Chronic Kidney Disease Improvement in Research and Treatment Act
This bill expands, establishes, and otherwise modifies requirements under Medicare and other health care programs relating to individuals with end-stage renal disease (ESRD).
Among other things, the bill
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3912 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 3912
To amend title XVIII of the Social Security Act to increase awareness,
expand preventative services, and improve care for individuals with
end-stage renal disease, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 23, 2019
Mr. Lewis (for himself and Mr. Buchanan) 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 amend title XVIII of the Social Security Act to increase awareness,
expand preventative services, and improve care for individuals with
end-stage renal 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''.
TITLE I--INCREASING AWARENESS, EXPANDING PREVENTATIVE SERVICES, AND
IMPROVING CARE COORDINATION
SEC. 101. 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,
2020.
SEC. 102. 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. 103. IMPROVING ACCESS IN UNDERSERVED 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.
SEC. 104. IMPROVING CARE COORDINATION FOR DIALYSIS PATIENTS.
(a) 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.''.
TITLE II--INCENTIVIZING INNOVATION FOR TRULY INNOVATIVE NEW DRUGS,
BIOLOGICALS, DEVICES, AND OTHER TECHNOLOGIES.
SEC. 201. 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--
(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, 2020, 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, 2020, 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.''.
(c) Affirmation of Availability of Bad Debt Reimbursement for Non-
Composite Rate Services.--
(1) Repeal of mippa bad debt rule of contruction.--Section
153(b)(4) of the Medicare Improvements for Patients and
Providers Act (42 U.S.C. 1395rr note) is repealed.
(2) Bad debt payments.--Section 1881(b)(14) of the Social
Security Act (42 U.S.C. 1395rr(b)), as amended by subsections
(a) and (b), is further amended by adding at the end the
following new subparagraphs:
``(L) Notwithstanding any other provision of this title,
the Secretary shall provide payments for any unrecovered amount
for any bad debt attributable to deductible and coinsurance for
any item or service reimbursed under the system under this
paragraph or bad debt described in section 153(b)(4) of the
Medicare Improvements for Patients and Providers Act of 2008.
Such payments for any unrecovered amount shall be made in
addition to payments made under such system and such drug
designation process.
``(M) The additional payments made under subparagraph (L)--
``(i) shall not be considered an adjustment under
subparagraph (D); and
``(ii) shall not be implemented in a budget neutral
manner.''.
(3) Effective date.--Paragraph (1) and the amendments made
by paragraph (2) shall apply to payments beginning on January
1, 2020.
(d) Productivity Adjustment.--Section 1886(b)(3)(B)(xi) of the
Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(xi)) is amended--
(1) in subclause (I), by striking ``For 2012'' and
inserting ``Subject to subclause (IV), for 2012''; and
(2) by adding at the end, the following new subclause:
``(IV) For 2020 through 2024, the
productivity adjustment described in
subclause (II) shall be zero for a
payment system for any year in which
the Medicare Payment Advisory
Commission established under section
1805 estimates that payments provided
under such payment system, on an
aggregate national basis, exceed costs,
on an aggregate national basis, by 3.0
percent or less.''.
(e) Payment for New and Innovative Drugs and Biologicals That Are
Renal Dialysis Services.--Section 1881(b)(14) of the Social Security
Act (42 U.S.C. 1395ww(b)(14)), as amended by subsections (a), (b), and
(c), is further amended by adding the following new subparagraph:
``(N) Payment for new and innovative drugs,
biologicals, and devices that are renal dialysis
services.--
``(i) In general.--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 it is
not. The Secretary shall use the cost and
utilization data collected during the two-year
transitional period, as set forth in the final
regulation entitled `Medicare Program; End-
Stage Renal Disease Prospective Payment System,
Payment for Renal Dialysis Services Furnished
to Individuals With Acute Kidney Injury, End-
Stage Renal Disease Quality Incentive Program,
Durable Medical Equipment, Prosthetics,
Orthotics and Supplies (DMEPOS) Competitive
Bidding Program (CBP) and Fee Schedule Amounts,
and Technical Amendments To Correct Existing
Regulations Related to the CBP for Certain
DMEPOS' published on November 14, 2018 (83 Fed.
Reg. 56922 et seq.).
``(ii) Money to follow the patient.--The
Secretary through notice and comment rulemaking
shall implement a policy for any drug or
biological that is not provided to the average
patient that results in the amount by which the
single payment amount is increased pursuant to
this clause shall be paid only when a provider
or renal dialysis facility has demonstrated
that it has administered the drug or biological
to a patient.''.
(f) New Devices and Other Technologies.--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 (42 U.S.C. 1395rr(b)(14)) for calendar year 2021
and in consultation with stakeholders, the Secretary of Health and
Human Services shall establish a process for identifying and
determining appropriate payment amounts for incorporating new devices
and technologies into the bundled payment under such system.
TITLE III--IMPROVING THE ACCURACY AND TRANSPARENCY OF END-STAGE RENAL
DISEASE QUALITY PROGRAMS
SEC. 301. 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--
(1) by striking subparagraph (A) and inserting the
following:
``(A) In general.--The measures specified under
this paragraph with respect to the year involved shall
be selected 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.''.
(2) 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
shall--
``(i) assign stars using the same
methodology and total performance score results
from the quality incentive program under this
subsection;
``(ii) determine the stars using the same
methodology used under such quality incentive
program; and
``(iii) not use a forced bell curve when
determining the stars or rebaselining the
stars.''.
(d) Incentive Payments.--
(1) In general.--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.''.
(2) Effective date.--The amendments made by this section
shall apply to items and services furnished on or after January
1, 2020.
TITLE IV--EMPOWERING PATIENTS
SEC. 401. 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 all that follows through the period at
the end 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, 2021.
(b) Additional Enrollment Period for Certain Individuals.--
(1) One-time enrollment period.--
(A) In general.--In the case of an individual
described in paragraph (2), 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, 2021, and shall end June 30, 2021.
(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));
(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. 402. 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, 2020'' 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, 2020 (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).
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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