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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4814 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4814

 To improve the understanding of, and promote access to treatment for, 
            chronic kidney disease, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              June 9, 2014

 Mr. Marino (for himself and Mr. Lewis) 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 improve the understanding of, and promote access to treatment for, 
            chronic 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.

    This Act may be cited as the ``Chronic Kidney Disease Improvement 
in Research and Treatment Act of 2014''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
  TITLE I--IMPROVING UNDERSTANDING OF CHRONIC KIDNEY DISEASE THROUGH 
                   EXPANDED RESEARCH AND COORDINATION

Sec. 101. Identifying gaps in chronic kidney disease research.
Sec. 102. Coordinating research on chronic kidney disease.
Sec. 103. Understanding the progression of kidney disease and treatment 
                            of kidney failure in minority populations.
    TITLE II--PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENTS

Sec. 201. Increasing access to Medicare kidney disease education 
                            benefit.
Sec. 202. Improving access to chronic kidney disease treatment in 
                            underserved rural and urban areas.
Sec. 203. Promoting access to home dialysis treatments.
Sec. 204. Expand access for patients with acute kidney injury.
    TITLE III--CREATING ECONOMIC STABILITY FOR PROVIDERS CARING FOR 
                INDIVIDUALS WITH CHRONIC KIDNEY DISEASE

Sec. 301. Stabilizing Medicare payments for services provided to 
                            beneficiaries with stage V chronic kidney 
                            disease receiving dialysis services.
Sec. 302. Allowing individuals with kidney failure to retain access to 
                            private insurance.
Sec. 303. Providing individuals with kidney failure access to managed 
                            care and coordinated care programs.

  TITLE I--IMPROVING UNDERSTANDING OF CHRONIC KIDNEY DISEASE THROUGH 
                   EXPANDED RESEARCH AND COORDINATION

SEC. 101. IDENTIFYING GAPS IN CHRONIC KIDNEY DISEASE RESEARCH.

    (a) Report.--Not later than one year after the date of enactment of 
this Act, the Comptroller General of the United States shall develop 
and submit to the Congress a comprehensive report assessing the 
adequacy of Federal expenditures in chronic kidney disease research 
relative to Federal expenditures for chronic kidney disease care.
    (b) Contents.--The report required by this section shall--
            (1) analyze the current chronic kidney disease research 
        projects being funded by Federal agencies;
            (2) identify, including by surveying the kidney care 
        community, areas of chronic kidney disease knowledge gaps that 
        are not part of current Federal research efforts;
            (3) report on the level of Federal expenditures on kidney 
        research as compared to the amount of Federal expenditures on 
        treating individuals with chronic kidney disease; and
            (4) identify areas of kidney failure knowledge gaps in 
        research to assess treatment patterns associated with providing 
        care to minority populations that are disproportionately 
        affected by kidney failure.

SEC. 102. COORDINATING RESEARCH ON CHRONIC KIDNEY DISEASE.

    (a) Interagency Committee.--The Secretary of Health and Human 
Services shall establish and maintain an interagency committee for the 
purpose of improving the coordination of chronic kidney disease 
research.
    (b) Reports.--For the purpose described in subsection (a), the 
interagency committee established under such subsection shall issue 
public reports that--
            (1) include a strategic plan, including recommendations 
        for--
                    (A) improving communication and coordination among 
                Federal agencies;
                    (B) procedures for monitoring Federal chronic 
                kidney disease research activities; and
                    (C) ways to maximize the efficiency of the Federal 
                chronic kidney disease research investment and minimize 
                the potential for unnecessary duplication;
            (2) include a portfolio analysis that provides information 
        on chronic kidney disease research projects, organized by the 
        strategic plan objectives; and
            (3) address such other topics as the interagency committee 
        determines appropriate.
    (c) Meetings.--The interagency committee established under 
subsection (a) shall meet not less than semi-annually.

SEC. 103. UNDERSTANDING THE PROGRESSION OF KIDNEY DISEASE AND TREATMENT 
              OF KIDNEY FAILURE IN MINORITY POPULATIONS.

