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[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 691 Introduced in Senate (IS)]

110th CONGRESS
  1st Session
                                 S. 691

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 SENATE OF THE UNITED STATES

                           February 27, 2007

  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 the benefits 
 under the Medicare program for beneficiaries with kidney disease, and 
                          for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Kidney Care 
Quality and Education Act of 2007''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
   TITLE I--IMPROVING QUALITY THROUGH PATIENT EDUCATION, ACCESS, AND 
                           SAFETY INITIATIVES

Sec. 101. Support of public and patient education initiatives regarding 
                            kidney disease.
Sec. 102. Medicare coverage of kidney disease patient education 
                            services.
Sec. 103. Blood flow monitoring demonstration projects.
Sec. 104. Institute of Medicine Evaluation and report on treatment 
                            modalities for patients with kidney 
                            failure.
Sec. 105. Required training for patient care dialysis technicians.
   TITLE II--ASSURING QUALITY OF CARE FOR PROVIDERS, FACILITIES, AND 
 PHYSICIANS THAT PROVIDE SERVICES TO INDIVIDUALS WITH END-STAGE RENAL 
                   DISEASE WHO ARE ENROLLED IN PART B

Sec. 201. Establishment of the End-Stage Renal Disease (ESRD) Advisory 
                            Committee.
Sec. 202. Update for the Medicare ESRD composite rate for 2008, 2009, 
                            and 2010.
Sec. 203. Continuous quality improvement initiative in the Medicare 
                            end-stage renal disease program.
Sec. 204. Extension of Medicare secondary payer.

   TITLE I--IMPROVING QUALITY THROUGH PATIENT EDUCATION, ACCESS, AND 
                           SAFETY INITIATIVES

SEC. 101. SUPPORT OF PUBLIC AND PATIENT EDUCATION INITIATIVES REGARDING 
              KIDNEY DISEASE.

    (a) Chronic Kidney Disease Demonstration Projects.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        establish demonstration projects to--
                    (A) increase public awareness about the factors 
                that lead to chronic kidney disease, how to prevent it, 
                how to treat it, and how to avoid kidney failure; and
                    (B) enhance surveillance systems and expand 
                research to better assess the prevalence and incidence 
                of chronic kidney disease.
            (2) Scope and duration.--
                    (A) Scope.--The Secretary shall select at least 3 
                States in which to conduct demonstration projects under 
                this subsection. In selecting the States under this 
                subparagraph, the Secretary shall take into account the 
                size of the population of individuals with end-stage 
                renal disease who are enrolled in part B of title XVIII 
                of the Social Security Act and ensure the participation 
                of individuals who reside in rural and urban areas.
                    (B) Duration.--The demonstration projects under 
                this subsection shall be conducted for a period that is 
                not longer than 5 years that begins on January 1, 2009.
            (3) Evaluation and report.--
                    (A) Evaluation.--The Secretary shall conduct an 
                evaluation of the demonstration projects conducted 
                under this subsection.
                    (B) Report.--Not later than 6 months after the date 
                on which the demonstration projects under this 
                subsection are completed, the Secretary shall submit to 
                Congress a report on the evaluation conducted under 
                subparagraph (A) together with recommendations for such 
                legislation and administrative action as the Secretary 
                determines appropriate.
            (4) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this subsection $2,000,000 for 
        each of fiscal years 2009 through 2013.
    (b) ESRD Self-Management Demonstration Projects.--
            (1) In general.--The Secretary shall establish 
        demonstration projects to enable individuals with end-stage 
        renal disease to develop self-management skills.
            (2) Application.--The provisions of paragraph (2) (relating 
        to scope and duration) and paragraph (3) (relating to an 
        evaluation and a report) of subsection (a) shall apply to the 
        demonstration projects under this subsection in the same manner 
        as such provisions apply to the demonstration projects under 
        subsection (a).
            (3) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this subsection $2,000,000 for 
        each of fiscal years 2009 through 2013.

SEC. 102. MEDICARE COVERAGE OF KIDNEY DISEASE PATIENT EDUCATION 
              SERVICES.

