II 

115TH CONGRESS 

1ST SESSION S. 1890 

To improve the understanding of, and promote access to treatment for, 

chronic kidney disease, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 28, 2017 

Mr. CARDIN (for himself, Mr. BLUNT, and Mr. NELSON) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To improve the understanding of, and promote access to 

treatment for, chronic 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. 

4 This Act may be cited as the ‘‘Chronic Kidney Dis5 ease Improvement in Research and Treatment Act of 

6 2017’’. 

7 SEC. 2. TABLE OF CONTENTS. 

8 The table of contents of this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—IMPROVING PATIENT LIVES AND QUALITY OF CARE 

THROUGH RESEARCH AND INNOVATION 


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Sec. 101. Improving patient lives and quality of care through research and innovation. 

Sec. 102. Enhancing care through new technologies. 

Sec. 103. Understanding current utilization of palliative care services. 

Sec. 104. Understanding the progression of kidney disease and treatment of 

kidney failure in minority populations. 

TITLE II—EMPOWER PATIENT DECISION MAKING AND CHOICE 

Sec. 201. Providing individuals with kidney failure access to managed care. 

Sec. 202. Medigap coverage for beneficiaries with end-stage renal disease. 

Sec. 203. Promoting access to home dialysis treatments. 

TITLE III—IMPROVING PATIENT CARE AND ENSURING QUALITY 

OUTCOMES 

Sec. 301. Maintain an economically stable dialysis infrastructure. 

Sec. 302. Improve patient decision making and transparency by consolidating 

and modernizing quality programs. 

Sec. 303. Increasing access to Medicare kidney disease education benefit. 

Sec. 304. Certification of new facilities. 

Sec. 305. Improving access in underserved areas. 

1 TITLE I—IMPROVING PATIENT 

2 LIVES AND QUALITY OF CARE 

3 THROUGH RESEARCH AND IN4 NOVATION 

5 SEC. 101. IMPROVING PATIENT LIVES AND QUALITY OF 

6 CARE THROUGH RESEARCH AND INNOVA7 TION. 

8 (a) STUDY.—The Secretary of Health and Human 

9 Services (in this section referred to as the ‘‘Secretary’’) 

10 shall conduct a study on increasing kidney transplantation 

11 rates. Such study shall include an analysis of each of the 

12 following: 

13 (1) Any disincentives in the payment systems 

14 under the Medicare program under title XVIII of 

15 the Social Security Act that create barriers to kidVerDate Sep 11 2014 04:41 Oct 03, 2017 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1890.IS S1890

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1 ney transplants and post-transplant care for bene2 ficiaries with end-stage renal disease. 

3 (2) The practices used by States with higher 

4 than average donation rates and whether those prac5 tices and policies could be successfully utilized in 

6 other States. 

7 (3) Practices and policies that could increase 

8 deceased donation rates of minority populations. 

9 (4) Whether cultural and policy barriers exist to 

10 increasing living donation rates, including an exam11 ination of how to better facilitate chained donations. 

12 (5) Other areas determined appropriate by the 

13 Secretary. 

14 (b) REPORT.—Not later than 18 months after the 

15 date of the enactment of this Act, the Secretary shall sub16 mit to Congress a report on the study conducted under 

17 subsection (a), together with such recommendations as the 

18 Secretary determines to be appropriate. 

19 SEC. 102. ENHANCING CARE THROUGH NEW TECH20 NOLOGIES. 

21 (a) AGREEMENT WITH NATIONAL ACADEMY OF

22 SCIENCES.—The Secretary of Health and Human Services 

23 shall seek to enter into an agreement with the National 

24 Academy of Sciences within six months of the date of the 

25 enactment of this Act under which the National Academy 


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1 of Sciences will conduct a study on the design of payments 

2 for renal dialysis services under the Medicare program 

3 under title XVIII of the Social Security Act, including an 

4 analysis of whether adjustments to such payments are 

5 needed to allow for the incorporation of new technologies 

6 and therapies. 

