I 

109TH CONGRESS 

1ST SESSION H. R. 1298

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

under the Medicare Program for beneficiaries with kidney disease, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 15, 2005

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

on Energy and 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 improve 

the benefits under the Medicare Program for beneficiaries 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 Care Quality and Improvement Act of 2005’’. 

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

7 this Act is as follows:

Sec. 1. Short title. 
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TITLE I—RECOGNIZING AND IMPROVING QUALITY FOR PATIENTS 

Sec. 101. Modification of physician surgical reimbursement for dialysis access 

procedures to align incentives for cost and quality. 

Sec. 102. Demonstration project for outcomes-based ESRD reimbursement system. 

Sec. 103. Required training for patient care dialysis technicians. 

TITLE II—ENSURING QUALITY THROUGH IMPROVEMENTS IN 

THE ESRD PAYMENT SYSTEM 

Sec. 201. Establishment of annual update framework for the medicare ESRD 

composite rate. 

Sec. 202. Extension of medicare secondary payer. 

Sec. 203. GAO study and report on impact of G-codes. 

TITLE III—IMPROVING QUALITY THROUGH PATIENT EDUCATION, 

ACCESS, AND SAFETY INITIATIVES 

Sec. 301. Support of public and patient education initiatives regarding kidney 

disease. 

Sec. 302. Medicare coverage of kidney disease patient education services. 

Sec. 303. Blood flow monitoring demonstration projects. 

TITLE IV—IMPROVING QUALITY THROUGH IMPROVED COVERAGE 

Sec. 401. Improving the home dialysis benefit. 

Sec. 402. Institute of Medicine evaluation and report on home dialysis. 

Sec. 403. Establishment of an End-Stage Renal Disease (ESRD) Advisory 

committee.

1 TITLE I—RECOGNIZING AND IM2 PROVING QUALITY FOR PA3 TIENTS 

4 SEC. 101. MODIFICATION OF PHYSICIAN SURGICAL REIM5 BURSEMENT FOR DIALYSIS ACCESS PROCE6 DURES TO ALIGN INCENTIVES FOR COST AND 

7 QUALITY. 

8 (a) FULL COVERAGE OF DIALYSIS ACCESS PROCE9 DURES IN THE AMBULATORY SURGICAL CENTER SET10 TING.—The Secretary of Health and Human Services 

11 shall include in the surgical procedures specified under 

12 section 1833(i)(1) of the Social Security Act (42 U.S.C. 
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1 1395l(i)(1)) the full range of dialysis access procedures 

2 when provided to individuals with end-stage renal disease 

3 who are entitled to benefits under part A and enrolled 

4 under part B of title XVIII of the Social Security Act pur5 suant to section 226A of that Act (42 U.S.C. 426). For 

6 purposes of the preceding sentence, the full range of dialy7 sis services includes all reasonable and necessary interven8 tion procedures for the creation, repair, and maintenance 

9 of an individual’s dialysis access, such as the placement, 

10 insertion, and maintenance services related to fistulas, 

11 synthetic grafts, tunnel catheters, and peritoneal dialysis 

12 catheters. 

13 (b) REVISION OF RBRVS TO REFLECT THE DIF14 FICULTY OF VASCULAR ACCESS PROCEDURES.—The Sec15 retary of Health and Human Services shall structure the 

16 relative value units determined under section 1848(c)(2) 

17 of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) that 

18 are applicable with respect to physicians’ services for vas19 cular access procedures to encourage clinically appropriate 

20 placement of natural vascular access for dialysis patients. 

21 SEC. 102. DEMONSTRATION PROJECT FOR OUTCOMES22 BASED ESRD REIMBURSEMENT SYSTEM. 

23 (a) ESTABLISHMENT.—Subject to the succeeding 

24 provisions of this section, the Secretary of Health and 

25 Human Services (in this section referred to as the ‘‘Sec-
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1 retary’’) shall establish demonstration projects under 

2 which the Secretary shall evaluate methods that improve 

3 the quality of care provided to medicare beneficiaries with 

4 end-stage renal disease. 