    (a) Coverage of Kidney Disease Education Services.--
            (1) Coverage.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (Z), by striking ``and'' after 
                the semicolon at the end;
                    (B) in subparagraph (AA), by adding ``and'' after 
                the semicolon at the end; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(BB) kidney disease education services (as 
                defined in subsection (ccc));''.
            (2) Services described.--Section 1861 of the Social 
        Security Act (42 U.S.C. 1395x) is amended by adding at the end 
        the following new subsection:

                  ``Kidney Disease Education Services

    ``(ccc)(1) The term `kidney disease education services' means 
educational services that are--
            ``(A) furnished to an individual with kidney disease who, 
        according to accepted clinical guidelines identified by the 
        Secretary, will require dialysis or a kidney transplant;
            ``(B) furnished, upon the referral of the physician 
        managing the individual's kidney condition, by a qualified 
        person (as defined in paragraph (2)); and
            ``(C) designed--
                    ``(i) to provide comprehensive information 
                regarding--
                            ``(I) the management of comorbidities;
                            ``(II) the prevention of uremic 
                        complications; and
                            ``(III) each option for renal replacement 
                        therapy (including home and in-center as well 
                        as vascular access options and 
                        transplantation); and
                    ``(ii) to ensure that the individual has the 
                opportunity to actively participate in the choice of 
                therapy.
    ``(2) The term `qualified person' means--
            ``(A) a physician (as described in subsection (r)(1));
            ``(B) an individual who--
                    ``(i) is--
                            ``(I) a registered nurse;
                            ``(II) a registered dietitian or nutrition 
                        professional (as defined in subsection 
                        (vv)(2));
                            ``(III) a clinical social worker (as 
                        defined in subsection (hh)(1));
                            ``(IV) a physician assistant, nurse 
                        practitioner, or clinical nurse specialist (as 
                        those terms are defined in subsection (aa)(5)); 
                        or
                            ``(V) a transplant coordinator; and
                    ``(ii) meets such requirements related to 
                experience and other qualifications that the Secretary 
                finds necessary and appropriate for furnishing the 
                services described in paragraph (1); or
            ``(C) a renal dialysis facility subject to the requirements 
        of section 1881(b)(1) with personnel who--
                    ``(i) provide the services described in paragraph 
                (1); and
                    ``(ii) meet the requirements of subparagraph (A) or 
                (B).
    ``(3) The Secretary shall develop the information to be provided 
under paragraph (1)(C)(i) and the requirements under (2)(B)(ii) after 
consulting with physicians, health educators, professional 
organizations, accrediting organizations, kidney patient organizations, 
dialysis facilities, transplant centers, network organizations 
described in section 1881(c)(2), and other knowledgeable persons.
    ``(4) In promulgating regulations to carry out this subsection, the 
Secretary shall ensure that each beneficiary who is entitled to kidney 
disease education services under this title receives such services in a 
timely manner to maximize the benefit of those services.
    ``(5) The Secretary shall monitor the implementation of this 
subsection to ensure that beneficiaries who are eligible for kidney 
disease education services receive such services in the manner 
described in paragraph (4).
    ``(6) No individual shall be eligible to be provided more than 6 
sessions of kidney disease education services under this title.''.
            (3) Payment under the physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(BB),'' after ``(2)(AA),''.
            (4) Payment to renal dialysis facilities.--Section 1881(b) 
        of the Social Security Act (42 U.S.C. 1395rr(b)) is amended by 
        adding at the end the following new paragraph:
            ``(14) For purposes of paragraph (12), the single composite 
        weighted formulas determined under such paragraph shall not 
        take into account the amount of payment for kidney disease 
        education services (as defined in section 1861(ccc)). Instead, 
        payment for such services shall be made to the renal dialysis 
        facility on an assignment-related basis under section 1848.''.
            (5) Limitation on number of sessions.--Section 1862(a)(1) 
        of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--
                    (A) in subparagraph (M), by striking ``and'' at the 
                end;
                    (B) in subparagraph (N), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(O) in the case of kidney disease education 
                services (as defined in section 1861(ccc)), which are 
                performed in excess of the number of sessions covered 
                under such section;''.
            (6) Annual report to congress.--Not later than April 1, 
        2009, and annually thereafter, the Secretary of Health and 
        Human Services shall submit a report to Congress on the number 
        of Medicare beneficiaries who are entitled to kidney disease 
        education services (as defined in section 1861(ccc) of the 
        Social Security Act, as added by paragraph (2)) under title 
        XVIII of such Act and who receive such services, together with 
        such recommendations for legislative and administrative action 
        as the Secretary determines to be appropriate to fulfill the 
        legislative intent that resulted in the enactment of that 
        subsection.
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2009.

