II 

112TH CONGRESS 

2D SESSION S. 2163 

To amend title XVIII of the Social Security Act to improve Medicare benefits 

for individuals with kidney disease, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 6, 2012 

Mr. CONRAD introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to improve 

Medicare benefits for individuals with kidney disease, 

and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Kidney Disease Equitable Access, Prevention, and Re6 search Act of 2012’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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TITLE I—PROVIDING EQUITABLE ACCESS TO CARE FOR 

INDIVIDUALS WITH KIDNEY DISEASE 

Sec. 101. Improving access to care through improvements in the initial survey 

process for renal dialysis facilities. 

Sec. 102. Providing choice in primary insurer. 

Sec. 103. Protecting individuals with kidney failure from unfair practices. 

TITLE II—SUPPORTING RESEARCH TO IMPROVE ACCESS TO HIGH 

QUALITY KIDNEY CARE 

Sec. 201. Understanding the progression of kidney disease in minority populations. 

Sec. 202. Recommendations on dialysis quality and care management research 

gaps. 

Sec. 203. GAO study on transportation barriers to access kidney care. 

TITLE III—IMPROVING ACCESS TO PREVENTIVE CARE FOR 

INDIVIDUALS WITH KIDNEY DISEASE 

Sec. 301. Improving access to medicare kidney disease education. 

1 TITLE I—PROVIDING EQUITABLE 

2 ACCESS TO CARE FOR INDI3 VIDUALS WITH KIDNEY DIS4 EASE 

5 SEC. 101. IMPROVING ACCESS TO CARE THROUGH IM6 PROVEMENTS IN THE INITIAL SURVEY PROC7 ESS FOR RENAL DIALYSIS FACILITIES. 

8 Section 1864 of the Social Security Act (42 U.S.C. 

9 1395aa) is amended— 

10 (1) by redesignating subsection (e) as sub11 section (f); 

12 (2) by inserting after subsection (d) the fol13 lowing new subsection: 

14 ‘‘(e)(1) If the Secretary has entered into an agree15 ment with any State under this section under which the 

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1 vey related to determining the compliance of a renal dialy2 sis facility subject to the requirements of section 1881(b) 

3 and the State licensure survey requirements are consistent 

4 with or exceed such Federal requirements, the Secretary 

5 must accept the results of the State licensure survey for 

6 purposes of determining Federal certification of compli7 ance. In the case of such an initial survey of a renal dialy8 sis facility, the Secretary may allow any State to waive 

9 the reimbursement for conducting the survey under this 

10 section if it requests such a waiver. 

11 ‘‘(2) In the case of a renal dialysis facility that has 

12 waited for more than 6 months to receive the results of 

13 an initial survey under this section, the Secretary shall 

14 establish a specific timetable for completing and reporting 

15 the results of the survey.’’; and 

16 (3) in subsection (f), as so redesignated— 

17 (A) by striking ‘‘Notwithstanding any 

18 other provision of law,’’ and inserting ‘‘(1) Not19 withstanding any other provision of law and ex20 cept as provided in paragraph (2)’’; and 

21 (B) by adding at the end the following: 

22 ‘‘(2) The Secretary may assess and collect fees for 

23 the initial Medicare survey from a renal dialysis facility 

24 subject to the requirements of section 1881(b) in an 

25 amount not to exceed a reasonable fee necessary to cover 


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1 the costs of initial surveys conducted for purposes of deter2 mining the compliance of a renal dialysis facility with the 

3 requirements of section 1881(b). Fees may be assessed 

4 and collected under this paragraph only in such manner 

5 as would result in an aggregate amount of fees collected 

6 during any fiscal year being equal to the aggregate 

7 amount of costs for such fiscal year for initial surveys of 

8 such facilities under this section. A renal dialysis facility’s 

9 liability for such fees shall be reasonably based on the pro10 portion of the survey costs which relate to such facility. 

11 Any funds collected under this paragraph shall be used 

12 only to conduct the initial survey of the facilities providing 

13 the fees. 

14 ‘‘(3) Fees authorized under paragraph (2) shall be 

15 collected by the Secretary and available only to the extent 

16 and in the amount provided in advance in appropriations 

17 Acts and upon request of the Secretary, subject to the 

18 amount and usage limitations of such paragraph. Such 

19 fees so collected are authorized to remain available until 

20 expended.’’. 