5 (b) OUTCOMES-BASED ESRD REIMBURSEMENT SYS6 TEM.—

7 (1) IN GENERAL.—Under the demonstration 

8 projects, the Secretary shall provide financial incen9 tives to providers of services and renal dialysis facili10 ties that demonstrate improved quality of care to 

11 such beneficiaries. 

12 (2) CONSIDERATION OF OUTCOMES AND CASE13 MIX.—In determining whether a provider or facility 

14 has demonstrated an improved quality of care under 

15 paragraph (1), the Secretary shall take into account 

16 the outcomes of individuals receiving services from 

17 the provider or facility and the case-mix of the pro18 vider or facility, paying particular attention to im19 proved patient safety, better vaccination rates, and 

20 improved care for diabetics. 

21 (3) INCENTIVES DESCRIBED.—The financial in22 centives provided under paragraph (1) shall—

23 (A) reflect the interactions of payments 

24 under parts A and B of title XVIII of the So25 cial Security Act; and 
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1 (B) recognize improvements based on high 

2 quality outcomes during previous periods as 

3 well as recent changes in performance to re4 ward long-term improvements. 

5 (c) DURATION.—The Secretary shall conduct the 

6 demonstration project under this section for a period that 

7 is not longer than 5 years that begins on January 1, 2007. 

8 (d) EVALUATION AND REPORT.—

9 (1) EVALUATION.—The Secretary shall conduct 

10 an evaluation of the demonstration projects con11 ducted under this section. 

12 (2) REPORT.—Not later than 6 months after 

13 the date on which the demonstration projects are 

14 completed, the Secretary shall submit to Congress a 

15 report on the evaluation conducted under paragraph 

16 (1) together with recommendations for such legisla17 tion and administrative action as the Secretary de18 termines appropriate. 

19 (e) WAIVER AUTHORITY.—The Secretary shall waive 

20 compliance with the requirements of title XVIII of the So21 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

22 and for such period as the Secretary determines is nec23 essary to conduct the demonstration projects. 

24 (f) AUTHORIZATION OF APPROPRIATIONS.—
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1 (1) IN GENERAL.—Payments for the costs of 

2 carrying out the demonstration project under this 

3 section shall be made from the Federal Supple4 mentary Medical Insurance Trust Fund under sec5 tion 1841 of such Act (42 U.S.C. 1395t). 

6 (2) AMOUNT.—There are authorized to be ap7 propriated from such Trust Fund such sums as may 

8 be necessary to carry out this section. 

9 SEC. 103. REQUIRED TRAINING FOR PATIENT CARE DIALY10 SIS TECHNICIANS. 

11 (a) IN GENERAL.—Section 1881 of the Social Secu12 rity Act (42 U.S.C. 1395rr) is amended by adding the fol13 lowing: 

14 ‘‘(h)(1) Except as provided in paragraph (3), begin15 ning January 1, 2007, a provider of services or a renal 

16 dialysis facility may not use any individual as a patient 

17 care dialysis technician for more than 4 months unless the 

18 individual—

19 ‘‘(A) has completed a training program in the 

20 care and treatment of an individual with chronic 

21 kidney failure who is undergoing dialysis treatment; 

22 ‘‘(B) has been certified by a nationally recog23 nized certification entity for dialysis technicians; and 

24 ‘‘(C) is competent to provide dialysis-related 

25 services. 
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1 ‘‘(2) Beginning January 1, 2008, a provider of serv2 ices or a renal dialysis facility may not use on a tem3 porary, per diem, leased, or on any basis other than as 

4 a permanent employee, any individual as a patient care 

5 dialysis technician unless the individual meets the require6 ments described in subparagraphs (A), (B), and (C) of 

7 paragraph (1). 

8 ‘‘(3) A provider of services or a renal dialysis facility 

9 may permit an individual enrolled in a training program 

10 described in paragraph (1)(A) to serve as a patient care 

11 dialysis technician while they are so enrolled. 