SEC. 103. BLOOD FLOW MONITORING DEMONSTRATION PROJECTS.

    (a) Establishment.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish 
demonstration projects to evaluate how blood flow monitoring affects 
the quality and cost of care for Medicare beneficiaries with end-stage 
renal disease.
    (b) Duration.--The demonstration projects under this section shall 
be conducted for a period of not longer than 5 years that begins on 
January 1, 2009.
    (c) Evaluation and Report.--
            (1) Evaluation.--The Secretary shall conduct an evaluation 
        of the demonstration projects conducted under this section.
            (2) Report.--Not later than 6 months after the date on 
        which the demonstration projects under this section are 
        completed, the Secretary shall submit to Congress a report on 
        the evaluation conducted under paragraph (1) together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines appropriate.
    (d) Waiver Authority.--The Secretary shall waive compliance with 
the requirements of title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) to the extent, and for such period as, the Secretary 
determines is necessary to conduct the demonstration projects.
    (e) Authorization of Appropriations.--
            (1) In general.--Payments for the costs of carrying out the 
        demonstration projects under this section shall be made from 
        the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841 of the Social Security Act (42 U.S.C. 1395t).
            (2) Amount.--There are authorized to be appropriated from 
        such Trust Fund $1,000,000 for each of fiscal years 2009 
        through 2013 to carry out this section.

SEC. 104. INSTITUTE OF MEDICINE EVALUATION AND REPORT ON TREATMENT 
              MODALITIES FOR PATIENTS WITH KIDNEY FAILURE.

    (a) Evaluation.--
            (1) In general.--Not later than 2 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') 
        shall enter into an arrangement under which the Institute of 
        Medicine of the National Academy of Sciences (in this section 
        referred to as the ``Institute'') shall conduct an evaluation 
        of the barriers that exist to increasing the number of 
        individuals with end-stage renal disease who elect to receive 
        home dialysis services or other treatment modalities under the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.).
            (2) Specific matters evaluated.--In conducting the 
        evaluation under paragraph (1), the Institute shall--
                    (A) compare current Medicare home dialysis costs 
                and payments with current in-center and hospital 
                dialysis costs and payments;
                    (B) catalogue and evaluate the incentives and 
                disincentives in the current reimbursement system that 
                influence whether patients receive home dialysis 
                services or other treatment modalities;
                    (C) evaluate patient education services and how 
                such services impact the treatment choices made by 
                patients; and
                    (D) consider such other matters as the Institute 
                determines appropriate.
            (3) Scope of review.--In conducting the evaluation under 
        paragraph (1), the Institute shall consider a variety of 
        perspectives, including the perspectives of physicians, other 
        health care professionals, hospitals, dialysis facilities, 
        health plans, purchasers, and patients.
    (b) Report.--Not later than 19 months after the date of enactment 
of this Act, the Institute shall submit to the Secretary and to 
Congress a report on the evaluation conducted under subsection (a)(1). 
Such report shall contain a detailed description of the findings of 
such evaluation and recommendations for implementing incentives to 
encourage patients to elect to receive home dialysis services or other 
treatment modalities under the Medicare program.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for the purposes of 
conducting the evaluation and preparing the report required by this 
section.

SEC. 105. REQUIRED TRAINING FOR PATIENT CARE DIALYSIS TECHNICIANS.

    (a) In General.--Section 1881 of the Social Security Act (42 U.S.C. 
1395rr) is amended by adding the following new subsection:
    ``(h)(1) Except as provided in paragraph (3), beginning January 1, 
2009, a provider of services or a renal dialysis facility may not use 
any individual as a patient care dialysis technician for more than 4 
months unless the individual--
            ``(A) has completed a training program in the care and 
        treatment of an individual with chronic kidney failure who is 
        undergoing dialysis treatment;
            ``(B) has been certified by a nationally recognized 
        certification entity for dialysis technicians; and
            ``(C) is competent to provide dialysis-related services.
    ``(2) Beginning January 1, 2010, a provider of services or a renal 
dialysis facility may not use on a temporary, per diem, leased, or on 
any basis other than as a permanent employee, any individual as a 
patient care dialysis technician unless the individual meets the 
requirements described in subparagraphs (A), (B), and (C) of paragraph 
(1).
    ``(3) A provider of services or a renal dialysis facility may 
permit an individual enrolled in a training program described in 
paragraph (1)(A) to serve as a patient care dialysis technician while 
they are so enrolled.
    ``(4) For purposes of paragraph (1), if, since the most recent 
completion by an individual of a training program described in 
paragraph (1)(A), there has been a period of 24 consecutive months 
during which the individual has not performed dialysis-related services 
for monetary compensation, such individual shall be required to 
complete a new training program or become recertified as described in 
paragraph (1)(B).
    ``(5) A provider of services or a renal dialysis facility shall 
provide such regular performance review and regular in-service 
education as assures that individuals serving as patient care dialysis 
technicians for the provider or facility are competent to perform 
dialysis-related services.''.

