I 

111TH CONGRESS 

2D SESSION H. R. 6537 

To amend titles XVIII and XIX of the Social Security Act and other Acts 

to improve Medicare and other benefits for beneficiaries with kidney 

disease, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2010 

Mr. LEWIS of Georgia 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 titles XVIII and XIX of the Social Security Act 

and other Acts to improve Medicare and other benefits 

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 ‘‘Improving Care for Kidney Patients Act of 2010’’. 

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

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—IMPROVING PATIENT CARE 

Sec. 101. Improvement of pre-dialysis care for Medicaid beneficiaries. 

Sec. 102. Study the progression kidney disease in minority populations. 

Sec. 103. AHRQ recommendations on dialysis quality and care management research gaps. 

Sec. 104. Kidney disease screening. 

Sec. 105. Kidney disease education in hospitals. 

Sec. 106. Increasing access to medicare kidney disease education benefit. 

Sec. 107. Kidney disease accountable care organizations (ACOs). 

Sec. 108. Coordination of care between hospitals and renal dialysis facilities. 

Sec. 109. Clarification of coverage of certain occulsive dressings. 

TITLE II—PROVIDING ACCESS TO PATIENTS IN NEED OF 

DIALYSIS TREATMENT 

Sec. 201. Survey requirements for renal dialysis facilities. 

Sec. 202. GAO study on transportation barriers to accessing kidney care. 

Sec. 203. Vascular access care service sites. 

TITLE III—ELIMINATING INEQUITIES FOR PATIENTS WITH 

KIDNEY FAILURE 

Sec. 301. Patient choice of primary insurer. 

Sec. 302. Access to medigap policies. 

Sec. 303. Protecting individuals with kidney failure from unfair practices under 

health care reform. 

1 TITLE I—IMPROVING PATIENT 

2 CARE 

3 SEC. 101. IMPROVEMENT OF PRE-DIALYSIS CARE FOR MED4 ICAID BENEFICIARIES. 

5 (a) IN GENERAL.—Section 1905(b) of the Social Se6 curity Act (42 U.S.C. 1396d(b)) is amended by adding 

7 at the end the following new sentence: ‘‘Notwithstanding 

8 the first sentence of this subsection, the Federal medical 

9 assistance percentage with respect to the placement of an 

10 arteriovenous fistula or graft for purposes of hemodialysis 

11 treatment shall be 100 percent’’. 


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

2 subsection (a) apply to fistulas and grafts placed on or 

3 after January 1, 2011. 

4 SEC. 102. STUDY THE PROGRESSION KIDNEY DISEASE IN 

5 MINORITY POPULATIONS. 

6 Not later than one year after the date of the enact7 ment of this Act, the Secretary of Health and Human 

8 Services, acting through the Director of the Agency for 

9 Healthcare Research and Quality, shall complete a study 

10 (and submit a report to Congress) on— 

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

12 leading to kidney disease; and 

13 (2) efforts to slow the progression of kidney dis14 ease in minority populations that are disproportion15 ately affected by such disease. 

16 SEC. 103. AHRQ RECOMMENDATIONS ON DIALYSIS QUALITY 

17 AND CARE MANAGEMENT RESEARCH GAPS. 

18 Not later than 2 years after the date of the enact19 ment of this Act, the Secretary of Health and Human 

20 Services, acting through the Director of the Agency for 

21 Healthcare Research and Quality, shall submit to Con22 gress a report regarding the research gaps with respect 

23 to the development of quality measures and care manage24 ment for patients with end-stage renal disease, including 

25 pediatric patients. Such report shall include recommendaVerDate Mar 15 2010 02:47 Dec 19, 2010 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6537.IH H6537

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1 tions about undertaking research to fill such gaps and 

2 prioritizing such research. 