    Not later than one year after the date of enactment of this Act, 
the Secretary of Health and Human Services shall--
            (1) complete a study on--
                    (A) the social, behavioral, and biological factors 
                leading to kidney disease;
                    (B) efforts to slow the progression of kidney 
                disease in minority populations that are 
                disproportionately affected by such disease; and
                    (C) treatment patterns associated with providing 
                care, under the Medicare program under title XVIII of 
                the Social Security Act, the Medicaid program under 
                title XIX of such Act, and through private health 
                insurance, to minority populations that are 
                disproportionately affected by kidney failure; and
            (2) submit a report to the Congress on the results of such 
        study.

    TITLE II--PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENTS

SEC. 201. INCREASING ACCESS TO MEDICARE KIDNEY DISEASE EDUCATION 
              BENEFIT.

    (a) In General.--Section 1861(ggg) of the Social Security Act (42 
U.S.C. 1395x(ggg)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A), by inserting `` or stage 
                V'' after ``stage IV'';
                    (B) in subparagraph (B), by inserting ``or of a 
                physician assistant, nurse practitioner, or clinical 
                nurse specialist (as defined in section 1861(aa)(5)) 
                assisting in the treatment of the individual's kidney 
                condition'' after ``kidney condition''; and
            (2) in paragraph (2)--
                    (A) by striking subparagraph (B); and
                    (B) in subparagraph (A)--
                            (i) by striking ``(A)'' after ``(2)'';
                            (ii) by striking ``and'' at the end of 
                        clause (i);
                            (iii) by striking the period at the end of 
                        clause (ii) and inserting ``; and'';
                            (iv) by redesignating clauses (i) and (ii) 
                        as subparagraphs (A) and (B), respectively; and
                            (v) by adding at the end the following:
                    ``(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) is a physician (as defined in 
                        subsection (r)(1)) or a physician assistant, 
                        nurse practitioner, or clinical nurse 
                        specialist (as defined in subsection 
                        (aa)(5)).''.
    (b) Payment to Renal Dialysis Facilities.--Section 1881(b) of such 
Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following 
new paragraph:
            ``(15) For purposes of paragraph (14), the single payment 
        for renal dialysis services under such paragraph shall not take 
        into account the amount of payment for kidney disease education 
        services (as defined in section 1861(ggg)). Instead, payment 
        for such services shall be made to the renal dialysis facility 
        on an assignment-related basis under section 1848.''.
    (c) Effective Date.--The amendments made by this section apply to 
kidney disease education services furnished on or after January 1, 
2015.

SEC. 202. IMPROVING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENT IN 
              UNDERSERVED RURAL AND URBAN AREAS.

    (a) Definition of Primary Care Services.--Section 331(a)(3)(D) of 
the Public Health Service Act (42 U.S.C. 254d(a)(3)(D)) is amended by 
inserting ``and includes renal dialysis services'' before the period at 
the end.
    (b) National Health Service Corps Scholarship Program.--Section 
338A(a)(2) of the Public Health Service Act (42 U.S.C. 254l(a)(2)) is 
amended by inserting ``, including nephrologists and non-physician 
practitioners providing renal dialysis services'' before the period at 
the end.
    (c) National Health Service Corps Loan Repayment Program.--Section 
338B(a)(2) of the Public Health Service Act (42 U.S.C. 254l-1(a)(2)) is 
amended by inserting ``, including nephrologists and non-physician 
practitioners providing renal dialysis services'' before the period at 
the end.

SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREATMENTS.

    (a) Monthly Capitation Payments.--Notwithstanding any other 
provision of law, with respect to dialysis services furnished on or 
after January 1, 2015, the Secretary of Health and Human Services shall 
apply with respect to visits by a physician provided within a month to 
an end stage renal disease patient receiving dialysis services at home, 
the alternative Medicare billing procedures, as described in the final 
rule promulgated by the Secretary in the Federal Register on November 
7, 2003 (68 Fed. Reg. 63216), for physicians managing patients on 
dialysis, with respect to visits by such a physician provided within a 
month to an end stage renal disease patient who is hospitalized during 
the month.
    (b) Telehealth.--Section 1834(m)(4)(C)(ii) of the Social Security 
Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end the 
following new subclause:
                                    ``(IX) A renal dialysis facility 
                                (as defined in section 1881).''.

SEC. 204. EXPAND ACCESS FOR PATIENTS WITH ACUTE KIDNEY INJURY.

    Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is 
amended--
            (1) in paragraph (1), by inserting ``or acute kidney 
        injury'' after ``individuals who have been determined to have 
        end stage renal disease'';
            (2) in paragraph (2)(A), by inserting ``or acute kidney 
        injury'' after ``end stage renal disease'';
            (3) in paragraph (2)(B), by inserting ``or acute kidney 
        injury'' after ``end stage renal disease'';
            (4) in paragraph (3), in the matter preceding subparagraph 
        (A), by inserting ``or acute kidney injury'' after ``end stage 
        renal disease'';
            (5) in paragraph (11)(A), by inserting ``or acute kidney 
        injury'' after ``end stage renal disease'';
            (6) in paragraph (11)(B), by inserting ``or acute kidney 
        injury'' after ``end stage renal disease'';
            (7) in paragraph (14)(B)--
                    (A) in clause (ii), by inserting ``or acute kidney 
                injury'' after ``end stage renal disease'';
                    (B) in clause (iii), by inserting ``or acute kidney 
                injury'' after ``end stage renal disease''; and
                    (C) in clause (iv), by inserting ``or acute kidney 
                injury'' after ``end stage renal disease''; and
            (8) in paragraph (14)(H)(i), by inserting ``or acute kidney 
        injury'' after ``end stage renal disease''.

    TITLE III--CREATING ECONOMIC STABILITY FOR PROVIDERS CARING FOR 
                INDIVIDUALS WITH CHRONIC KIDNEY DISEASE

SEC. 301. STABILIZING MEDICARE PAYMENTS FOR SERVICES PROVIDED TO 
              BENEFICIARIES WITH STAGE V CHRONIC KIDNEY DISEASE 
              RECEIVING DIALYSIS SERVICES.

    Section 1881(b)(14) of the Social Security Act (42 U.S.C. 
1395rr(b)(14)) is amended--
            (1) in subparagraph (D), in the matter preceding clause 
        (i), by striking ``Such system'' and inserting ``Subject to 
        subparagraph (J), such system''; and
            (2) by adding at the end the following new subparagraph:
    ``(J)(i) For payment for renal dialysis services furnished on or 
after January 1, 2015, under the system under this paragraph--
            ``(I) the payment adjustment described in clause (i) of 
        subparagraph (D) shall not take into account comorbidities;
            ``(II) the payment adjustment described in clause (ii) of 
        such subparagraph shall not be included;
            ``(III) the standardization factor described in the final 
        rule published in the Federal Register on November 8, 2012 (77 
        Fed. Reg. 67470), shall be established using the most currently 
        available data (and not historical data) and adjusted on an 
        annual basis, based on such available data, to account for any 
        change in utilization of drugs and any modification in 
        adjustors applied under this paragraph; and
            ``(IV) the Secretary shall take into account reasonable 
        costs consistent with paragraph (2)(B) when calculating such 
        payments.
    ``(ii) Not later than January 1, 2015, the Secretary shall amend 
the ESRD facility cost report to--
            ``(I) include the per treatment network fee (as described 
        in paragraph (7)) as an allowable cost; and
            ``(II) eliminate the limitation for reporting medical 
        director fees on such reports in order to take into account the 
        wages of a board-certified nephrologist.''.

SEC. 302. ALLOWING INDIVIDUALS WITH KIDNEY FAILURE TO RETAIN ACCESS TO 
              PRIVATE INSURANCE.

    (a) In General.--Section 1862(b)(1)(C) of the Social Security Act 
(42 U.S.C.1395y(b)(1)(C) is amended--
            (1) in the last sentence, by inserting ``and before January 
        1, 2015'' after ``prior to such date''; and
            (2) by adding at the end the following new sentence: 
        ``Effective for items and services furnished on or after 
        January 1, 2015 (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.''.
    (b) 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 
subsection (a), 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 subsection (a)(2).

SEC. 303. PROVIDING INDIVIDUALS WITH KIDNEY FAILURE ACCESS TO MANAGED 
              CARE AND COORDINATED CARE PROGRAMS.