   TITLE II--ASSURING QUALITY OF CARE FOR PROVIDERS, FACILITIES, AND 
 PHYSICIANS THAT PROVIDE SERVICES TO INDIVIDUALS WITH END-STAGE RENAL 
                   DISEASE WHO ARE ENROLLED IN PART B

SEC. 201. ESTABLISHMENT OF THE END-STAGE RENAL DISEASE (ESRD) ADVISORY 
              COMMITTEE.

    (a) In General.--Pursuant to section 222 of the Public Health 
Service Act (42 U.S.C. 217a), the Secretary of Health and Human 
Services (in this section referred to as the ``Secretary'') shall 
establish within 1 year of the date of enactment of this Act an 
independent, multidisciplinary, nonpartisan End-Stage Renal Disease 
Advisory Committee (in this section referred to as the ``Committee'').
    (b) Membership.--
            (1) In general.--The Committee shall consist of such 
        members as the Secretary may appoint who shall serve for such 
        term as the Secretary may specify. The Secretary shall ensure 
        that a representative of the Centers for Medicare & Medicaid 
        Services is included among the members of the Committee.
            (2) Consultation.--In appointing members of the Committee, 
        the Secretary shall consult with patients, facilities and 
        providers, physicians, nurses, a representative from the 
        pediatric community, payers and insurers, manufacturers, and a 
        representative of the Centers for Medicare & Medicaid Services 
        who coordinates activities related to end-stage renal disease 
        within the Centers.
    (c) Purpose of the Committee.--
            (1) Duties.--The Committee shall provide a forum for expert 
        discussion and deliberation and the formulation of advice and 
        recommendations to the Secretary regarding Medicare coverage 
        for individuals with end-stage renal disease, as described 
        under section 1881 of the Social Security Act (42 U.S.C. 
        1395rr).
            (2) Recommendations.--
                    (A) Annual recommendations.--The Committee shall 
                provide annual recommendations to the Secretary 
                regarding--
                            (i) selecting, modifying, and updating 
                        clinical and quality of life measures;
                            (ii) modifying the payment structure;
                            (iii) determining hardship criteria to 
                        exempt certain facilities and providers from 
                        the program; and
                            (iv) other issues related to implementation 
                        of a quality initiative by the Secretary.
                    (B) Periodic recommendations.--The Committee shall 
                provide periodic advice and recommendations to the 
                Secretary regarding Medicare coverage for individuals 
                with end-stage renal disease, as described in such 
                section 1881.

SEC. 202. UPDATE FOR THE MEDICARE ESRD COMPOSITE RATE FOR 2008, 2009, 
              AND 2010.

    Section 1881(b)(12)(G) of the Social Security Act (42 U.S.C. 
1395rr(b)(12)(G)), as amended by section 103 of the Tax Relief and 
Health Care Act of 2006 (Public Law 109-432), is amended--
            (1) in clause (i), by striking ``and'' at the end;
            (2) in clause (ii)--
                    (A) by inserting ``and before January 1, 2008,'' 
                after ``April 1, 2007''; and
                    (B) by striking the period at the end and inserting 
                a semicolon; and
            (3) by adding at the end the following new clauses:
            ``(iii) furnished during 2008, by the amount equal to the 
        ESRD market basket (as developed pursuant to section 422(b) of 
        the Medicare, Medicaid, and SCHIP Benefits Improvement and 
        Protection Act of 2000 (Public Law 106-554), as enacted into 
        law by section 1(a)(6) of Public Law 106-554) percentage 
        increase for 2008 above the amount of such composite rate 
        component for such services furnished on December 31, 2007;
            ``(iv) furnished during 2009, by the amount equal to the 
        ESRD market basket (as so developed) percentage increase for 
        2009 above the amount of such composite rate component for such 
        services furnished on December 31, 2008; and
            ``(v) furnished on or after January 1, 2010, by the amount 
        equal to the ESRD market basket (as so developed) percentage 
        increase for 2010 above the amount of such composite rate 
        component for such services furnished on December 31, 2009.''.