21 SEC. 102. PROVIDING CHOICE IN PRIMARY INSURER. 

22 (a) PROVIDING FOR PATIENT CHOICE.— 

23 (1) IN GENERAL.—Section 1862(b)(1)(C) of the 

24 Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is 

25 amended— 


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1 (A) in the last sentence, by inserting ‘‘and 

2 before January 1, 2013,’’ after ‘‘prior to such 

3 date)’’; and 

4 (B) by adding at the end the following new 

5 sentence: ‘‘Effective for items and services fur6 nished on or after January 1, 2013 (with re7 spect to periods beginning on or after the date 

8 that is 42 months prior to such date), clauses 

9 (i) and (ii) shall be applied by substituting ‘42- 

10 month’ for ‘12-month’ each place it appears in 

11 the first sentence.’’. 

12 (2) EFFECTIVE DATE.—The amendments made 

13 by this subsection shall take effect on the date of en14 actment of this Act. For purposes of determining an 

15 individual’s status under section 1862(b)(1)(C) of 

16 the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), 

17 as amended by paragraph (1), an individual who is 

18 within the coordinating period as of the date of en19 actment of this Act shall have that period extended 

20 to the full 42 months described in the last sentence 

21 of such section, as added by the amendment made 

22 by paragraph (1)(B). 

23 (b) PROVIDING EQUITABLE ACCESS TO INSURANCE

24 FOR INDIVIDUALS WITH KIDNEY FAILURE.—The Sec25 retary of Health and Human Services shall clarify upon 


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1 enactment of this Act that the Medicare Secondary Payer 

2 rules set forth in section 1862(b)(1)(C) of the Social Secu3 rity Act (42 U.S.C. 1395y(b)(1)(C)), as amended by this 

4 Act, apply to qualified health plans established under sec5 tion 1311(b)(1)(B) of Public Law 111–148 (42 U.S.C. 

6 13031(b)(1)(B)). 

7 SEC. 103. PROTECTING INDIVIDUALS WITH KIDNEY FAIL8 URE FROM UNFAIR PRACTICES. 

9 (a) IN GENERAL.—Section 1862(b)(1)(C)(ii) of the 

10 Social Security Act (42 U.S.C. 1395y(b)(1)(C)(ii)) is 

11 amended to read as follows: 

12 ‘‘(ii) may not differentiate in the ben13 efits it provides between individuals having 

14 end stage renal disease and other individ15 uals covered by such plan or issuer on the 

16 basis of the existence of end stage renal 

17 disease, the need for renal dialysis, or in 

18 any other manner, and such plan— 

19 ‘‘(I) shall provide adequate, ad20 vanced, written notification to pa21 tients regarding changes to dialysis 

22 service benefits, new restrictions on 

23 out-of-network access, or reductions in 

24 rates paid for out-of-network benefits 

25 for such services; 


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1 ‘‘(II) shall allow patients to con2 tinue using their existing provider or 

3 facility of such services for at least 24 

4 months following the date of notice of 

5 any change by the plan or issuer in 

6 the dialysis services network of the 

7 plan or issuer; 

8 ‘‘(III) shall hold patients harm9 less from provider network changes 

10 with respect to such services if such 

11 changes require unreasonable drive 

12 time or disrupt the physician-patient 

13 relationship; 

14 ‘‘(IV) may not restrict the dura15 tion or number of dialysis sessions for 

16 patients, such as based on a fixed 

17 number of treatments per week, to 

18 less than the number for which pay19 ment may be made pursuant to sec20 tion 1881(b)(1); 

21 ‘‘(V) may not require assignment 

22 of benefits for such services; 

23 ‘‘(VI) shall ensure that out-of24 pocket payments for such services 

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1 pocket maximums and not treated as 

2 routine for purposes of calculating 

3 beneficiary copayments; 

4 ‘‘(VII) may not deny or limit cov5 erage for patients for such services if 

6 premiums, copayments, or other pay7 ments are made by third parties on 

8 their behalf; and 

9 ‘‘(VIII) shall meet minimum net10 work adequacy standards specified by 

11 the Secretary with respect to such 

12 services;’’. 

13 (b) EFFECTIVE DATE.—The amendment made by 

14 subsection (a) shall apply to group health plans as of Jan15 uary 1, 2014. 

16 TITLE II—SUPPORTING RE17 SEARCH TO IMPROVE ACCESS 

18 TO HIGH QUALITY KIDNEY 

19 CARE 

20 SEC. 201. UNDERSTANDING THE PROGRESSION OF KIDNEY 

21 DISEASE IN MINORITY POPULATIONS. 

22 Not later than one year after the date of the enact23 ment of this Act, the Secretary of Health and Human 

24 Services shall complete a study (and submit a report to 

25 Congress) on— 


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1 (1) the social, behavioral, and biological factors 

2 leading to kidney disease; and 

3 (2) efforts to slow the progression of kidney dis4 ease in minority populations that are disproportion5 ately affected by such disease. 