12 ‘‘(4) For purposes of paragraph (1), if, since the most 

13 recent completion by an individual of a training program 

14 described in paragraph (1)(A), there has been a period 

15 of 24 consecutive months during which the individual has 

16 not performed dialysis-related services for monetary com17 pensation, such individual shall be required to complete 

18 a new training program or become re-certified as described 

19 in paragraph (1)(B). 

20 ‘‘(5) A provider of services or a renal dialysis facility 

21 shall provide such regular performance review and regular 

22 in-service education as assures that individuals serving as 

23 patient care dialysis technicians for the provider or facility 

24 are competent to perform dialysis-related services.’’. 
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1 TITLE II—ENSURING QUALITY 

2 THROUGH IMPROVEMENTS IN 

3 THE ESRD PAYMENT SYSTEM 

4 SEC. 201. ESTABLISHMENT OF ANNUAL UPDATE FRAME5 WORK FOR THE MEDICARE ESRD COMPOSITE 

6 RATE. 

7 (a) IN GENERAL.—Section 1881(b)(12)(F) of the So8 cial Security Act (42 U.S.C. 1395rr(b)(12)(F)) is amend9 ed to read as follows: 

10 ‘‘(F) Beginning with 2006, the Secretary shall annu11 ally increase the basic case-mix adjusted payment amounts 

12 established under this paragraph—

13 ‘‘(i) with respect to the component of the basic 

14 case-mix adjusted system described in clause (ii) of 

15 subparagraph (B), by—

16 ‘‘(I) applying the estimated growth in ex17 penditures for drugs and biologicals (including 

18 erythropoietin) that are separately billable to 

19 such component; and 

20 ‘‘(II) converting the amount determined in 

21 subclause (I) to an increase applicable to the 

22 basic case-mix adjusted payment amounts es23 tablished under such subparagraph; and 

24 ‘‘(ii) with respect to the composite rate compo25 nent of the basic case-mix adjusted system described 
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1 in subparagraph (B)(i), for dialysis services fur2 nished—

3 ‘‘(I) during 2006, by 2.5 percent above 

4 such payment amounts for such services fur5 nished on December 31, 2005; 

6 ‘‘(II) during 2007 through 2014, by an 

7 amount equal to 1 percent of the ESRD market 

8 basket percentage increase (as defined in para9 graph (14)(A) and including any additional fac10 tors that may increase costs described in para11 graph (14)(B)) above such composite rate pay12 ment amounts for such services furnished on 

13 December 31 of the previous year; and 

14 ‘‘(III) during 2015 and subsequent years, 

15 by the ESRD market basket percentage in16 crease (as defined in paragraph (14)(A) and in17 cluding any additional factors that may increase 

18 costs described in paragraph (14)(B)) above 

19 such composite rate payment amounts for such 

20 services furnished on December 31 of the pre21 vious year.’’. 

22 (b) ESRD MARKET BASKET PERCENTAGE INCREASE

23 DEFINED.—Section 1881(b) of the Social Security Act 

24 (42 U.S.C. 1395rr(b)) is amended by adding at the end 

25 the following new paragraph: 
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1 ‘‘(14)(A) For purposes of this title, the term ‘ESRD 

2 market basket percentage increase’ means, with respect to 

3 a calendar year, the percentage (estimated by the Sec4 retary before the beginning of such year) by which—

5 ‘‘(i) the cost of the mix of goods and services 

6 included in the provision of dialysis services (includ7 ing the costs described in subparagraph (D)) that is 

8 determined based on an index of appropriately 

9 weighted indicators of changes in wages and prices 

10 which are representative of the mix of goods and 

11 services included in such dialysis services for the cal12 endar year; exceeds 

13 ‘‘(ii) the cost of such mix of goods and services 

14 for the preceding calendar year. 

