[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4814 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4814
To improve the understanding of, and promote access to treatment for,
chronic kidney disease, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 9, 2014
Mr. Marino (for himself and Mr. Lewis) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To improve the understanding of, and promote access to treatment for,
chronic kidney disease, 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 ``Chronic Kidney Disease Improvement
in Research and Treatment Act of 2014''.
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 UNDERSTANDING OF CHRONIC KIDNEY DISEASE THROUGH
EXPANDED RESEARCH AND COORDINATION
Sec. 101. Identifying gaps in chronic kidney disease research.
Sec. 102. Coordinating research on chronic kidney disease.
Sec. 103. Understanding the progression of kidney disease and treatment
of kidney failure in minority populations.
TITLE II--PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENTS
Sec. 201. Increasing access to Medicare kidney disease education
benefit.
Sec. 202. Improving access to chronic kidney disease treatment in
underserved rural and urban areas.
Sec. 203. Promoting access to home dialysis treatments.
Sec. 204. Expand access for patients with acute kidney injury.
TITLE III--CREATING ECONOMIC STABILITY FOR PROVIDERS CARING FOR
INDIVIDUALS WITH CHRONIC KIDNEY DISEASE
Sec. 301. Stabilizing Medicare payments for services provided to
beneficiaries with stage V chronic kidney
disease receiving dialysis services.
Sec. 302. Allowing individuals with kidney failure to retain access to
private insurance.
Sec. 303. Providing individuals with kidney failure access to managed
care and coordinated care programs.
TITLE I--IMPROVING UNDERSTANDING OF CHRONIC KIDNEY DISEASE THROUGH
EXPANDED RESEARCH AND COORDINATION
SEC. 101. IDENTIFYING GAPS IN CHRONIC KIDNEY DISEASE RESEARCH.
(a) Report.--Not later than one year after the date of enactment of
this Act, the Comptroller General of the United States shall develop
and submit to the Congress a comprehensive report assessing the
adequacy of Federal expenditures in chronic kidney disease research
relative to Federal expenditures for chronic kidney disease care.
(b) Contents.--The report required by this section shall--
(1) analyze the current chronic kidney disease research
projects being funded by Federal agencies;
(2) identify, including by surveying the kidney care
community, areas of chronic kidney disease knowledge gaps that
are not part of current Federal research efforts;
(3) report on the level of Federal expenditures on kidney
research as compared to the amount of Federal expenditures on
treating individuals with chronic kidney disease; and
(4) identify areas of kidney failure knowledge gaps in
research to assess treatment patterns associated with providing
care to minority populations that are disproportionately
affected by kidney failure.
SEC. 102. COORDINATING RESEARCH ON CHRONIC KIDNEY DISEASE.
(a) Interagency Committee.--The Secretary of Health and Human
Services shall establish and maintain an interagency committee for the
purpose of improving the coordination of chronic kidney disease
research.
(b) Reports.--For the purpose described in subsection (a), the
interagency committee established under such subsection shall issue
public reports that--
(1) include a strategic plan, including recommendations
for--
(A) improving communication and coordination among
Federal agencies;
(B) procedures for monitoring Federal chronic
kidney disease research activities; and
(C) ways to maximize the efficiency of the Federal
chronic kidney disease research investment and minimize
the potential for unnecessary duplication;
(2) include a portfolio analysis that provides information
on chronic kidney disease research projects, organized by the
strategic plan objectives; and
(3) address such other topics as the interagency committee
determines appropriate.
(c) Meetings.--The interagency committee established under
subsection (a) shall meet not less than semi-annually.
SEC. 103. UNDERSTANDING THE PROGRESSION OF KIDNEY DISEASE AND TREATMENT
OF KIDNEY FAILURE IN MINORITY POPULATIONS.
Not later than one year after the date of enactment of this Act,
the Secretary of Health and Human Services shall--
(1) complete a study on--
(A) the social, behavioral, and biological factors
leading to kidney disease;
(B) efforts to slow the progression of kidney
disease in minority populations that are
disproportionately affected by such disease; and
(C) 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; and
(2) submit a report to the Congress on the results of such
study.