6 SEC. 202. RECOMMENDATIONS ON DIALYSIS QUALITY AND 

7 CARE MANAGEMENT RESEARCH GAPS. 

8 Not later than 2 years after the date of the enact9 ment of this Act, the Secretary of Health and Human 

10 Services shall submit to Congress a report regarding the 

11 research gaps with respect to the development of quality 

12 metrics and care management metrics for patients with 

13 end-stage renal disease, including pediatric and home di14 alysis patients. Such report shall include recommendations 

15 about undertaking research to fill such gaps and 

16 prioritizing such research. 

17 SEC. 203. GAO STUDY ON TRANSPORTATION BARRIERS TO 

18 ACCESS KIDNEY CARE. 

19 (a) IN GENERAL.—The Comptroller General of the 

20 United States shall conduct an evaluation of the transpor21 tation barriers facing dialysis patients that result in less 

22 than 100 percent compliance with their plan of care under 

23 the Medicare program. 


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1 (b) SPECIFIC MATTERS EVALUATED.—In conducting 

2 the evaluation under subsection (a), the Comptroller Gen3 eral shall examine— 

4 (1) the costs associated with providing dialysis 

5 services; 

6 (2) the number and characteristics of patients 

7 who miss at least 2 dialysis treatments during a 

8 month or have shortened treatments because of bar9 riers to transportation; and 

10 (3) the potential sources of providing dialysis 

11 patients with such transportation services. 

12 (c) REPORT.—Not later than the date that is 6 

13 months after the date of the enactment of this Act, the 

14 Comptroller General shall submit to Congress a report on 

15 the study conducted under subsection (a) together with 

16 recommendations for such legislation and administrative 

17 action as the Comptroller General determines appropriate. 

18 TITLE III—IMPROVING ACCESS 

19 TO PREVENTIVE CARE FOR 

20 INDIVIDUALS WITH KIDNEY 

21 DISEASE 

22 SEC. 301. IMPROVING ACCESS TO MEDICARE KIDNEY DIS23 EASE EDUCATION. 

24 (a) IN GENERAL.—Section 1861(ggg)(2) of the So25 cial Security Act (42 U.S.C. 1395x(ggg)(2)) is amended— 


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1 (1) by striking subparagraph (B); and 

2 (2) in subparagraph (A)— 

3 (A) by striking ‘‘(A)’’ after ‘‘(2)’’; 

4 (B) by striking ‘‘and’’ at the end of clause 

5 (i); 

6 (C) by striking the period at the end of 

7 clause (ii) and inserting ‘‘; and’’; 

8 (D) by redesignating clauses (i) and (ii) as 

9 subparagraphs (A) and (B), respectively; and 

10 (E) by adding at the end the following: 

11 ‘‘(C) a renal dialysis facility subject to the 

12 requirements of section 1881(b)(1) with per13 sonnel— 

14 ‘‘(i) who provide the services described 

15 in paragraph (1); and 

16 ‘‘(ii) that include a physician (as de17 fined in subsection (r)(1)) or a physician 

18 assistant, nurse practitioner, or clinical 

19 nurse specialist (as defined in subsection 

20 (aa)(5)).’’. 

21 (b) PAYMENT TO RENAL DIALYSIS FACILITIES.— 

22 Section 1881(b) of such Act (42 U.S.C. 1395rr(b)) is 

23 amended by adding at the end the following new para24 graph: 


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1 ‘‘(15) For purposes of paragraph (14), the single pay2 ment for renal dialysis services under such paragraph shall 

3 not take into account the amount of payment for kidney 

4 disease education services (as defined in section 

5 1861(ggg)). Instead, payment for such services shall be 

6 made to the renal dialysis facility on an assignment-re7 lated basis under section 1848.’’. 

8 (c) PROVIDING EDUCATION SERVICES TO INDIVID9 UALS WITH KIDNEY FAILURE.—Section 1861(ggg)(1)(A) 

10 of the Social Security Act (42 U.S.C. 1395x(ggg)(1)(A)) 

11 is amended— 

12 (1) by inserting ‘‘or stage V’’ after ‘‘stage IV’’; 

13 and 

14 (2) by inserting ‘‘and who is not receiving dialy15 sis services’’ after ‘‘chronic kidney disease’’. 

16 (d) EFFECTIVE DATE.—The amendments made by 

17 this section apply to kidney disease education services fur18 nished on or after January 1, 2013. 

Æ 


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