7 (b) CONTENTS.—In conducting the study under sub8 section (a), the National Academy of Sciences shall evalu9 ate the current payment system for renal dialysis services 

10 under the Medicare program, identify barriers to adopting 

11 innovative items, services, and therapies, and make rec12 ommendations as to how to eliminate such barriers. 

13 SEC. 103. UNDERSTANDING CURRENT UTILIZATION OF PAL14 LIATIVE CARE SERVICES. 

15 (a) STUDY.— 

16 (1) IN GENERAL.—The Comptroller General of 

17 the United States (in this section referred to as the 

18 ‘‘Comptroller General’’) shall conduct a study on the 

19 utilization of palliative care in treating individuals 

20 with advanced kidney disease, from stage 4 through 

21 stage 5, including individuals with kidney failure on 

22 dialysis through any progression of the disease. Such 

23 study shall include an analysis of— 

24 (A) how palliative care can be utilized to 

25 improve the quality of life of those with kidney 


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1 disease and facilitate care tailored to their indi2 vidual goals and values; 

3 (B) the successful use of palliative care in 

4 the care of patients with other chronic diseases 

5 and serious illnesses; 

6 (C) the utilization of palliative care at any 

7 point in an illness, including when used at the 

8 same time as curative treatment; and 

9 (D) other areas determined appropriate by 

10 the Comptroller General. 

11 (2) DEFINITION OF PALLIATIVE CARE.—In this 

12 section, the term ‘‘palliative care’’ means patient 

13 and family centered care that optimizes quality of 

14 life by anticipating, preventing, and treating suf15 fering. Such term includes care that is furnished 

16 throughout the continuum of the illness that ad17 dresses physical, intellectual, emotional, social, and 

18 spiritual needs and that facilitates patient autonomy, 

19 access to information and choice. 

20 (b) REPORT.—Not later than 1 year after the date 

21 of the enactment of this Act, the Comptroller General shall 

22 submit to the Congress a report on the study conducted 

23 under subsection (a), together with such recommendations 

24 as the Comptroller General determines to be appropriate. 


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1 SEC. 104. UNDERSTANDING THE PROGRESSION OF KIDNEY 

2 DISEASE AND TREATMENT OF KIDNEY FAIL3 URE IN MINORITY POPULATIONS. 

4 (a) STUDY.—The Secretary of Health and Human 

5 Services (in this section referred to as the ‘‘Secretary’’) 

6 shall conduct a study on— 

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

8 leading to kidney disease; 

9 (2) efforts to slow the progression of kidney dis10 ease in minority populations that are disproportion11 ately affected by such disease; and 

12 (3) treatment patterns associated with pro13 viding care, under the Medicare program under title 

14 XVIII of the Social Security Act, the Medicaid pro15 gram under title XIX of such Act, and through pri16 vate health insurance, to minority populations that 

17 are disproportionately affected by kidney failure. 

18 (b) REPORT.—Not later than 1 year after the date 

19 of the enactment of this Act, the Secretary shall submit 

20 to Congress a report on the study conducted under sub21 section (a), together with such recommendations as the 

22 Secretary determines to be appropriate. 


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1 TITLE II—EMPOWER PATIENT 

2 DECISION MAKING AND CHOICE 

3 SEC. 201. PROVIDING INDIVIDUALS WITH KIDNEY FAILURE 

4 ACCESS TO MANAGED CARE. 

5 (a) PERMANENT EXTENSION OF MEDICARE ADVAN6 TAGE ESRD SPECIAL NEEDS PLANS AUTHORITY.—Sec7 tion 1859(f)(1) of the Social Security Act (42 U.S.C. 

8 1395w–28(f)(1)) is amended by inserting ‘‘, in the case 

9 of a specialized MA plan for special needs individuals who 

10 have not been determined to have end stage renal dis11 ease,’’ before ‘‘for periods before January 1, 2019’’. 

12 (b) ACCELERATED ACCESS TO MEDICARE ADVAN13 TAGE.—Section 17006(a)(3) of the 21st Century Cures 

14 Act (Public Law 114–255) is amended by striking ‘‘2021’’ 

15 and inserting ‘‘2020’’. 

