).''.
(2) No facility fee if originating site for home dialysis
therapy is the home.--Section 1834(m)(2)(B) of the Social
Security (42 U.S.C. 1395m(m)(2)(B)) is amended--
(A) by redesignating clauses (i) and (ii) as subclauses (I)
and (II), and indenting appropriately;
(B) in subclause (II), as redesignated by subparagraph (A),
by striking ``clause (i) or this clause'' and inserting
``subclause (I) or this subclause'';
(C) by striking ``site.--With respect to'' and inserting
``site.--
``(i) In general.--Subject to clause (ii), with respect
to''; and
(D) by adding at the end the following new clause:
``(ii) No facility fee if originating site for home
dialysis therapy is the home.--No facility fee shall be paid
under this subparagraph to an originating site described in
paragraph (4)(C)(ii)(X).''.
(c) Conforming Amendment.--Section 1881(b)(1) of the Social
Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking
``paragraph (3)(A)'' and inserting ``paragraph (3)(A)(i)''.
(d) Exclusion From Remuneration for Purposes of Applying
Civil Monetary Penalties.--
(1) In general.--Section 1128A(i)(6) of the Social Security
Act (42 U.S.C. 1320a-7a(i)(6)) is amended--
(A) in subparagraph (H)(iv), by striking ``; or'' at the
end;
(B) in subparagraph (I), by striking the period at the end
and inserting ``; or''; and
(C) by adding at the end the following new subparagraph:
``(J) the provision of telehealth or remote patient
monitoring technologies to individuals under title XVIII by a
health care provider for the purpose of furnishing telehealth
or remote patient monitoring services.''.
(2) Effective date.--The amendments made by this subsection
shall apply to services furnished on or after the date of the
enactment of this Act.
TITLE III--IMPROVING PATIENT CARE AND ENSURING QUALITY OUTCOMES
SEC. 301. MAINTAIN AN ECONOMICALLY STABLE DIALYSIS
INFRASTRUCTURE.
(a) In General.--Section 1881(b)(14) of the Social Security
Act (42 U.S.C. 1395rr(b)(14)) is amended--
[[Page S6227]]
(1) in subparagraph (D), in the matter preceding clause
(i), by striking ``Such system'' and inserting ``Subject to
subparagraph (J), such system''; and
(2) by adding at the end the following new subparagraph:
``(J) For payment for renal dialysis services furnished on
or after January 1, 2018, under the system under this
paragraph--
``(i) the payment adjustment described in clause (i) of
subparagraph (D)--
``(I) shall not take into account comorbidities; and
``(II) shall only 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;
``(ii) the Secretary shall reassess any adjustments related
to patient weight under such clause;
``(iii) the payment adjustment described in clause (ii) of
such subparagraph shall not be included;
``(iv) the standardization factor described in the final
rule published in the Federal Register on November 8, 2012
(77 Fed. Reg. 67470), shall be established using the most
currently available data (and not historical data) and
adjusted on an annual basis, based on such available data, to
account for any change in utilization of drugs and any
modification in adjustors applied under this paragraph; and
``(v) take into account reasonable costs for determining
the payment rate consistent with paragraph (2)(B).''.
(b) Inclusion of Network Fee as an Allowable Cost.--Section
1881(b)(14) of the Social Security Act (42 U.S.C.
1395rr(b)(14)), as amended by subsection (a), is amended by
adding at the end the following new subparagraph:
``(K) Not later than January 1, 2018, 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.''.
SEC. 302. IMPROVE PATIENT DECISION MAKING AND TRANSPARENCY BY
CONSOLIDATING AND MODERNIZING QUALITY PROGRAMS.
(a) Measures.--Section 1881(h)(2) of the Social Security
Act (42 U.S.C. 1395rr(h)(2)) is amended by adding at the end
the following new subparagraphs:
``(F) Weighting limitation.--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.
``(G) Statistically valid and reliable.--In specifying
measures under subparagraph (A), the Secretary shall only
specify measures that have been shown to be statistically
valid and reliable through testing.''.
(b) Endorsement.--Section 1881(h)(2)(B) of the Social
Security Act (42 U.S.C. 1395rr(h)(2)(B)) is amended--
(1) in clause (ii), by adding at the end the following new
sentence: ``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.''; and
(2) by adding at the end the following new clause:
``(iii) Composite measures.--Clauses (i) and (ii) shall
apply to composite measures in the same manner as such
clauses apply to individual measures.''.