15 ‘‘(B) In addition to determining the percentage up16 date under subparagraph (A), the Secretary shall also take 

17 into account any change in the costs of furnishing the mix 

18 of goods and services described in such subparagraph re19 sulting from—

20 ‘‘(i) the adoption of scientific and technological 

21 innovations used to provide dialysis services; 

22 ‘‘(ii) changes in the manner or method of deliv23 ering dialysis services; 

24 ‘‘(iii) productivity improvements in the provi25 sion of dialysis services; and 
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1 ‘‘(iv) any other relevant factor. 

2 ‘‘(C) The Secretary shall annually review and update 

3 the items and services included in the mix of goods and 

4 services used to determine the percentage under subpara5 graph (A). 

6 ‘‘(D) The costs described in this subparagraph in7 clude—

8 ‘‘(i) labor costs, including direct patient care 

9 costs and administrative labor costs, vacation and 

10 holiday pay, payroll taxes, and employee benefits; 

11 ‘‘(ii) other direct costs, including drugs, sup12 plies, and laboratory fees; 

13 ‘‘(iii) overhead costs, including medical director 

14 fees, temporary services, general and administrative 

15 costs, interest expenses, and bad debt; 

16 ‘‘(iv) capital costs, including rent, real estate 

17 taxes, depreciation, utilities, repairs, and mainte18 nance; and 

19 ‘‘(v) such other allowable costs as the Secretary 

20 may specify.’’. 

21 SEC. 202. EXTENSION OF MEDICARE SECONDARY PAYER. 

22 Section 1862(b)(1)(C) of the Social Security Act (42 

23 U.S.C. 1395y(b)(1)(C)) is amended—
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1 (1) in the last sentence, by inserting ‘‘, and be2 fore January 1, 2006’’ after ‘‘prior to such date)’’; 

3 and 

4 (2) by adding at the end the following new sen5 tence: ‘‘Effective for items and services furnished on 

6 or after January 1, 2006 (with respect to periods 

7 beginning on or after the date that is 30 months 

8 prior to such date), clauses (i) and (ii) shall be ap9 plied by substituting ‘33-month’ for ‘12-month’ each 

10 place it appears in the first sentence.’’. 

11 SEC. 203. GAO STUDY AND REPORT ON IMPACT OF G12 CODES. 

13 (a) STUDY.—The Comptroller General of the United 

14 States shall conduct a study on the impact of the tem15 porary codes for nephrologists’ services applicable under 

16 the fee schedule for physicians’ services under section 

17 1848 of the Social Security Act (42 U.S.C. 1395w-4) 

18 (commonly known as ‘‘G-codes’’). 

19 (b) REPORT.—Not later than the date that is 6 

20 months after the date of enactment of this Act, the Comp21 troller General shall submit to Congress a report on the 

22 study conducted under subsection (a) together with rec23 ommendations for such legislation and administrative ac24 tion as the Comptroller General determines appropriate. 
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1 TITLE III—IMPROVING QUALITY 

2 THROUGH PATIENT EDU3 CATION, ACCESS, AND SAFETY 

4 INITIATIVES 

5 SEC. 301. SUPPORT OF PUBLIC AND PATIENT EDUCATION 

6 INITIATIVES REGARDING KIDNEY DISEASE. 

7 (a) CHRONIC KIDNEY DISEASE DEMONSTRATION

8 PROJECTS.—

9 (1) IN GENERAL.—The Secretary of Health and 

10 Human Services (in this section referred to as the 

11 ‘‘Secretary’’) shall establish demonstration projects 

12 to—

13 (A) increase public awareness about the 

14 factors that lead to chronic kidney disease, how 

15 to prevent it, how to treat it, and how to avoid 

16 kidney failure; and 

17 (B) enhance surveillance systems and ex18 pand research to better assess the prevalence 

19 and incidence of chronic kidney disease. 