SEC. 203. CONTINUOUS QUALITY IMPROVEMENT INITIATIVE IN THE MEDICARE 
              END-STAGE RENAL DISEASE PROGRAM.

    (a) Establishment of the Program.--Section 1881 of the Social 
Security Act (42 U.S.C. 1395rr), as amended by section 105, is amended 
by adding at the end the following new subsection:
    ``(i) Continuous Quality Improvement Initiative in the End-Stage 
Renal Disease Program.--
            ``(1) In general.--Not later than January 1, 2008, the 
        Secretary shall establish a 3-year continuous quality 
        improvement initiative (in this section referred to as the 
        `quality initiative') under which quality payments are provided 
        to renal dialysis facilities, providers of services, and 
        physicians that provide items and services to individuals with 
        end-stage renal disease who are enrolled under part B and that 
        meet quality benchmarks and demonstrate quality improvements.
            ``(2) Participation.--
                    ``(A) Facilities and providers.--
                            ``(i) In general.--Except as provided in 
                        subparagraph (C)(i) and subject to clause (ii), 
                        all independent dialysis facilities and 
                        hospital-based dialysis providers that provide 
                        items and services to individuals with end-
                        stage renal disease who are enrolled in part B 
                        shall participate in the quality initiative.
                            ``(ii) Positive update required.--The 
                        quality initiative shall not apply to 
                        facilities and providers in a year unless the 
                        ESRD market basket percentage increase 
                        described in subsection (b)(12)(G) for such 
                        year is positive.
                    ``(B) Physicians.--
                            ``(i) In general.--Except as provided in 
                        subparagraph (C)(i) and subject to clause (ii), 
                        all physicians who receive the monthly 
                        capitated payment under this title with respect 
                        to end-stage renal disease items and services 
                        shall participate in the quality initiative.
                            ``(ii) Positive update required.--The 
                        quality initiative shall not apply to 
                        physicians in a year unless the update to the 
                        conversion factor under section 1848(d) for 
                        such year is positive.
                    ``(C) Pediatric facilities, providers, and 
                physicians.--
                            ``(i) In general.--Subject to clause (ii), 
                        a pediatric facility, provider, or physician 
                        who provides items and services to individuals 
                        with end-stage renal disease who are enrolled 
                        in part B and with at least 50 percent of its 
                        patients being individuals under 18 years of 
                        age shall be required to report data for 
                        pediatric-specific measures under this 
                        subsection in order to receive the full market 
                        basket update during 2008, 2009, and 2010 under 
                        subsection (b)(12)(G) or the full update under 
                        section 1848(d).
                            ``(ii) Positive update required.--The 
                        reporting requirement under clause (i) shall 
                        not apply to--
                                    ``(I) pediatric facilities and 
                                providers in a year unless the ESRD 
                                market basket percentage increase 
                                described in subsection (b)(12)(G) for 
                                such year is positive; and
                                    ``(II) to pediatric physicians in a 
                                year unless the update to the 
                                conversion factor under section 1848(d) 
                                for such year is positive.
                            ``(iii) Evaluation.--The Secretary, in 
                        consultation with the End-Stage Renal Disease 
                        Advisory Committee established under section 
                        201 of the Kidney Care Quality and Education 
                        Act of 2007 (in this subsection referred to as 
                        the `ESRD Advisory Committee'), shall evaluate 
                        and make recommendations to Congress regarding 
                        the feasibility of incorporating pediatric 
                        facilities, providers, and physicians described 
                        in clause (i) fully into the quality initiative 
                        if the initiative were to extend beyond 2010.
            ``(3) Duration.--The quality initiative shall be conducted 
        during a period of 3 years beginning January 1, 2008.
            ``(4) Funding.--
                    ``(A) Bonus pool for providers and facilities.--
                During 2008, 2009, and 2010, the Secretary shall set 
                aside at least \1/4\, but no more than \1/2\, of the 
                ESRD market basket amount under subsection (b)(12)(G) 
                for each year, respectively, to establish a bonus pool 
                to be used to provide bonus payments for providers and 
                facilities described in paragraph (2)(A) that 
                demonstrate improvements in quality or attainment of 
                quality benchmarks.
                    ``(B) Bonus pool for physicians.--During 2008, 
                2009, and 2010, the Secretary shall set aside at least 
                \1/4\, but no more than \1/2\, of the portion of the 
                physician fee schedule update under section 1848(d) 
                that applies to physicians who receive the monthly 
                capitated payment under this title with respect to end-
                stage renal disease items and services for each year 
                respectively to establish a bonus pool to be used to 
                provide bonus payments for physicians described in 
                paragraph (2)(B) that demonstrate improvements in 
                quality or attainment of quality benchmarks.
            ``(5) Establishment of quality incentive payments.--
                    ``(A) Incentives for reporting in 2008.--
                            ``(i) In general.--During 2008, the 
                        Secretary shall make quality incentive payments 
                        from the bonus pool described in paragraph 
                        (4)(A) to facilities and providers and from the 
                        bonus pool described in paragraph (4)(B) to 
                        physicians described in subparagraphs (A) and 
                        (B) of paragraph (2) for reporting data about 
                        clinical and quality of life measures adopted 
                        by the Secretary in consultation with the ESRD 
                        Advisory Committee.
                            ``(ii) Extension.--If the Secretary 
                        determines that there are problems associated 
                        with reporting that should be resolved before 
                        implementing the quality payment system under 
                        subparagraph (B), the Secretary may extend the 