16 (c) ACCELERATED MEDPAC RISK ADJUSTMENT RE17 PORT.—Section 17006(f)(2)(A)(i)(II) of the 21st Century 

18 Cures Act (Public Law 114–255) is amended by striking 

19 ‘‘2020’’ and inserting ‘‘2019’’. 

20 SEC. 202. MEDIGAP COVERAGE FOR BENEFICIARIES WITH 

21 END-STAGE RENAL DISEASE. 

22 (a) GUARANTEED AVAILABILITY OF MEDIGAP POLI23 CIES TO ALL ESRD MEDICARE BENEFICIARIES.— 


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1 (1) IN GENERAL.—Section 1882(s) of the So2 cial Security Act (42 U.S.C. 1395ss(s)) is amend3 ed— 

4 (A) in paragraph (2)— 

5 (i) in subparagraph (A), by striking 

6 ‘‘is 65’’ and inserting the following: ‘‘is— 

7 ‘‘(i) 65 years of age or older and is 

8 enrolled for benefits under part B; or 

9 ‘‘(ii) is entitled to benefits under 

10 226A(b) and is enrolled for benefits under 

11 part B.’’; and 

12 (ii) in subparagraph (D), in the mat13 ter preceding clause (i), by inserting ‘‘(or 

14 is entitled to benefits under 226A(b))’’ 

15 after ‘‘is 65 years of age or older’’; and 

16 (B) in paragraph (3)(B)— 

17 (i) in clause (ii), by inserting ‘‘(or is 

18 entitled to benefits under 226A(b))’’ after 

19 ‘‘is 65 years of age or older’’; and 

20 (ii) in clause (vi), by inserting ‘‘(or 

21 under 226A(b))’’ after ‘‘at age 65’’. 

22 (2) EFFECTIVE DATE.—The amendments made 

23 by paragraph (1) shall apply to Medicare supple24 mental policies effective on or after January 1, 

25 2020. 


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1 (b) ADDITIONAL ENROLLMENT PERIOD FOR CER2 TAIN INDIVIDUALS.— 

3 (1) ONE-TIME ENROLLMENT PERIOD.— 

4 (A) IN GENERAL.—In the case of an indi5 vidual described in subparagraph (B), the Sec6 retary of Health and Human Services shall es7 tablish a one-time enrollment period during 

8 which such an individual may enroll in any 

9 Medicare supplemental policy under section 

10 1882 of the Social Security Act (42 U.S.C. 

11 1395ss) of the individual’s choosing. 

12 (B) ENROLLMENT PERIOD.—The enroll13 ment period established under subparagraph 

14 (A) shall begin on January 1, 2020, and shall 

15 end June 30, 2020. 

16 (2) INDIVIDUAL DESCRIBED.—An individual de17 scribed in this paragraph is an individual who— 

18 (A) is entitled to hospital insurance bene19 fits under part A of title XVIII of the Social 

20 Security Act under section 226A(b) of such Act 

21 (42 U.S.C. 426–1); 

22 (B) is enrolled for benefits under part B of 

23 such title XVIII; and 

24 (C) would not, but for the provisions of, 

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1 gible for the guaranteed issue of a Medicare 

2 supplemental policy under paragraph (2) or (3) 

3 of section 1882(s) of such Act (42 U.S.C. 

4 1395ss(s)). 

5 SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREAT6 MENTS. 

7 (a) IN GENERAL.—Section 1881(b)(3) of the Social 

8 Security Act (42 U.S.C. 1395rr(b)(3)) is amended— 

9 (1) by redesignating subparagraphs (A) and 

10 (B) as clauses (i) and (ii), respectively; 

11 (2) in clause (ii), as redesignated by subpara12 graph (A), by striking ‘‘on a comprehensive’’ and in13 serting ‘‘subject to subparagraph (B), on a com14 prehensive’’; 

15 (3) by striking ‘‘With respect to’’ and inserting 

16 ‘‘(A) With respect to’’; and 

17 (4) by adding at the end the following new sub18 paragraph: 

19 ‘‘(B) For purposes of subparagraph (A)(ii), an indi20 vidual determined to have end-stage renal disease receiv21 ing home dialysis may choose to receive the monthly end22 stage renal disease-related visits furnished on or after 

23 January 1, 2018, via telehealth if the individual receives 

24 a face-to-face visit, without the use of telehealth, at least 

25 once every three consecutive months.’’. 