20 (2) SCOPE AND DURATION.—

21 (A) SCOPE.—The Secretary shall select at 

22 least 3 States in which to conduct demonstra23 tion projects under this subsection. In selecting 

24 the States under this subparagraph, the Sec25 retary shall take into account the size of the 
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1 population of medicare beneficiaries with end2 stage renal disease and ensure the participation 

3 of individuals who reside in rural and urban 

4 areas. 

5 (B) DURATION.—The demonstration 

6 projects under this subsection shall be con7 ducted for a period that is not longer than 5 

8 years that begins on January 1, 2007. 

9 (3) EVALUATION AND REPORT.—

10 (A) EVALUATION.—The Secretary shall 

11 conduct an evaluation of the demonstration 

12 projects conducted under this subsection. 

13 (B) REPORT.—Not later than 6 months 

14 after the date on which the demonstration 

15 projects under this subsection are completed, 

16 the Secretary shall submit to Congress a report 

17 on the evaluation conducted under subpara18 graph (A) together with recommendations for 

19 such legislation and administrative action as the 

20 Secretary determines appropriate. 

21 (4) AUTHORIZATION OF APPROPRIATIONS.—

22 There are authorized to be appropriated to carry out 

23 this subsection $2,000,000 for each of fiscal years 

24 2007 through 2011. 
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1 (b) ESRD SELF-MANAGEMENT DEMONSTRATION

2 PROJECTS.—

3 (1) IN GENERAL.—The Secretary shall establish 

4 demonstration projects to enable individuals with 

5 end-stage renal disease to develop self-management 

6 skills. 

7 (2) SCOPE AND DURATION.—

8 (A) SCOPE.—The Secretary shall select at 

9 least 3 States in which to conduct demonstra10 tion projects under this subsection. In selecting 

11 the States under this subparagraph, the Sec12 retary shall take into account the size of the 

13 population of medicare beneficiaries with end14 stage renal disease and ensure the participation 

15 of individuals who reside in rural and urban 

16 areas. 

17 (B) DURATION.—The demonstration 

18 projects under this section shall be conducted 

19 for a period that is not longer than 5 years that 

20 begins on January 1, 2007. 

21 (3) EVALUATION AND REPORT.—

22 (A) EVALUATION.—The Secretary shall 

23 conduct an evaluation of the demonstration 

24 projects conducted under this subsection. 
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1 (B) REPORT.—Not later than 6 months 

2 after the date on which the demonstration 

3 projects under this subsection are completed, 

4 the Secretary shall submit to Congress a report 

5 on the evaluation conducted under subpara6 graph (A) together with recommendations for 

7 such legislation and administrative action as the 

8 Secretary determines appropriate. 

9 (4) AUTHORIZATION OF APPROPRIATIONS.—

10 There are authorized to be appropriated to carry out 

11 this subsection $2,000,000 for each of fiscal years 

12 2007 through 2011. 

13 SEC. 302. MEDICARE COVERAGE OF KIDNEY DISEASE PA14 TIENT EDUCATION SERVICES. 

15 (a) COVERAGE OF KIDNEY DISEASE EDUCATION

16 SERVICES.—

17 (1) COVERAGE.—Section 1861(s)(2) of the So18 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend19 ed—

20 (A) in subparagraph (Y), by striking 

21 ‘‘and’’ after the semicolon at the end; 

22 (B) in subparagraph (Z), by adding ‘‘and’’ 

23 after the semicolon at the end; and 

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

25 subparagraph: 
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1 ‘‘(AA) kidney disease education services (as de2 fined in subsection (bbb));’’. 