3 SEC. 104. KIDNEY DISEASE SCREENING. 

4 (a) IN GENERAL.—Section 1128B(b)(3) of the Social 

5 Security Act (42 U.S.C. 1320a–7b(b)(3)) is amended— 

6 (1) by striking ‘‘and’’ at the end of subpara7 graph (I); 

8 (2) in subparagraph (J), by moving the inden9 tation 2 ems to the left and by striking the period 

10 at the end and inserting ‘‘; and’’; and 

11 (3) by adding at the end the following new sub12 paragraph: 

13 ‘‘(K) a waiver of any fee or cost-sharing by 

14 a renal dialysis facility for the purpose of pro15 viding screening for chronic kidney disease so 

16 long as— 

17 ‘‘(i) receiving the screening is not con18 ditioned on the individual’s use of any 

19 other goods or services from the facility or 

20 any other particular health care provider; 

21 ‘‘(ii) individuals receiving the screen22 ing are referred to their own health care 

23 practitioner; 


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1 ‘‘(iii) no special discounts or waivers 

2 are available for any follow-up services; 

3 and 

4 ‘‘(iv) the facility does not bill for the 

5 screening to any Federal or State health 

6 care program or to any other third party 

7 payor.’’. 

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

9 subsection (a) shall apply to waivers occurring after the 

10 date of the enactment of this Act. 

11 SEC. 105. KIDNEY DISEASE EDUCATION IN HOSPITALS. 

12 (a) IN GENERAL.—Section 1861(e)(6) of the Social 

13 Security Act (42 U.S.C. 1395x(e)(6)) is amended— 

14 (1) by striking ‘‘and (B)’’ and inserting ‘‘, 

15 (B)’’; and 

16 (2) by inserting before the semicolon at the end 

17 the following: ‘‘, and (C) provides patients who are 

18 entitled to benefits under this title or title XIX diag19 nosed with stage IV or stage V kidney disease with 

20 educational materials regarding the treatment of 

21 kidney disease’’. 

22 (b) TECHNICAL ASSISTANCE.—Not later than one 

23 year after the date of the enactment of this Act, the Sec24 retary of Health and Human Services shall develop proto25 cols for the identification of chronic kidney disease in atVerDate Mar 15 2010 02:47 Dec 19, 2010 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6537.IH H6537

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1 risk Medicare and Medicaid beneficiaries for use in the 

2 inpatient hospital setting under the amendment made by 

3 subsection (a)(2). 

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

5 subsection (a) shall take effect 1 year after the date of 

6 the enactment of this Act. 

7 SEC. 106. INCREASING ACCESS TO MEDICARE KIDNEY DIS8 EASE EDUCATION BENEFIT. 

9 (a) IN GENERAL.—Section 1861(ggg)(2) of the So10 cial Security Act (42 U.S.C. 1395x(ggg)(2)) is amended— 

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

12 (2) in subparagraph (A)— 

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

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

15 (i); 

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

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

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

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

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

21 ‘‘(C) a renal dialysis facility subject to the re22 quirements of section 1881(b)(1) with personnel 

23 who— 

24 ‘‘(i) provide the services described in para25 graph (1); and 


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1 ‘‘(ii) is a physician (as defined in sub2 section (r)(1)) or a physician assistant, nurse 

3 practitioner, or clinical nurse specialist (as de4 fined in subsection (aa)(5)).’’. 

5 (b) PAYMENT TO RENAL DIALYSIS FACILITIES.— 

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

7 amended by adding at the end the following new para8 graph: 

9 ‘‘(15) For purposes of paragraph (14), the sin10 gle payment for renal dialysis services under such 

11 paragraph shall not take into account the amount of 

12 payment for kidney disease education services (as 

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

14 such services shall be made to the renal dialysis fa15 cility on an assignment-related basis under section 

16 1848.’’. 

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

18 this section apply to kidney disease education services fur19 nished on or after January 1, 2011. 

20 SEC. 107. KIDNEY DISEASE ACCOUNTABLE CARE ORGANI21 ZATIONS (ACOS). 

22 Section 1899(b)(1) of the Social Security Act (42 

23 U.S.C. 1395jjj(b)(1)), as added by section 3022, and 

24 amended by section 10307, of the Patient Protection and 

25 Affordable Care Act (Public Law 111–148), is amended— 


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1 (1) by redesignating subparagraph (E) as sub2 paragraph (F); and 

3 (2) by inserting after subparagraph (D) the fol4 lowing new subparagraph: 

5 ‘‘(E) A group consisting of dialysis facili6 ties, nephrologists, and other providers of serv7 ices and suppliers that treat patients with kid8 ney disease.’’. 