TITLE II--PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENTS
SEC. 201. 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'';
(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 such
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,
2015.
SEC. 202. IMPROVING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENT IN
UNDERSERVED RURAL AND URBAN 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 nephrologists and non-physician
practitioners providing renal dialysis services'' 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 nephrologists and non-physician
practitioners providing renal dialysis services'' before the period at
the end.
SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREATMENTS.
(a) Monthly Capitation Payments.--Notwithstanding any other
provision of law, with respect to dialysis services furnished on or
after January 1, 2015, the Secretary of Health and Human Services shall
apply with respect to visits by a physician provided within a month to
an end stage renal disease patient receiving dialysis services at home,
the alternative Medicare billing procedures, as described in the final
rule promulgated by the Secretary in the Federal Register on November
7, 2003 (68 Fed. Reg. 63216), for physicians managing patients on
dialysis, with respect to visits by such a physician provided within a
month to an end stage renal disease patient who is hospitalized during
the month.
(b) Telehealth.--Section 1834(m)(4)(C)(ii) of the Social Security
Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end the
following new subclause:
``(IX) A renal dialysis facility
(as defined in section 1881).''.
SEC. 204. EXPAND ACCESS FOR PATIENTS WITH ACUTE KIDNEY INJURY.
Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is
amended--
(1) in paragraph (1), by inserting ``or acute kidney
injury'' after ``individuals who have been determined to have
end stage renal disease'';
(2) in paragraph (2)(A), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(3) in paragraph (2)(B), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(4) in paragraph (3), in the matter preceding subparagraph
(A), by inserting ``or acute kidney injury'' after ``end stage
renal disease'';
(5) in paragraph (11)(A), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(6) in paragraph (11)(B), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(7) in paragraph (14)(B)--
(A) in clause (ii), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(B) in clause (iii), by inserting ``or acute kidney
injury'' after ``end stage renal disease''; and
(C) in clause (iv), by inserting ``or acute kidney
injury'' after ``end stage renal disease''; and
(8) in paragraph (14)(H)(i), by inserting ``or acute kidney
injury'' after ``end stage renal disease''.
TITLE III--CREATING ECONOMIC STABILITY FOR PROVIDERS CARING FOR
INDIVIDUALS WITH CHRONIC KIDNEY DISEASE
SEC. 301. STABILIZING MEDICARE PAYMENTS FOR SERVICES PROVIDED TO
BENEFICIARIES WITH STAGE V CHRONIC KIDNEY DISEASE
RECEIVING DIALYSIS SERVICES.
Section 1881(b)(14) of the Social Security Act (42 U.S.C.
1395rr(b)(14)) is amended--
(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)(i) For payment for renal dialysis services furnished on or
after January 1, 2015, under the system under this paragraph--
``(I) the payment adjustment described in clause (i) of
subparagraph (D) shall not take into account comorbidities;
``(II) the payment adjustment described in clause (ii) of
such subparagraph shall not be included;
``(III) 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
``(IV) the Secretary shall take into account reasonable
costs consistent with paragraph (2)(B) when calculating such
payments.
``(ii) Not later than January 1, 2015, the Secretary shall amend
the ESRD facility cost report to--
``(I) include the per treatment network fee (as described
in paragraph (7)) as an allowable cost; and
``(II) eliminate the limitation for reporting medical
director fees on such reports in order to take into account the
wages of a board-certified nephrologist.''.
SEC. 302. ALLOWING INDIVIDUALS WITH KIDNEY FAILURE TO RETAIN ACCESS TO
PRIVATE INSURANCE.