3 (2) SERVICES DESCRIBED.—Section 1861 of 

4 the Social Security Act (42 U.S.C. 1395x) is amend5 ed by adding at the end the following new sub6 section: 

7 ‘‘Kidney Disease Education Services 

8 ‘‘(bbb)(1) The term ‘kidney disease education serv9 ices’ means educational services that are—

10 ‘‘(A) furnished to an individual with kidney dis11 ease who, according to accepted clinical guidelines 

12 identified by the Secretary, will require dialysis or a 

13 kidney transplant; 

14 ‘‘(B) furnished, upon the referral of the physi15 cian managing the individual’s kidney condition, by 

16 a qualified person (as defined in paragraph (2)); and 

17 ‘‘(C) designed—

18 ‘‘(i) to provide comprehensive information 

19 regarding—

20 ‘‘(I) the management of comorbidities; 

21 ‘‘(II) the prevention of uremic com22 plications; and 

23 ‘‘(III) each option for renal replace24 ment therapy (including home and in-cen-
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1 ter as well as vascular access options and 

2 transplantation); and 

3 ‘‘(ii) to ensure that the individual has the 

4 opportunity to actively participate in the choice 

5 of therapy. 

6 ‘‘(2) The term ‘qualified person’ means—

7 ‘‘(A) a physician (as described in subsection 

8 (r)(1)); 

9 ‘‘(B) an individual who—

10 ‘‘(i) is—

11 ‘‘(I) a registered nurse; 

12 ‘‘(II) a registered dietitian or nutri13 tion professional (as defined in subsection 

14 (vv)(2)); 

15 ‘‘(III) a clinical social worker (as de16 fined in subsection (hh)(1)); 

17 ‘‘(IV) a physician assistant, nurse 

18 practitioner, or clinical nurse specialist (as 

19 those terms are defined in subsection 

20 (aa)(5)); or 

21 ‘‘(V) a transplant coordinator; and 

22 ‘‘(ii) meets such requirements related to 

23 experience and other qualifications that the 

24 Secretary finds necessary and appropriate for 
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1 furnishing the services described in paragraph 

2 (1); or 

3 ‘‘(C) a renal dialysis facility subject to the re4 quirements of section 1881(b)(1) with personnel 

5 who—

6 ‘‘(i) provide the services described in para7 graph (1); and 

8 ‘‘(ii) meet the requirements of subpara9 graph (A) or (B). 

10 ‘‘(3) The Secretary shall develop the requirements 

11 under paragraphs (1)(C)(i) and (2)(B)(ii) after consulting 

12 with physicians, health educators, professional organiza13 tions, accrediting organizations, kidney patient organiza14 tions, dialysis facilities, transplant centers, network orga15 nizations described in section 1881(c)(2), and other 

16 knowledgeable persons. 

17 ‘‘(4) In promulgating regulations to carry out this 

18 subsection, the Secretary shall ensure that each bene19 ficiary who is entitled to kidney disease education services 

20 under this title receives such services in a timely manner 

21 to maximize the benefit of those services. 

22 ‘‘(5) The Secretary shall monitor the implementation 

23 of this subsection to ensure that beneficiaries who are eli24 gible for kidney disease education services receive such 

25 services in the manner described in paragraph (4). 
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1 ‘‘(6) No individual shall be eligible to be provided 

2 more than 6 sessions of kidney disease education services 

3 under this title.’’. 

4 (3) PAYMENT UNDER THE PHYSICIAN FEE

5 SCHEDULE.—Section 1848(j)(3) of the Social Secu6 rity Act (42 U.S.C. 1395w–4(j)(3)) is amended by 

7 inserting ‘‘(2)(AA),’’ after ‘‘(2)(W),’’. 

8 (4) PAYMENT TO RENAL DIALYSIS FACILI9 TIES.—Section 1881(b) of the Social Security Act 

10 (42 U.S.C. 1395rr(b)), as amended by section 

11 201(b), is amended by adding at the end the fol12 lowing new paragraph: 

13 ‘‘(15) For purposes of paragraph (12), the single 

14 composite weighted formulas determined under such para15 graph shall not take into account the amount of payment 

16 for kidney disease education services (as defined in section 

17 1861(bbb)). Instead, payment for such services shall be 

18 made to the renal dialysis facility on an assignment-re19 lated basis under section 1848.’’. 