9 SEC. 108. COORDINATION OF CARE BETWEEN HOSPITALS 

10 AND RENAL DIALYSIS FACILITIES. 

11 (a) IN GENERAL.—Section 1861(ee)(2) of the Social 

12 Security Act (42 U.S.C. 1395x(ee)(2)) is amended by add13 ing at the end the following new subparagraph: 

14 ‘‘(I) In the case of a patient who has end 

15 stage renal disease and is or will be receiving 

16 dialysis treatments upon discharge, the hospital 

17 must transmit the discharge summary and any 

18 other relevant health information defined by the 

19 Secretary to the renal dialysis facility or hos20 pital-based provider when the patient is dis21 charged from the hospital.’’. 

22 (b) DEADLINE.—The Secretary of Health and 

23 Human Services shall implement guidelines and standards 

24 to carry out the amendment made by subsection (a) not 


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1 later than 6 months after the date of the enactment of 

2 this Act. 

3 SEC. 109. CLARIFICATION OF COVERAGE OF CERTAIN 

4 OCCULSIVE DRESSINGS. 

5 (a) IN GENERAL.—Section 1861(s)(5) of the Social 

6 Security Act (42 U.S.C. 1395x(s)(5)) is amended by in7 serting before the semicolon the following: ‘‘and special8 ized occlusive dressings used by a patient with receiving 

9 dialysis treatment to protect the individual against life 

10 threatening catheter-related infections during mainte11 nance of personal hygiene at home (such as during bathing 

12 and showering)’’. 

13 (b) EXCLUSION FROM ESRD BUNDLED PAYMENT

14 RATE.—The last sentence of section 1881(b)(14)(B) of 

15 such Act (42 U.S.C. 1395rr(b)(14)(B)) is amended by in16 serting before the period at the end the following: ‘‘or oc17 clusive dressings described in section 1861(s)(5)’’. 

18 (c) PAYMENT UNDER SURGICAL DRESSING PROVI19 SIONS.—Section 1834(i)(1) of such Act (42 U.S.C. 

20 1395m(i)(1)) is amended by inserting ‘‘, including special21 ized occlusive dressings described in such section’’ after 

22 ‘‘1861(s)(5)’’. 

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

24 this section shall apply to dressings furnished on or after 

25 January 1, 2011. 


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1 TITLE II—PROVIDING ACCESS 

2 TO PATIENTS IN NEED OF DI3 ALYSIS TREATMENT 

4 SEC. 201. SURVEY REQUIREMENTS FOR RENAL DIALYSIS 

5 FACILITIES. 

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

7 1395aa) is amended— 

8 (1) by redesignating subsection (e) as sub9 section (f) and by inserting after subsection (d) the 

10 following new subsection: 

11 ‘‘(e)(1) If the Secretary has entered into an agree12 ment with any State under this section under which the 

13 appropriate State or local agency that performs any sur14 vey related to determining the compliance of a renal dialy15 sis facility subject to the requirements of section 1881(b) 

16 and the State licensure survey requirements are consistent 

17 with or exceed such Federal requirements, the Secretary 

18 must accept the results of the State licensure survey for 

19 purposes of determining Federal certification of compli20 ance. In the case of such an initial survey of a renal dialy21 sis facility, the Secretary may allow any State to waive 

22 the reimbursement for conducting the survey under this 

23 subsection if it requests such a waiver. 

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

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


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1 an initial survey under this section, the Secretary shall 

2 establish a specific timetable for completing and reporting 

3 the results of the survey.’’; 

4 (2) in subsection (f), as so redesignated— 

5 (A) by striking ‘‘Notwithstanding any 

6 other provision of law,’’ and inserting ‘‘(1) Not7 withstanding any other provision of law and ex8 cept as provided in paragraph (2)’’; and 

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

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

11 the initial Medicare survey from a renal dialysis facility 

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

13 amount not to exceed a reasonable fee necessary to cover 

14 the costs of initial surveys conducted for purposes of deter15 mining the compliance of a renal dialysis facility with the 

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

17 and collected under this paragraph only in such manner 

18 as would result in an aggregate amount of fees collected 

19 during any fiscal year which equals the aggregate amount 

20 of costs for such fiscal year for initial surveys of such fa21 cilities under this section. A renal dialysis facility’s liabil22 ity for such fees shall be reasonably based on the propor23 tion of the survey costs which relate to such facility. Any 

24 funds collected under this paragraph shall be used only 


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1 to conduct the initial survey of the facilities providing the 

2 fees. 