                        reporting period an additional year.
                            ``(iii) Exception to reporting 
                        requirement.--The Secretary shall establish 
                        criteria for an application for a hardship 
                        exception that would allow small or rural 
                        facilities and providers to receive the full 
                        update under subsection (b)(12)(G) even if they 
                        are not able to report data.
                    ``(B) Quality incentive payments in 2009 and 
                2010.--
                            ``(i) In general.--During 2009 and 2010, 
                        the Secretary shall make quality incentive 
                        payments from their respective bonus pools 
                        under paragraph (4) to facilities, providers, 
                        and physicians described in subparagraphs (A) 
                        and (B) of paragraph (2) with respect to a year 
                        if the Secretary determines that the quality of 
                        care provided in that year by the facility, 
                        provider, or physician to individuals with end-
                        stage renal disease who are enrolled under part 
                        B--
                                    ``(I) has substantially improved 
                                (as determined by the Secretary in 
                                consultation with the ESRD Advisory 
                                Committee) over the prior year; or
                                    ``(II) exceeds a threshold 
                                established by the Secretary in 
                                consultation with the ESRD Advisory 
                                Committee.
                            ``(ii) Requirements.--In determining which 
                        facilities, providers, or physicians qualify 
                        for the quality incentive payments under clause 
                        (i), the Secretary shall do the following:
                                    ``(I) Adopt clinical and quality of 
                                life measures in consultation with the 
                                ESRD Advisory Committee.
                                    ``(II) For 2008, ensure that 
                                payments will be based on the reporting 
                                of data regarding clinical and quality 
                                of life measures adopted by the 
                                Secretary in consultation with the ESRD 
                                Advisory Committee.
                                    ``(III) For 2009 and 2010, subject 
                                to subparagraph (C), ensure that 
                                payments will be based upon the 
                                composite score awarded to the 
                                facilities, providers, and physicians. 
                                The composite score will be based upon 
                                the submission of data about clinical 
                                and quality of life measures adopted by 
                                the Secretary in consultation with the 
                                ESRD Advisory Committee.
                    ``(C) Determination of amount of incentive 
                payment.--
                            ``(i) In general.--Subject to clause (ii), 
                        the Secretary shall determine the amount of a 
                        quality incentive payment to a facility, 
                        provider, or physician based upon a quintile 
                        scale of a weighted composite score of clinical 
                        and quality of life measures.
                            ``(ii) Limitation.--The Secretary shall 
                        establish the quality incentive payments so 
                        that the total amount of such payments made in 
                        a year--
                                    ``(I) to facilities and providers 
                                from the bonus pool under paragraph 
                                (4)(A) is equal to the total amount 
                                available for such payments for the 
                                year under such paragraph; and
                                    ``(II) to physicians from the bonus 
                                pool under paragraph (4)(B) is equal to 
                                the total amount available for such 
                                payments for the year under such 
                                paragraph.
                    ``(D) Requirements for establishment of the 
                composite score.--In establishing the composite score 
                under this subsection, the Secretary shall--
                            ``(i) consult with the ESRD Advisory 
                        Committee to develop the clinical and quality 
                        of life measures and formula used to calculate 
                        the weighted composite score;
                            ``(ii) use a transparent process consistent 
                        with the requirements of chapter 5 of title 5, 
                        United States Code (commonly referred to as the 
                        `Administrative Procedure Act') to develop the 
                        measures and the formula used to calculate the 
                        weighted composite score; and
                            ``(iii) assure that the payments reward 
                        facilities, providers, and physicians for--
                                    ``(I) the attainment of minimum 
                                quality targets; and
                                    ``(II) substantial improvement over 
                                the previous year, as demonstrated by 
                                the movement of a facility, provider, 
                                or physician from 1 quintile to 
                                another.
            ``(6) Requirements for incentive payments.--
                    ``(A) In general.--In order for a facility, 
                provider, or physician to be eligible for quality 
                incentive payments described in paragraph (5) for a 
                year, the provider, facility, or physician must have 
                provided for the submission of data in accordance with 
                subparagraph (B) with respect to that year.
                    ``(B) Submission of data.--For 2008, 2009, and 
                2010, each facility, provider, and physician described 
                in subparagraphs (A) and (B) of paragraph (2) shall 
                submit to the Secretary such data that the Secretary 
                determines are appropriate for the measurement of 
                health outcomes and other indices of quality, including 
                data necessary for the operation of the continuous 
                quality improvement initiative under this subsection. 
                Such data shall be submitted in a form and manner, and 
                at a time, specified by the Secretary for purposes of 
                this subsection.
                    ``(C) Attestation regarding data.--In order for a 
                facility, provider, or physician to be eligible for a 
                quality incentive payment under this subsection for a 
                year, the facility, provider, or physician must have 