(a) In General.--Section 1862(b)(1)(C) of the Social Security Act
(42 U.S.C.1395y(b)(1)(C) is amended--
(1) in the last sentence, by inserting ``and before January
1, 2015'' after ``prior to such date''; and
(2) by adding at the end the following new sentence:
``Effective for items and services furnished on or after
January 1, 2015 (with respect to periods beginning on or after
the date that is 42 months prior to such date), clauses (i) and
(ii) shall be applied by substituting `42-month' for `12-month'
each place it appears.''.
(b) Effective Date.--The amendments made by this subsection shall
take effect on the date of enactment of this Act. For purposes of
determining an individual's status under section 1862(b)(1)(C) of the
Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by
subsection (a), an individual who is within the coordinating period as
of the date of enactment of this Act shall have that period extended to
the full 42 months described in the last sentence of such section, as
added by the amendment made by subsection (a)(2).
SEC. 303. PROVIDING INDIVIDUALS WITH KIDNEY FAILURE ACCESS TO MANAGED
CARE AND COORDINATED CARE PROGRAMS.
(a) Expanding Access to Medicare Advantage.--
(1) Eligibility under medicare advantage.--
(A) In general.--Section 1851(a)(3) of the Social
Security Act (42 U.S.C. 1395w-21(a)(3)) is amended--
(i) by striking subparagraph (B); and
(ii) by striking ``eligible individual.--''
and all that follows through ``In this title''
and inserting ``eligible individual.--In this
title''.
(B) Conforming amendment.--Section 1852(b)(1) of
the Social Security Act (42 U.S.C. 1395w-22(b)(1)) is
amended--
(i) by striking subparagraph (B); and
(ii) by striking ``Beneficiaries.--'' and
all that follows through ``A Medicare+Choice
organization'' and inserting ``Beneficiaries.--
A Medicare Advantage organization''.
(C) Effective date.--The amendments made by this
paragraph shall apply with respect to plan years
beginning on or after January 1, 2015.
(2) Education.--Section 1851(d)(2)(A)(iii) of the Social
Security Act (42 U.S.C. 1395w-21(d)(2)(A)(iii)) is amended by
inserting before the period at the end the following ``,
including any additional information that individuals
determined to have end stage renal disease may need to make
informed decisions with respect to such an election''.
(3) Quality metrics.--Section 1852(e)(3)(A) of the Social
Security Act (42 U.S.C. 1395w-22(e)(3)(A)) is amended by adding
at the end the following new clause:
``(v) Requirements with respect to
individuals with esrd.--In addition to the data
required to be collected, analyzed, and
reported under clause (i) and notwithstanding
the limitations under subparagraph (B), as part
of the quality improvement program under
paragraph (1), each MA organization shall
provide for the collection, analysis, and
reporting of data, determined in consultation
with the kidney care community, that permits
the measurement of health outcomes and other
indices of quality with respect to individuals
determined to have end stage renal disease.''.
(b) 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, 2017''.
(c) Voluntary ESRD Coordinated Care Gainsharing Program.--
(1) In general.--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)(A) Not later than January 1, 2016, the Secretary shall, in
accordance with this paragraph, establish an ESRD Care Coordination
gainsharing program for nephrologists, renal dialysis facilities, and
providers of services that develop coordinated care organizations to
provide a full range of clinical and supportive services (as described
in subparagraph (D)) to individuals determined to have end stage renal
disease.
``(B) Under such program, subject to subparagraph (C), the payment
amounts renal dialysis facilities and providers of services described
in subparagraph (A) would otherwise receive under paragraph (14) and
nephrologists described in subparagraph (A) would otherwise receive
under section 1848 with respect to dialysis services furnished by such
a facility, provider, or nephrologist during a year, shall be increased
by a portion of the amount (as determined by the Secretary) of actual
reductions in expenditure under this title attributable to the
coordinated care organization developed by such facility, provider, or
nephrologist involved, taking into account non-dialysis expenditures
under parts A and B, during the preceding calendar year. The payment
amount under this subparagraph shall be provided to a nephrologist,
renal dialysis facility, and provider of services that developed the
coordinated care organization no later than March 31 of the year after
the year during which such services are provided by such nephrologist,
facility, or provider.