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

4 collected by the Secretary and available only to the extent 

5 and in the amount provided in advance in appropriations 

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

7 amount and usage limitations of such paragraph. Such 

8 fees so collected are authorized to remain available until 

9 expended.’’. 

10 SEC. 202. GAO STUDY ON TRANSPORTATION BARRIERS TO 

11 ACCESSING KIDNEY CARE. 

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

13 United States shall conduct an evaluation of the transpor14 tation barriers facing dialysis patients that result in less 

15 than 100 percent compliance with their plan of care under 

16 the Medicare program. 

17 (b) SPECIFIC MATTERS EVALUATED.—In conducting 

18 the evaluation under subsection (a), the Comptroller Gen19 eral shall examine— 

20 (1) the costs associated with providing dialysis 

21 services; 

22 (2) the number and characteristics of patients 

23 who miss at least 2 dialysis treatments during a 

24 month or have shortened treatments because of bar25 riers to transportation; and 


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1 (3) the potential sources of providing dialysis 

2 patients with such transportation services. 

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

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

5 Comptroller General shall submit to Congress a report on 

6 the study conducted under subsection (a) together with 

7 recommendations for such legislation and administrative 

8 action as the Comptroller General determines appropriate. 

9 SEC. 203. VASCULAR ACCESS CARE SERVICE SITES. 

10 Not later than 1 year after the date of the enactment 

11 of this Act, the Secretary of Health and Human Services 

12 shall report and provide recommendations to the Congress 

13 on the benefits of recognizing dialysis vascular and peri14 toneal dialysis access care service sites for purposes of re15 ceiving reimbursement under the Medicare program. 

16 TITLE III—ELIMINATING INEQUI17 TIES FOR PATIENTS WITH 

18 KIDNEY FAILURE 

19 SEC. 301. PATIENT CHOICE OF PRIMARY INSURER. 

20 (a) PROVIDING PATIENT CHOICE IN MEDICARE.— 

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

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

23 amended— 


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

2 before January 1, 2011’’ 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, 2011 (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) APPLICATION OF RULES TO QUALIFIED HEALTH

24 PLANS AND INDIVIDUAL HEALTH INSURANCE COV25 ERAGE.—Such section is further amended, in the matter 


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1 before clause (i), by inserting after ‘‘subparagraph 

2 (A)(v))’’ the following: ‘‘, a qualified health plan estab3 lished pursuant to or governed by subtitle D of title I of 

4 the Patient Protection and Affordable Care Act, or any 

5 individual health insurance coverage (as defined in section 

6 2791(b)(5) of the Public Health Service Act, excluding ex7 cepted coverage under subsection (c) of such section)’’. 

8 SEC. 302. ACCESS TO MEDIGAP POLICIES. 

9 (a) IN GENERAL.—Section 1882(s) of the Social Se10 curity Act (42 U.S.C. 1395ss(s)) is amended— 

11 (1) in paragraph (2)(A), by inserting ‘‘, or is el12 igible for hospital insurance benefits under part A 

13 on the basis of sections 226(b) or 226A’’ after ‘‘65 

14 years of age or older’’; 

15 (2) in paragraph (2)(D), by striking ‘‘the 6- 

16 month period described in subparagraph (A) to an 

17 individual who is 65 years of age or older as of the 

18 date of issuance and’’ and inserting ‘‘a 6-month pe19 riod described in subparagraph (A) to an indi20 vidual’’; and 

21 (3) in paragraph (3)(B)(vi), by striking ‘‘at age 

22 65’’. 

23 (b) EFFECTIVE DATE.— 


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1 (1) IN GENERAL.—The amendments made by 

2 subsection (a) shall take effect as of the date of the 

3 enactment of this Act. 