                provided the Secretary (under procedures established by 
                the Secretary in consultation with the ESRD Advisory 
                Committee) with an attestation that the data submitted 
                under this subsection for the year are complete and 
                accurate.
            ``(7) Payment methods and timing of payment.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                payment of quality incentive payments shall be based on 
                such method as the Secretary, in consultation with the 
                ESRD Advisory Committee, determines appropriate.
                    ``(B) Timing.--The Secretary shall ensure that 
                quality incentive payments with respect to a year are 
                made by no later than June 30 of the subsequent year.
            ``(8) Feedback.--The Secretary shall provide quality 
        incentive payments and feedback to facilities, providers, and 
        physicians as frequently as possible and as close to the date 
        on which such facilities, providers, and physicians submitted 
        quality data.
            ``(9) Technical assistance.--The Secretary shall identify 
        or establish an appropriately skilled group or organization, 
        such as the ESRD Networks, to provide technical assistance to 
        consistently low-performing facilities, providers, or 
        physicians that are in the bottom quintile.
            ``(10) Streamline reporting.--The Secretary shall--
                    ``(A) evaluate the current data systems used by 
                facilities, providers, and physicians to submit data; 
                and
                    ``(B) eliminate redundant reporting by 
                consolidating all current data reporting into a new 
                web-based system in order to minimize redundancy and 
                reduce regulatory and administrative demands.
            ``(11) Public reporting.--
                    ``(A) Availability to the public.--The Secretary 
                shall establish procedures for making weighted 
                composite scores calculated under this subsection 
                available to the public in a clear and understandable 
                form, including through its website and the 
                Medicare.gov comparison tool. Such procedures shall 
                ensure that a facility, provider, or physician has the 
                opportunity to review the data that is to be made 
                public with respect to the facility, provider, or 
                physician prior to such data being made public.
                    ``(B) Certificates.--The Secretary shall provide 
                certificates to facilities, providers, and physicians 
                who provide services to individuals with end-stage 
                renal disease under this title to display in patient 
                areas. The certificate shall indicate the weighted 
                composite score obtained by the facility, provider, or 
                physician under the quality initiative.
                    ``(C) Web-based quality list.--The Secretary shall 
                establish a web-based quality list for facilities, 
                providers, and physicians who provide items and 
                services to individuals with end-stage renal disease 
                who are enrolled under part B that indicates whether 
                measures were met or not.
            ``(12) Evaluations.--
                    ``(A) Evaluation by the secretary.--
                            ``(i) Recognizing part a savings from 
                        continuous quality improvement initiative.--Not 
                        later than January 1, 2010, the Secretary shall 
                        evaluate and make recommendations to Congress 
                        regarding the feasibility of continuing the 
                        quality initiative by funding an annual 
                        increase to the composite rate by the ESRD 
                        market basket amount under subsection 
                        (b)(12)(G) through reduced expenditures under 
                        the Federal Hospital Insurance Trust Fund as a 
                        result of the quality initiative.
                            ``(ii) Recommendations for an annual update 
                        mechanism.--Not later than 12 months after the 
                        date of enactment of this subsection, the 
                        Secretary, acting through the Administrator of 
                        the Centers for Medicare & Medicaid Services, 
                        shall submit a report to Congress using the 
                        data collected as part of the quality 
                        initiative to make recommendations about 
                        establishing a permanent update mechanism for 
                        the composite rate under this section.
                    ``(B) Evaluation by medpac.--
                            ``(i) Study.--The Medicare Payment Advisory 
                        Commission shall conduct a study on the 
                        advisability and feasibility of making the 
                        quality initiative permanent.
                            ``(ii) Report.--Not later than June 1, 
                        2009, the Commission shall submit a report to 
                        Congress and the Secretary on the study 
                        conducted under clause (i) together with 
                        recommendations for such legislation and 
                        administrative actions as the Commission 
                        considers appropriate, including the need for 
                        establishing an annual update mechanism for the 
                        composite rate under this section.
                    ``(C) Evaluation by the institute of medicine.--
                            ``(i) In general.--Not later than 2 years 
                        after the date of enactment of this subsection, 
                        the Secretary shall enter into an arrangement 
                        under which the Institute of Medicine of the 
                        National Academy of Sciences (in this section 
                        referred to as the `Institute') shall conduct 
                        an evaluation of the effectiveness of the 
                        quality initiative.
                            ``(ii) Scope of review.--The Institute 
                        shall consider a variety of perspectives, 
                        including the perspectives of facilities, 
                        providers, physicians, nurses, other health 
                        care professionals, and patients.
                            ``(iii) Report.--Not later than 3 years 
                        after the date of enactment of this subsection, 
                        the Institute shall submit to the Secretary and 
                        to Congress a report on the evaluation 
                        conducted under clause (i). Such report shall 
                        contain a detailed description of the findings 
                        of such evaluation and recommendations for 
                        implementing on an ongoing basis the quality 
                        initiative.
                            ``(iv) Authorization of appropriations.--
                        There are authorized to be appropriated such 
                        sums as may be necessary for the purpose of 
                        conducting the evaluation and preparing the 
                        report required by this subparagraph.''.