20 (5) LIMITATION ON NUMBER OF SESSIONS.—

21 Section 1862(a)(1) of the Social Security Act (42 

22 U.S.C. 1395y(a)(1)) is amended—

23 (A) by striking ‘‘and’’ at the end of sub24 paragraph (L); 
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1 (B) by striking the semicolon at the end of 

2 subparagraph (M) and inserting ‘‘, and’’; and 

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

4 subparagraph: 

5 ‘‘(N) in the case of kidney disease education 

6 services (as defined in section 1861(bbb)), which are 

7 performed in excess of the number of sessions cov8 ered under such section;’’. 

9 (6) ANNUAL REPORT TO CONGRESS.—Not later 

10 than April 1, 2007, and annually thereafter, the 

11 Secretary of Health and Human Services (in this 

12 section referred to as the ‘‘Secretary’’) shall submit 

13 to Congress a report on the number of medicare 

14 beneficiaries who are entitled to kidney disease edu15 cation services (as defined in section 1861(bbb) of 

16 the Social Security Act, as added by paragraph (2)) 

17 under title XVIII of such Act and who receive such 

18 services, together with such recommendations for 

19 legislative and administrative action as the Secretary 

20 determines to be appropriate to fulfill the legislative 

21 intent that resulted in the enactment of that sub22 section. 

23 (b) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply to services furnished on and after 

25 January 1, 2007. 
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1 SEC. 303. BLOOD FLOW MONITORING DEMONSTRATION 

2 PROJECTS. 

3 (a) ESTABLISHMENT.—The Secretary of Health and 

4 Human Services (in this section referred to as the ‘‘Sec5 retary’’) shall establish demonstration projects to evaluate 

6 how blood flow monitoring affects the quality and cost of 

7 care for medicare beneficiaries with end-stage renal dis8 ease. 

9 (b) DURATION.—The demonstration projects under 

10 this section shall be conducted for a period of not longer 

11 than 5 years that begins on January 1, 2007. 

12 (c) EVALUATION AND REPORT.—

13 (1) EVALUATION.—The Secretary shall conduct 

14 an evaluation of the demonstration projects con15 ducted under this section. 

16 (2) REPORT.—Not later than 6 months after 

17 the date on which the demonstration projects under 

18 this section are completed, the Secretary shall sub19 mit to Congress a report on the evaluation con20 ducted under paragraph (1) together with rec21 ommendations for such legislation and administra22 tive action as the Secretary determines appropriate. 

23 (d) WAIVER AUTHORITY.—The Secretary shall waive 

24 compliance with the requirements of title XVIII of the So25 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 
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1 and for such period as the Secretary determines is nec2 essary to conduct the demonstration projects. 

3 (e) AUTHORIZATION OF APPROPRIATIONS.—

4 (1) IN GENERAL.—Payments for the costs of 

5 carrying out the demonstration project under this 

6 section shall be made from the Federal Supple7 mentary Medical Insurance Trust Fund under sec8 tion 1841 of such Act (42 U.S.C. 1395t). 

9 (2) AMOUNT.—There are authorized to be ap10 propriated from such Trust Fund $1,000,000 for 

11 each of fiscal years 2007 through 2011 to carry out 

12 this section. 

13 TITLE IV—IMPROVING QUALITY 

14 THROUGH IMPROVED COV15 ERAGE 

16 SEC. 401. IMPROVING THE HOME DIALYSIS BENEFIT. 

17 (a) IN GENERAL.—The Secretary of Health and 

18 Human Services (in this section referred to as the ‘‘Sec19 retary’’) shall provide appropriate incentives to improve 

20 the home dialysis benefit for individuals on behalf of whom 

21 payment may be made under section 1881 of the Social 

22 Security Act (42 U.S.C. 1395rr). 

23 (b) CONSIDERATIONS.—In developing the incentives 

24 under subsection (a), the Secretary shall consider revising 

25 the fee schedule for physicians’ services under section 
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1 1848 of the Social Security Act (42 U.S.C. 1395w–4) so 

2 that the amount paid for services related to end-stage 

3 renal disease furnished to home dialysis patients is equal 

4 to the amount paid for services related to end-stage renal 

5 disease furnished to other patients with 4 or more face6 to-face physician visits per month. 

