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104TH CONGRESS

1ST SESSION H. R. 1068

To direct the Secretary of Health and Human Services to conduct a demonstration project under which payment shall be made under the medicare program for renal disease management services furnished to individuals at risk for end stage renal disease to accurately assess whether

those management services can prevent the progression of renal disease

to renal failure and thereby delay the onset of dialysis and cause savings

for the medicare program.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 27, 1995

Mr. STARK introduced the following bill; which was referred to the Committee

on 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 direct the Secretary of Health and Human Services to

conduct a demonstration project under which payment

shall be made under the medicare program for renal

disease management services furnished to individuals at

risk for end stage renal disease to accurately assess

whether those management services can prevent the progression of renal disease to renal failure and thereby

delay the onset of dialysis and cause savings for the

medicare program.
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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. ESTABLISHMENT OF DEMONSTRATION

4 PROJECT.

5 (a) IN GENERAL.—Not later than six months after

6 the date of the enactment of this Act, the Secretary of

7 Health and Human Services (hereafter referred to as the

8 ‘‘Secretary’’) shall conduct a demonstration project under

9 which the Secretary shall make payment under the medi10 care program for renal disease management services fur11 nished to eligible individuals participating in the project

12 to accurately assess whether those management services

13 can prevent the progression of renal disease to renal fail14 ure and thereby delay the onset of dialysis and cause sav15 ings for the medicare program.

16 (b) SELECTION OF SITES.—The Secretary shall con17 duct the demonstration project under this Act at two sites

18 selected by the Secretary in accordance with such criteria

19 as the Secretary may establish.

20 SEC. 2. DESCRIPTION OF ELIGIBLE INDIVIDUALS AND

21 COVERED SERVICES.

22 (a) ELIGIBLE INDIVIDUALS.—An individual is an eli23 gible individual for purposes of participation in the dem24 onstration project if—
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1 (1) the individual’s attending physician certifies

2 that the individual is at risk for, but does not suffer

3 from, end stage renal disease (in accordance with

4 criteria established by the Secretary);

5 (2) the individual is not entitled to benefits

6 under Part A or enrolled under part B of the medi7 care program; and

8 (3) the individual meets such other require9 ments as the Secretary may impose.

10 (b) RENAL DISEASE MANAGEMENT SERVICES DE11 SCRIBED.—For purposes of this Act, ‘‘renal disease man12 agement services’’ are services designed to prevent the

13 onset of end stage renal disease, including—

14 (1) dietary counseling and improvement in nu15 tritional status;

16 (2) the management of diabetes, hypertension,

17 and other conditions associated with the onset of end

18 stage renal disease;

19 (3) reduction of cardiovascular risk factors;

20 (4) correction of metabolic, endocrinologic, and

21 hematologic abnormalities;

22 (5) improvements in patient education of the

23 causes and course of the disease;

24 (6) the evaluation and control of environmental

25 nephrotoxins; and
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1 (7) such other services as the Secretary consid2 ers appropriate.

3 SEC. 3. DETERMINATION OF AMOUNT OF PAYMENT FOR

4 COVERED SERVICES.

5 (a) APPLICATION OF MEDICARE PAYMENT METH6 ODOLOGIES.—To the extent that a renal disease manage7 ment service for which payment may be made under the

8 demonstration project is a service for which payment may

9 be made under title XVIII of the Social Security Act, the

10 amount of payment made for the service under the dem11 onstration project shall be determined in accordance with

12 the methodology used to determine the amount of payment

13 for the service under such title.

14 (b) PAYMENT FOR SERVICES NOT COVERED UNDER

15 MEDICARE.—To the extent that a renal disease manage16 ment service for which payment may be made under the

17 demonstration project is not a service for which payment

18 may be made under title XVIII of the Social Security Act,

19 the amount of payment made for the service under the

20 demonstration project shall be determined in accordance

21 with such methodology as the Secretary may establish.

22 SEC. 4. INDEPENDENT MONITORING OF PROJECT.

23 The Secretary shall enter into a contract with an en24 tity not otherwise participating in or affiliated with the
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1 demonstration project to monitor the project and to assess

2 and make public the extent to which—

3 (1) the implementation of renal disease man4 agement services produces increased job retention,

5 preservation of meaningful and taxable income, or

6 improvement in the quality of life as measured by

7 health status questionnaires or other tools as estab8 lished by the Secretary;

9 (2) renal disease management services affect

10 the patient’s functional outcome and/or natural his11 tory of their kidney disease as compared to a well12 matched control group and measured by variables as

13 the Secretary may establish; and

14 (3) the implementation of renal disease man15 agement services in eligible individuals as a means

16 to aggressively manage the factors contributing to

17 kidney disease has delayed the progression of renal

18 disease and, therefore, the onset of dialysis.

19 SEC. 5. TERMINATION OF PROJECT.

20 The demonstration project conducted under this Act

21 shall terminate upon the expiration of the three-year pe22 riod which begins on the first date on which the project

23 is in effect.

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