A bill to amend title XVIII of the Social Security Act to provide coverage for kidney disease education services under the medicare program, and for other purposes.

Summary: Kidney Disease Educational Benefits Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act to provide for Medicare coverage of kidney disease education services.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Kidney Disease Educational Benefits 
Act of 2005''.

SEC. 2. MEDICARE COVERAGE OF KIDNEY DISEASE EDUCATION SERVICES.

    (a) Coverage of Kidney Disease Education Services.--
            (1) In general.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x) is amended--
                    (A) in subsection (s)(2)--
                            (i) in subparagraph (Y), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (Z), by adding ``and'' 
                        at the end; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(AA) kidney disease education services (as defined in 
        subsection (bbb));''; and
                    (B) by adding at the end the following new 
                subsection:

            ``Kidney Disease Education Services&lt;plus-minus&gt;

    ``(bbb)(1) The term `kidney disease education services' means 
educational services that are--
            ``(A) furnished to an individual with kidney disease who, 
        according to accepted clinical guidelines identified by the 
        Secretary, will require dialysis or a kidney transplant;
            ``(B) furnished, upon the referral of the physician 
        managing the individual's kidney condition, by a qualified 
        person (as defined in paragraph (2)); and
            ``(C) designed--
                    ``(i) to provide comprehensive information 
                regarding--
                            ``(I) the management of comorbidities;
                            ``(II) the prevention of uremic 
                        complications; and
                            ``(III) each option for renal replacement 
                        therapy (including home and in-center, as well 
                        as vascular access options and 
                        transplantation); and
                    ``(ii) to ensure that the individual has the 
                opportunity to actively participate in the choice of 
                therapy.
    ``(2) The term `qualified person' means--
            ``(A) a physician (as described in subsection (r)(1));
            ``(B) an individual who--
                    ``(i) is--
                            ``(I) a registered nurse;
                            ``(II) a registered dietitian or nutrition 
                        professional (as defined in subsection 
                        (vv)(2));
                            ``(III) a clinical social worker (as 
                        defined in subsection (hh)(1));
                            ``(IV) a physician assistant, nurse 
                        practitioner, or clinical nurse specialist (as 
                        those terms are defined in subsection (aa)(5)); 
                        or
                            ``(V) a transplant coordinator; and
                    ``(ii) meets such requirements related to 
                experience and other qualifications that the Secretary 
                finds necessary and appropriate for furnishing the 
                services described in paragraph (1); or
            ``(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) meet the requirements of subparagraph (A) or 
                (B).
    ``(3) The Secretary shall develop the requirements under paragraph 
(2)(B)(ii) after consulting with physicians, health educators, 
professional organizations, accrediting organizations, kidney patient 
organizations, dialysis facilities, transplant centers, network 
organizations described in section 1881(c)(2), and other knowledgeable 
persons.
    ``(4) In promulgating regulations to carry out this subsection, the 
Secretary shall ensure that each beneficiary who is entitled to kidney 
disease education services under this title receives such services in a 
timely manner that ensures that the beneficiary receives the maximum 
benefit of those services.
    ``(5) The Secretary shall monitor the implementation of this 
subsection to ensure that beneficiaries who are eligible for kidney 
disease education services receive such services in the manner 
described in paragraph (4).
    ``(6) No individual shall be eligible to be provided more than 6 
sessions of kidney disease education services under this title.''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(AA),'', after ``(2)(W),''.
            (3) 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:
            ``(14) For purposes of paragraph (12), the single composite 
        weighted formulas determined under such paragraph shall not 
        take into account the amount of payment for kidney disease 
        education services (as defined in section 1861(bbb)). Instead, 
        payment for such services shall be made to the renal dialysis 
        facility on an assignment-related basis under section 1848.''.
            (4) Limitation on number of sessions.--Section 1862(a)(1) 
        of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (L);
                    (B) by striking the semicolon at the end of 
                subparagraph (M) and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(N) in the case of kidney disease education services (as 
        defined in section 1861(bbb)), which are performed in excess of 
        the number of sessions covered under such section;''.
            (5) Annual report to congress.--Not later than April 1, 
        2007, and annually thereafter, the Secretary of Health and 
        Human Services shall submit to Congress a report on the number 
        of medicare beneficiaries who are entitled to kidney disease 
        education services (as defined in section 1861(bbb) of the 
        Social Security Act, as added by paragraph (1)) under title 
        XVIII of such Act and who receive such services, together with 
        such recommendations for legislative and administrative action 
        as the Secretary determines to be appropriate to fulfill the 
        legislative intent that resulted in the enactment of that 
        subsection.
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2007.