7 SEC. 402. INSTITUTE OF MEDICINE EVALUATION AND RE8 PORT ON HOME DIALYSIS. 

9 (a) EVALUATION.—

10 (1) IN GENERAL.—Not later than the date that 

11 is 2 months after the date of enactment of this Act, 

12 the Secretary of Health and Human Services (in this 

13 section referred to as the ‘‘Secretary’’) shall enter 

14 into an arrangement under which the Institute of 

15 Medicine of the National Academy of Sciences (in 

16 this section referred to as the ‘‘Institute’’) shall con17 duct an evaluation of the barriers that exist to in18 creasing the number of individuals with end-stage 

19 renal disease who elect to receive home dialysis serv20 ices under the medicare program under title XVIII 

21 of the Social Security Act (42 U.S.C. 1395 et seq.). 

22 (2) SPECIFIC MATTERS EVALUATED.—In con23 ducting the evaluation under paragraph (1), the In24 stitute shall—
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1 (A) compare current medicare home dialy2 sis costs and payments with current in-center 

3 and hospital dialysis costs and payments; 

4 (B) catalogue and evaluate the incentives 

5 and disincentives in the current reimbursement 

6 system that influence whether patients receive 

7 home dialysis services; 

8 (C) evaluate patient education services and 

9 how such services impact the treatment choices 

10 made by patients; and 

11 (D) consider such other matters as the In12 stitute determines appropriate. 

13 (3) SCOPE OF REVIEW.—The Institute shall 

14 consider a variety of perspectives, including the per15 spectives of physicians, other health care profes16 sionals, hospitals, dialysis facilities, health plans, 

17 purchasers, and patients. 

18 (b) REPORT.—Not later than the date that is 18 

19 months after the date of enactment of this Act, the Insti20 tute shall submit to the Secretary and appropriate com21 mittees of Congress a report on the evaluation conducted 

22 under subsection (a)(1) describing the findings of such 

23 evaluation and recommendations for implementing incen24 tives to encourage patients to elect to receive home dialysis 

25 services under the medicare program. 
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1 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary for the purposes of conducting the evaluation 

4 and preparing the report required by this section. 

5 SEC. 403. END-STAGE RENAL DISEASE (ESRD) ADVISORY 

6 COMMITTEE. 

7 (a) ESTABLISHMENT.—Pursuant to section 222 of 

8 the Public Health Service Act (42 U.S.C. 217a), the Sec9 retary of Health and Human Services shall establish with10 in 1 year of the date of enactment of this Act an inde11 pendent, multidisciplinary, nonpartisan End-Stage Renal 

12 Disease Advisory Committee (in this section referred to 

13 as the ‘‘Committee’’). 

14 (b) MEMBERSHIP.—The Committee shall consist of 

15 such members as the Secretary may appoint who shall 

16 serve for such term as the Secretary may specify. In ap17 pointing members of the Committee, the Secretary shall 

18 consult with the dialysis community and shall include indi19 viduals drawn from diverse backgrounds, such as medi20 cine, nursing, health care policy, the dialysis patient com21 munity, the dialysis provider community, and health eco22 nomics. 

23 (c) PURPOSE OF THE COMMITTEE.—

24 (1) DUTIES.—The Committee shall provide a 

25 forum for expert discussion and deliberation and the 
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•HR 1298 IH 

1 formulation of advice and recommendations to the 

2 Secretary about medicare coverage for End-Stage 

3 Renal Disease patients, as described under section 

4 1881 of the Social Security Act (42 U.S.C. 1395rr). 

5 (2) REPORT.—The Committee shall provide the 

6 Secretary with periodic reports that summarize the 

7 Committee’s activities and its recommendations for 

8 such legislation and administrative action as it con9 siders appropriate. 

10 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

11 are authorized to be appropriated such sums as may be 

12 necessary to carry out the purposes of this section.

Æ