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1 (b) ORIGINATING SITE REQUIREMENTS.— 

2 (1) IN GENERAL.—Section 1834(m) of the So3 cial Security Act (42 U.S.C. 1395m(m)) is amend4 ed— 

5 (A) in paragraph (4)(C)(ii), by adding at 

6 the end the following new subclauses: 

7 ‘‘(IX) A renal dialysis facility, 

8 but only for purposes of section 

9 1881(b)(3)(B). 

10 ‘‘(X) The home of an individual, 

11 but only for purposes of section 

12 1881(b)(3)(B).’’; and 

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

14 paragraph: 

15 ‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY

16 ESRD-RELATED VISIT.—The geographic require17 ments described in paragraph (4)(C)(i) shall not 

18 apply with respect to telehealth services furnished on 

19 or after January 1, 2018, for purposes of section 

20 1881(b)(3)(B), at an originating site described in 

21 subclause (VI), (IX), or (X) of paragraph 

22 (4)(C)(ii).’’. 

23 (2) NO FACILITY FEE IF ORIGINATING SITE

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1 tion 1834(m)(2)(B) of the Social Security (42 

2 U.S.C. 1395m(m)(2)(B)) is amended— 

3 (A) by redesignating clauses (i) and (ii) as 

4 subclauses (I) and (II), and indenting appro5 priately; 

6 (B) in subclause (II), as redesignated by 

7 subparagraph (A), by striking ‘‘clause (i) or 

8 this clause’’ and inserting ‘‘subclause (I) or this 

9 subclause’’; 

10 (C) by striking ‘‘SITE.—With respect to’’ 

11 and inserting ‘‘SITE.— 

12 ‘‘(i) IN GENERAL.—Subject to clause 

13 (ii), with respect to’’; and 

14 (D) by adding at the end the following new 

15 clause: 

16 ‘‘(ii) NO FACILITY FEE IF ORIGI17 NATING SITE FOR HOME DIALYSIS THER18 APY IS THE HOME.—No facility fee shall 

19 be paid under this subparagraph to an 

20 originating site described in paragraph 

21 (4)(C)(ii)(X).’’. 

22 (c) CONFORMING AMENDMENT.—Section 1881(b)(1) 

23 of the Social Security Act (42 U.S.C. 1395rr(b)(1)) is 

24 amended by striking ‘‘paragraph (3)(A)’’ and inserting 

25 ‘‘paragraph (3)(A)(i)’’. 


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1 (d) EXCLUSION FROM REMUNERATION FOR PUR2 POSES OF APPLYING CIVIL MONETARY PENALTIES.— 

3 (1) IN GENERAL.—Section 1128A(i)(6) of the 

4 Social Security Act (42 U.S.C. 1320a–7a(i)(6)) is 

5 amended— 

6 (A) in subparagraph (H)(iv), by striking ‘‘; 

7 or’’ at the end; 

8 (B) in subparagraph (I), by striking the 

9 period at the end and inserting ‘‘; or’’; and 

10 (C) by adding at the end the following new 

11 subparagraph: 

12 ‘‘(J) the provision of telehealth or remote 

13 patient monitoring technologies to individuals 

14 under title XVIII by a health care provider for 

15 the purpose of furnishing telehealth or remote 

16 patient monitoring services.’’. 

17 (2) EFFECTIVE DATE.—The amendments made 

18 by this subsection shall apply to services furnished 

19 on or after the date of the enactment of this Act. 