4 (2) TRANSITION.— 

5 (A) No medicare supplemental policy of an 

6 issuer shall be deemed to meet the standards in 

7 subsection (c) of section 1882 of the Social Se8 curity Act (42 U.S.C. 1395ss) unless the issuer 

9 permits each individual described in subpara10 graph (B), during the 6-month period beginning 

11 on the first day of the first month beginning 

12 after the date of the enactment of this Act, to 

13 be enrolled under a medicare supplemental pol14 icy in accordance with subsection (s) of such 

15 section, as amended by subsection (a), applied 

16 as if the individual were first enrolled under 

17 part B of title XVIII of the Social Security Act 

18 as of the first day of such first month. 

19 (B) For purposes of subparagraph (A), an 

20 individual described in this subparagraph is an 

21 individual who, as of the first day of the first 

22 month beginning after the date of the enact23 ment of this Act— 

24 (i) is under 65 years of age; 


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1 (ii) is enrolled under part B of title 

2 XVIII of the Social Security Act; and 

3 (iii) is not enrolled in a medicare sup4 plemental policy. 

5 SEC. 303. PROTECTING INDIVIDUALS WITH KIDNEY FAIL6 URE FROM UNFAIR PRACTICES UNDER 

7 HEALTH CARE REFORM. 

8 (a) IN GENERAL.—Section 2719A of the Public 

9 Health Service Act (42 U.S.C. 300gg–19a), as added by 

10 section 10101(h) of the Patient Protection and Affordable 

11 Care Act (Public Law 111–148), is amended by adding 

12 at the end the following new subsection: 

13 ‘‘(e) ACCESS FOR PATIENTS WITH KIDNEY FAIL14 URE.— 

15 ‘‘(1) IN GENERAL.—In the case of an individual 

16 who is a participant, beneficiary, or enrollee under 

17 a group health plan, or health insurance coverage of18 fered by a health insurance issuer in the group or 

19 individual market and who has kidney failure, the 

20 plan or issuer may only impose restrictions with re21 spect to treatment for kidney failure if the restric22 tions are reasonable and assure adequate access to 

23 out-of-network providers consistent with this sub24 section. 


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1 ‘‘(2) SPECIFIC REQUIREMENTS.—In carrying 

2 out paragraph (1), a plan or issuer— 

3 ‘‘(A) may not set out-of-network rates 

4 through unilateral rate setting or other mecha5 nisms that restrict or limit negotiations with 

6 providers and facilities that furnish services to 

7 treat kidney failure; 

8 ‘‘(B) shall provide adequate, advanced, 

9 written notification to patients regarding 

10 changes to dialysis service benefits, new restric11 tions on out-of-network access, or reductions to 

12 rates paid for out-of-network benefits for such 

13 services; 

14 ‘‘(C) shall allow patients to continue using 

15 their existing provider or facility of such serv16 ices for at least 24 months following the date 

17 of notice of any change by the plan or issuer in 

18 their dialysis services network; 

19 ‘‘(D) shall hold patients harmless from 

20 provider network changes with respect to such 

21 services if such changes require unreasonable 

22 drive time or disrupt the physician-patient rela23 tionship; 

24 ‘‘(E) may not restrict the duration or num25 ber of dialysis sessions for patients, such as 


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1 based on a fixed number of treatments per 

2 week, to less than the number permitted under 

3 the Medicare program under title XVIII of the 

4 Social Security Act; 

5 ‘‘(F) may not penalize physicians for refer6 ring patients to out-of-network providers or fa7 cilities for such services; 

8 ‘‘(G) may not require assignment of bene9 fits for such services; 

10 ‘‘(H) shall ensure equity with respect to 

11 out-of-pocket payments for such services; 

12 ‘‘(I) may not deny or limit coverage for pa13 tients for such services if premiums, co-pay14 ments, or other payments are made by third 

15 parties on their behalf; and 

16 ‘‘(J) shall meet minimum network ade17 quacy standards specified by the Secretary with 

18 respect to such services.’’. 

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

20 subsection (a) shall apply to plans and issuers as of Janu21 ary 1, 2014. 

Æ 


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