``(C) The aggregate incentive payment amounts provided under such
program for a year may not exceed the amount equal to 2 percent less
than the estimated total amount of non-dialysis expenditures under
parts A and B for 2016 for items and services that are not related to
dialysis or transplant services.
``(D) For purposes of subparagraph (A), the full range of clinical
and supportive services includes at least the following:
``(i) Primary care and other preventative services.
``(ii) Specialty care for co-morbidities or non-renal acute
conditions, including at least podiatry, cardiology, and
orthopedics.
``(iii) Vascular access.
``(iv) Laboratory testing and diagnostic imaging.
``(v) Pharmacy care management.
``(vi) Patient, family, and caregiver education.
``(vii) Psychiatric, behavioral therapy, and counseling
services.
``(E) In providing payment incentive amounts under such program,
the Secretary shall apply a risk adjustment methodology that--
``(i) uses risk adjuster factors applied under part C; and
``(ii) adjusts such payments to exclude the top 2 percent
of outliers.
``(F) In establishing such program, the Secretary shall ensure that
each of the following is satisfied:
``(i) The program allows for all types and sizes of renal
dialysis facilities and providers of services described in
subparagraph (A), including profit and not-for-profit, urban
and rural, as well as all other types and sizes of such
facilities and providers, to participate.
``(ii) The program rewards high quality, efficient
facilities and providers through gain-sharing.
``(iii) For purposes of determining the actual reductions
in expenditures under this title attributable to a coordinated
care organization described in subparagraph (A), the program
includes a market-based benchmark system that will not be
rebased against which such expenditures shall be compared.
``(iv) The program results in reductions of expenditures
under parts A and B for services that are not dialysis-related
services.
``(v) The program allows new applicants to participate in
the program after the initial implementation period.
``(vi) The program establishes clear quality metrics in
consultation with the kidney care community.
``(vii) The program provides for waivers of Federal laws or
requirements, in consultation with interested stakeholders.
``(viii) Under such program the Secretary attributes
individuals described in subparagraph (A) who receive treatment
through a care coordination organization described in such
subparagraph to such organization rather than to any other
payment model that requires beneficiary attribution.
``(ix) Under such program the Secretary provides quarterly
Medicare parts A and B claims data to facilities and providers
described in subparagraph (A) participating in such program.
``(G) Not later than three years after the date of the
implementation of the ESRD Care Coordination gainsharing program, the
Secretary shall submit to the Congress a report on the waivers granted
under subparagraph (F)(vii) and the effectiveness of such waivers in
allowing the coordination of care.''.
(2) Conforming amendments.--
(A) Section 1881.--Section 1881(b) of the Social
Security Act (42 U.S.C. 1395rr(b)) is amended--
(i) in each of paragraphs (12)(A) and
(13)(A), by striking ``paragraph (14)'' and
inserting ``paragraphs (14) and (15)''; and
(ii) in paragraph (14)(A)(i), by inserting
``and paragraph (15)'' after ``Subject to
subparagraph (E)''.
(B) Section 1848.--Section 1848 of the Social
Security Act (42 U.S.C. 1395w-4) is amended by adding
at the end the following new subsection:
``(q) Voluntary ESRD Coordinated Care Program.--For provisions
related to incentive payment amounts to nephrologists under the ESRD
Care Coordination gainsharing program, see section 1881(b)(15).''.
(d) Patient Information Requirement.--The Secretary of Health and
Human Services shall require hospitals that furnish items and services
to individuals entitled to benefits under part A of title XVIII of the
Social Security Act or eligible for benefits under part B of such title
and who subsequently receive dialysis services at a renal dialysis
facility (as defined in section 1881 of such Act (42 U.S.C. 1395rr)) to
provide to such facility health information with respect to such
individual, including a discharge summary and co-morbidity information,
upon request of the facility, not later than 7 days after notification
by the hospital of the provision of such services to such individual or
of the determination that such individual has end stage renal disease,
as applicable.
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