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1 TITLE III—IMPROVING PATIENT 

2 CARE AND ENSURING QUAL3 ITY OUTCOMES 

4 SEC. 301. MAINTAIN AN ECONOMICALLY STABLE DIALYSIS 

5 INFRASTRUCTURE. 

6 (a) IN GENERAL.—Section 1881(b)(14) of the Social 

7 Security Act (42 U.S.C. 1395rr(b)(14)) is amended— 

8 (1) in subparagraph (D), in the matter pre9 ceding clause (i), by striking ‘‘Such system’’ and in10 serting ‘‘Subject to subparagraph (J), such system’’; 

11 and 

12 (2) by adding at the end the following new sub13 paragraph: 

14 ‘‘(J) For payment for renal dialysis serv15 ices furnished on or after January 1, 2018, 

16 under the system under this paragraph— 

17 ‘‘(i) the payment adjustment de18 scribed in clause (i) of subparagraph (D)— 

19 ‘‘(I) shall not take into account 

20 comorbidities; and 

21 ‘‘(II) shall only take into account 

22 age for purposes of distinguishing be23 tween individuals who are under 18 

24 years of age and those who are 18 


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1 years of age and older but shall not 

2 include any other adjustment for age; 

3 ‘‘(ii) the Secretary shall reassess any 

4 adjustments related to patient weight 

5 under such clause; 

6 ‘‘(iii) the payment adjustment de7 scribed in clause (ii) of such subparagraph 

8 shall not be included; 

9 ‘‘(iv) the standardization factor de10 scribed in the final rule published in the 

11 Federal Register on November 8, 2012 (77 

12 Fed. Reg. 67470), shall be established 

13 using the most currently available data 

14 (and not historical data) and adjusted on 

15 an annual basis, based on such available 

16 data, to account for any change in utiliza17 tion of drugs and any modification in ad18 justors applied under this paragraph; and 

19 ‘‘(v) take into account reasonable 

20 costs for determining the payment rate 

21 consistent with paragraph (2)(B).’’. 

22 (b) INCLUSION OF NETWORK FEE AS AN ALLOW23 ABLE COST.—Section 1881(b)(14) of the Social Security 

24 Act (42 U.S.C. 1395rr(b)(14)), as amended by subsection 


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1 (a), is amended by adding at the end the following new 

2 subparagraph: 

3 ‘‘(K) Not later than January 1, 2018, the 

4 Secretary shall amend the ESRD facility cost 

5 report to include the per treatment network fee 

6 (as described in paragraph (7)) as an allowable 

7 cost or offset to revenue.’’. 

8 SEC. 302. IMPROVE PATIENT DECISION MAKING AND 

9 TRANSPARENCY BY CONSOLIDATING AND 

10 MODERNIZING QUALITY PROGRAMS. 

11 (a) MEASURES.—Section 1881(h)(2) of the Social 

12 Security Act (42 U.S.C. 1395rr(h)(2)) is amended by add13 ing at the end the following new subparagraphs: 

14 ‘‘(F) WEIGHTING LIMITATION.—No single 

15 measure specified by the Secretary or individual 

16 measure within a composite measure so speci17 fied may be weighted less than 10 percent of 

18 the total performance score. 

19 ‘‘(G) STATISTICALLY VALID AND RELI20 ABLE.—In specifying measures under subpara21 graph (A), the Secretary shall only specify 

22 measures that have been shown to be statis23 tically valid and reliable through testing.’’. 


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1 (b) ENDORSEMENT.—Section 1881(h)(2)(B) of the 

2 Social Security Act (42 U.S.C. 1395rr(h)(2)(B)) is 

3 amended— 

4 (1) in clause (ii), by adding at the end the fol5 lowing new sentence: ‘‘The exception under the pre6 ceding sentence shall not apply to a measure that 

7 the entity with a contract under section 1890(a) (or 

8 a similar entity) considered but failed to endorse.’’; 

9 and 

10 (2) by adding at the end the following new 

11 clause: 

12 ‘‘(iii) COMPOSITE MEASURES.— 

13 Clauses (i) and (ii) shall apply to com14 posite measures in the same manner as 

15 such clauses apply to individual meas16 ures.’’. 

