I

104TH CONGRESS

1ST SESSION H. R. 1067

To amend title XVIII of the Social Security Act to require renal dialysis

facilities to meet hemodialysis standards as a condition of receiving

payment for renal hemodialysis services furnished under 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 amend title XVIII of the Social Security Act to require

renal dialysis facilities to meet hemodialysis standards

as a condition of receiving payment for renal

hemodialysis services furnished under the Medicare Program.

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

3 SECTION 1. HEMODIALYSIS STANDARDS FOR MEDICARE

4 RENAL DIALYSIS FACILITIES.

5 (a) REQUIRING FACILITIES TO MEET STANDARDS.—

6 Section 1881(b)(1) of the Social Security Act (42 U.S.C.
2

HR 1067 IH

1 1395rr(b)(1)) is amended by striking the period at the end

2 of the second sentence and inserting ‘‘, and requirements

3 for adequate hemodialysis in accordance with standards

4 under paragraph (12).’’.

5 (b) STANDARDS DESCRIBED.—Section 1881(b) of

6 such Act (42 U.S.C. 1395rr(b)) is amended by adding at

7 the end the following new paragraph:

8 ‘‘(12)(A) For purposes of paragraph (1), a pro9 vider of services or renal dialysis facility meets the

10 standards for adequate hemodialysis under this

11 paragraph for a cost reporting period if, during the

12 preceding cost reporting period, it certifies that for

13 not less than 50 percent of all the individuals receiv14 ing hemodialysis services from the facility during the

15 reporting period—

16 ‘‘(i) KT/V, defined as a fraction of body

17 water cleared of urea during dialysis, was not

18 less than 1.2, where ‘K’ equals the urea clear19 ance, ‘T’ equals the duration of the dialysis,

20 and ‘V’ equals the volume of distribution of

21 urea;

22 ‘‘(ii) in the case of a provider of services

23 or facility which the Secretary finds may be un24 able to implement the formula described in

25 clause (i) without incurring additional costs, the
3

HR 1067 IH

1 urea reduction ratio (URR) was not less than

2 0.65, where the URR is defined as the

3 predialysis urea concentration minus the

4 postdialysis urea concentration divided by the

5 predialysis urea concentration, or

6 ‘‘(iii) the provider of services or facility

7 maintains appropriate documentation of blood

8 clearance in each patient’s medical records file

9 and makes such data available for review by the

10 appropriate end stage renal disease network.

11 ‘‘(B) At any time, the Secretary may apply al12 ternative standards for adequate blood clearance

13 under this paragraph for a cost reporting period if

14 the Secretary certifies to Congress that the alter15 native standards are more medically appropriate

16 than the standards described in subparagraph (A)

17 for determining the quality of hemodialysis services

18 furnished to individuals under this title.

19 ‘‘(C) For reporting periods after January 1,

20 1998, the 50 percent requirement in subparagraph

21 (A) shall be increased to 75 percent.’’.
4

HR 1067 IH

1 SEC. 2. EFFECTIVE DATE.

2 The amendments made by section 1 shall apply to

3 services furnished during portions of cost reporting peri4 ods beginning on or after January 1, 1997.

Æ