SEC. 204. EXTENSION OF MEDICARE SECONDARY PAYER.

    (a) Extension.--
            (1) In general.--Section 1862(b)(1)(C) of the Social 
        Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended--
                    (A) in the last sentence, by inserting ``, and 
                before January 1, 2008'' after ``prior to such date)''; 
                and
                    (B) by adding at the end the following new 
                sentence: ``Effective for items and services furnished 
                on or after January 1, 2008 (with respect to periods 
                beginning on or after the date that is 42 months prior 
                to such date), clauses (i) and (ii) shall be applied by 
                substituting `42-month' for `12-month' each place it 
                appears in the first sentence.''.
            (2) Effective date.--The amendments made by this subsection 
        shall take effect on the date of enactment of this Act. For 
        purposes of determining an individual's status under section 
        1862(b)(1)(C) of the Social Security Act (42 U.S.C. 
        1395y(b)(1)(C)), as amended by paragraph (1), an individual who 
        is within the coordinating period as of the date of enactment 
        of this Act shall have that period extended to the full 42 
        months described in the last sentence of such section, as added 
        by the amendment made by paragraph (1)(B).
    (b) OIG Study and Report.--
            (1) Study.--The Inspector General of the Department of 
        Health and Human Services shall conduct a study on--
                    (A) the enforcement of the provisions of section 
                1862(b)(1)(C)(ii) of the Social Security Act (42 U.S.C. 
                1395y(b)(1)(C)(ii)); and
                    (B) how effective such provisions are at protecting 
                individuals on dialysis from receiving differential 
                treatment by health plans once the individual is 
                diagnosed with end stage renal disease.
            (2) Report.--Not later than 1 year after the date of 
        enactment of this Act, the Inspector General of the Department 
        of Health and Human Services shall submit to Congress a report 
        on the study conducted under paragraph (1), together with such 
        recommendations as the Inspector General determines 
        appropriate.
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