(c) Requirements for Dialysis Facility Compare Star Rating
Program.--Section 1881(h)(6) of the Social Security Act (42
U.S.C. 1395rr(h)(6)) is amended by adding at the end the
following new subparagraph:
``(E) Requirements for any dialysis facility compare star
rating program.--To the extent that the Secretary maintains a
dialysis facility compare star rating program, under such a
program the Secretary--
``(i) shall assign stars using the same methodology and
total performance score results from the quality incentive
program under this subsection;
``(ii) shall determine the stars using the same methodology
used under such quality incentive program; and
``(iii) shall not use a forced bell curve when determining
the stars or rebaselining the stars.''.
(d) Hospitals Required to Provide Information.--Section
1881 of the Social Security Act (42 U.S.C. 1395rr) is amended
by adding at the end the following new subsection:
``(i) Hospitals Required to Provide Information.--
``(1) In general.--The Secretary shall establish a process
under which a hospital or a critical access hospital shall
provide a renal dialysis facility with health and treatment
information with respect to an individual who is discharged
from the hospital or critical access hospital and who
subsequently receives treatment at facility.
``(2) Elements.--Under the process established under
paragraph (1)--
``(A) the request for the health information may be
initiated by the individual prior to discharge or upon
request by the renal dialysis facility after the patient is
discharged; and
``(B) the information must be provided to the facility
within 7 days of the request being made.''.
(e) Incentive Payments.--Section 1881(h)(1) of the Social
Security Act (42 U.S.C. 1395rr(h)(1)) is amended by adding at
the end the following new subparagraph:
``(D) Incentive payments.--
``(i) In general.--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).
``(ii) Funding.--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).
``(iii) No effect in subsequent years.--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.''.
(f) Effective Date.--The amendments made by this section
shall apply to items and services furnished on or after
January 1, 2019.
SEC. 303. INCREASING ACCESS TO MEDICARE KIDNEY DISEASE
EDUCATION BENEFIT.
(a) In General.--Section 1861(ggg) of the Social Security
Act (42 U.S.C. 1395x(ggg)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by inserting ``or stage V'' after
``stage IV''; and
(B) in subparagraph (B), by inserting ``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'' after
``kidney condition''; and
(2) in paragraph (2)--
(A) by striking subparagraph (B); and
(B) in subparagraph (A)--
(i) by striking ``(A)'' after ``(2)'';
(ii) by striking ``and'' at the end of clause (i);
(iii) by striking the period at the end of clause (ii) and
inserting ``; and'';
(iv) by redesignating clauses (i) and (ii) as subparagraphs
(A) and (B), respectively; and
(v) by adding at the end the following:
``(C) a renal dialysis facility subject to the requirements
of section 1881(b)(1) with personnel who--
``(i) provide the services described in paragraph (1); and
``(ii) 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)).''.
(b) Payment to Renal Dialysis Facilities.--Section 1881(b)
of the Social Security Act (42 U.S.C. 1395rr(b)) is amended
by adding at the end the following new paragraph:
``(15) 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.''.
(c) Effective Date.--The amendments made by this section
apply to kidney disease education services furnished on or
after January 1, 2018.
SEC. 304. CERTIFICATION OF NEW FACILITIES.
(a) Certification.--
(1) In general.--Section 1865(a)(1) of the Social Security
Act (42 U.S.C. 1395bb(a)(1)) is amended by striking ``or the
conditions and requirements under section 1881(b)''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect on the date of enactment of this Act and
apply to a finding made on or after such date.
(b) Timing for Acceptance of Requests From Accreditation
Organizations.--Not later than 6 months after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall accept a completed application from any
national accreditation body for providers and facilities that
provide services under 1881(b), in accordance with section
1865(3)(A)). Any application received pursuant to the
preceding sentence shall be deemed approved unless the
Secretary, within 90 days after the date of the submission of
the application to the Secretary, either denies such request
in writing or informs the applicant in writing with respect
to any additional information that is needed in order to make
a final determination with respect to the application. If the
Secretary requests additional information pursuant to the
preceding sentence and the applicant submits such
information, the application shall be deemed approved unless
the Secretary, within 90 days of date of receiving such
information, denies such request.
SEC. 305. IMPROVING ACCESS IN UNDER SERVED 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 ``and includes renal
dialysis services'' before the period at the end.
(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 ``, including
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 ``, including
nephrology health professionals'' before the period at the
end.
______