17 (c) REQUIREMENTS FOR DIALYSIS FACILITY COM18 PARE STAR RATING PROGRAM.—Section 1881(h)(6) of 

19 the Social Security Act (42 U.S.C. 1395rr(h)(6)) is 

20 amended by adding at the end the following new subpara21 graph: 

22 ‘‘(E) REQUIREMENTS FOR ANY DIALYSIS

23 FACILITY COMPARE STAR RATING PROGRAM.— 

24 To the extent that the Secretary maintains a 


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1 dialysis facility compare star rating program, 

2 under such a program the Secretary— 

3 ‘‘(i) shall assign stars using the same 

4 methodology and total performance score 

5 results from the quality incentive program 

6 under this subsection; 

7 ‘‘(ii) shall determine the stars using 

8 the same methodology used under such 

9 quality incentive program; and 

10 ‘‘(iii) shall not use a forced bell curve 

11 when determining the stars or rebaselining 

12 the stars.’’. 

13 (d) HOSPITALS REQUIRED TO PROVIDE INFORMA14 TION.—Section 1881 of the Social Security Act (42 U.S.C. 

15 1395rr) is amended by adding at the end the following 

16 new subsection: 

17 ‘‘(i) HOSPITALS REQUIRED TO PROVIDE INFORMA18 TION.— 

19 ‘‘(1) IN GENERAL.—The Secretary shall estab20 lish a process under which a hospital or a critical ac21 cess hospital shall provide a renal dialysis facility 

22 with health and treatment information with respect 

23 to an individual who is discharged from the hospital 

24 or critical access hospital and who subsequently re25 ceives treatment at facility. 


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1 ‘‘(2) ELEMENTS.—Under the process estab2 lished under paragraph (1)— 

3 ‘‘(A) the request for the health information 

4 may be initiated by the individual prior to dis5 charge or upon request by the renal dialysis fa6 cility after the patient is discharged; and 

7 ‘‘(B) the information must be provided to 

8 the facility within 7 days of the request being 

9 made.’’. 

10 (e) INCENTIVE PAYMENTS.—Section 1881(h)(1) of 

11 the Social Security Act (42 U.S.C. 1395rr(h)(1)) is 

12 amended by adding at the end the following new subpara13 graph: 

14 ‘‘(D) INCENTIVE PAYMENTS.— 

15 ‘‘(i) IN GENERAL.—In the case of a 

16 provider of services or a renal dialysis fa17 cility that the Secretary determines exceeds 

18 the attainment performance standards 

19 under paragraph (4) with respect to a 

20 year, the Secretary may make a bonus 

21 payment to the provider or facility (pursu22 ant to a process established by the Sec23 retary). 

24 ‘‘(ii) FUNDING.—The total amount of 

25 bonus payments under clause (i) in a year 


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1 shall be equal to the total amount of re2 duced payments in a year under subpara3 graph (A). 

4 ‘‘(iii) NO EFFECT IN SUBSEQUENT

5 YEARS.—The provisions of subparagraph 

6 (C) shall apply to a bonus payment under 

7 this subparagraph in the same manner 

8 subparagraph (C) applies to a reduction 

9 under such subparagraph.’’. 

10 (f) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply to items and services furnished on 

12 or after January 1, 2019. 

13 SEC. 303. INCREASING ACCESS TO MEDICARE KIDNEY DIS14 EASE EDUCATION BENEFIT. 

15 (a) IN GENERAL.—Section 1861(ggg) of the Social 

16 Security Act (42 U.S.C. 1395x(ggg)) is amended— 

17 (1) in paragraph (1)— 

18 (A) in subparagraph (A), by inserting ‘‘or 

19 stage V’’ after ‘‘stage IV’’; and 

20 (B) in subparagraph (B), by inserting ‘‘or 

21 of a physician assistant, nurse practitioner, or 

22 clinical nurse specialist (as defined in section 

23 1861(aa)(5)) assisting in the treatment of the 

24 individual’s kidney condition’’ after ‘‘kidney 

25 condition’’; and 


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1 (2) in paragraph (2)— 

2 (A) by striking subparagraph (B); and 

3 (B) in subparagraph (A)— 

4 (i) by striking ‘‘(A)’’ after ‘‘(2)’’; 

5 (ii) by striking ‘‘and’’ at the end of 

6 clause (i); 

7 (iii) by striking the period at the end 

8 of clause (ii) and inserting ‘‘; and’’; 

9 (iv) by redesignating clauses (i) and 

10 (ii) as subparagraphs (A) and (B), respec11 tively; and 

12 (v) by adding at the end the following: 

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

14 requirements of section 1881(b)(1) with per15 sonnel who— 

16 ‘‘(i) provide the services described in 

17 paragraph (1); and 

18 ‘‘(ii) is a physician (as defined in sub19 section (r)(1)) or a physician assistant, 

20 nurse practitioner, or clinical nurse spe21 cialist (as defined in subsection (aa)(5)).’’. 

22 (b) PAYMENT TO RENAL DIALYSIS FACILITIES.— 

23 Section 1881(b) of the Social Security Act (42 U.S.C. 

24 1395rr(b)) is amended by adding at the end the following 

25 new paragraph: 


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1 ‘‘(15) For purposes of paragraph (14), the sin2 gle payment for renal dialysis services under such 

3 paragraph shall not take into account the amount of 

4 payment for kidney disease education services (as 

5 defined in section 1861(ggg)). Instead, payment for 

6 such services shall be made to the renal dialysis fa7 cility on an assignment-related basis under section 

8 1848.’’. 

9 (c) EFFECTIVE DATE.—The amendments made by 

10 this section apply to kidney disease education services fur11 nished on or after January 1, 2018. 

12 SEC. 304. CERTIFICATION OF NEW FACILITIES. 

13 (a) CERTIFICATION.— 

14 (1) IN GENERAL.—Section 1865(a)(1) of the 

15 Social Security Act (42 U.S.C. 1395bb(a)(1)) is 

16 amended by striking ‘‘or the conditions and require17 ments under section 1881(b)’’. 

18 (2) EFFECTIVE DATE.—The amendment made 

19 by paragraph (1) shall take effect on the date of en20 actment of this Act and apply to a finding made on 

21 or after such date. 

22 (b) TIMING FOR ACCEPTANCE OF REQUESTS FROM

23 ACCREDITATION ORGANIZATIONS.—Not later than 6 

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

25 Secretary of Health and Human Services shall accept a 


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1 completed application from any national accreditation 

2 body for providers and facilities that provide services 

3 under 1881(b), in accordance with section 1865(3)(A)). 

4 Any application received pursuant to the preceding sen5 tence shall be deemed approved unless the Secretary, with6 in 90 days after the date of the submission of the applica7 tion to the Secretary, either denies such request in writing 

8 or informs the applicant in writing with respect to any 

9 additional information that is needed in order to make a 

10 final determination with respect to the application. If the 

11 Secretary requests additional information pursuant to the 

12 preceding sentence and the applicant submits such infor13 mation, the application shall be deemed approved unless 

14 the Secretary, within 90 days of the date of receiving such 

15 information, denies such request. 

16 SEC. 305. IMPROVING ACCESS IN UNDERSERVED AREAS. 

17 (a) DEFINITION OF PRIMARY CARE SERVICES.—Sec18 tion 331(a)(3)(D) of the Public Health Service Act (42 

19 U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘and in20 cludes renal dialysis services’’ before the period at the end. 

21 (b) NATIONAL HEALTH SERVICE CORPS SCHOLAR22 SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 

23 Service Act (42 U.S.C. 254l(a)(2)) is amended by insert24 ing ‘‘, including nephrology health professionals’’ before 

25 the period at the end. 


dlhill on DSK3GLQ082PROD with BILLS
24 

•S 1890 IS

1 (c) NATIONAL HEALTH SERVICE CORPS LOAN RE2 PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 

3 Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended 

4 by inserting ‘‘, including nephrology health professionals’’ 

5 before the period at the end. 

Æ 


dlhill on DSK3GLQ082PROD with BILLS