    (a) Expanding Access to Medicare Advantage.--
            (1) Eligibility under medicare advantage.--
                    (A) In general.--Section 1851(a)(3) of the Social 
                Security Act (42 U.S.C. 1395w-21(a)(3)) is amended--
                            (i) by striking subparagraph (B); and
                            (ii) by striking ``eligible individual.--'' 
                        and all that follows through ``In this title'' 
                        and inserting ``eligible individual.--In this 
                        title''.
                    (B) Conforming amendment.--Section 1852(b)(1) of 
                the Social Security Act (42 U.S.C. 1395w-22(b)(1)) is 
                amended--
                            (i) by striking subparagraph (B); and
                            (ii) by striking ``Beneficiaries.--'' and 
                        all that follows through ``A Medicare+Choice 
                        organization'' and inserting ``Beneficiaries.--
                        A Medicare Advantage organization''.
                    (C) Effective date.--The amendments made by this 
                paragraph shall apply with respect to plan years 
                beginning on or after January 1, 2015.
            (2) Education.--Section 1851(d)(2)(A)(iii) of the Social 
        Security Act (42 U.S.C. 1395w-21(d)(2)(A)(iii)) is amended by 
        inserting before the period at the end the following ``, 
        including any additional information that individuals 
        determined to have end stage renal disease may need to make 
        informed decisions with respect to such an election''.
            (3) Quality metrics.--Section 1852(e)(3)(A) of the Social 
        Security Act (42 U.S.C. 1395w-22(e)(3)(A)) is amended by adding 
        at the end the following new clause:
                            ``(v) Requirements with respect to 
                        individuals with esrd.--In addition to the data 
                        required to be collected, analyzed, and 
                        reported under clause (i) and notwithstanding 
                        the limitations under subparagraph (B), as part 
                        of the quality improvement program under 
                        paragraph (1), each MA organization shall 
                        provide for the collection, analysis, and 
                        reporting of data, determined in consultation 
                        with the kidney care community, that permits 
                        the measurement of health outcomes and other 
                        indices of quality with respect to individuals 
                        determined to have end stage renal disease.''.
    (b) Permanent Extension of Medicare Advantage ESRD Special Needs 
Plans Authority.--Section 1859(f)(1) of the Social Security Act (42 
U.S.C. 1395w-28(f)(1)) is amended by inserting ``, in the case of a 
specialized MA plan for special needs individuals who have not been 
determined to have end stage renal disease,'' before ``for periods 
before January 1, 2017''.
    (c) Voluntary ESRD Coordinated Care Gainsharing Program.--
            (1) In general.--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:
    ``(15)(A) Not later than January 1, 2016, the Secretary shall, in 
accordance with this paragraph, establish an ESRD Care Coordination 
gainsharing program for nephrologists, renal dialysis facilities, and 
providers of services that develop coordinated care organizations to 
provide a full range of clinical and supportive services (as described 
in subparagraph (D)) to individuals determined to have end stage renal 
disease.
    ``(B) Under such program, subject to subparagraph (C), the payment 
amounts renal dialysis facilities and providers of services described 
in subparagraph (A) would otherwise receive under paragraph (14) and 
nephrologists described in subparagraph (A) would otherwise receive 
under section 1848 with respect to dialysis services furnished by such 
a facility, provider, or nephrologist during a year, shall be increased 
by a portion of the amount (as determined by the Secretary) of actual 
reductions in expenditure under this title attributable to the 
coordinated care organization developed by such facility, provider, or 
nephrologist involved, taking into account non-dialysis expenditures 
under parts A and B, during the preceding calendar year. The payment 
amount under this subparagraph shall be provided to a nephrologist, 
renal dialysis facility, and provider of services that developed the 
coordinated care organization no later than March 31 of the year after 
the year during which such services are provided by such nephrologist, 
facility, or provider.
    ``(C) The aggregate incentive payment amounts provided under such 
program for a year may not exceed the amount equal to 2 percent less 
than the estimated total amount of non-dialysis expenditures under 
parts A and B for 2016 for items and services that are not related to 
dialysis or transplant services.
    ``(D) For purposes of subparagraph (A), the full range of clinical 
and supportive services includes at least the following:
            ``(i) Primary care and other preventative services.
            ``(ii) Specialty care for co-morbidities or non-renal acute 
        conditions, including at least podiatry, cardiology, and 
        orthopedics.
            ``(iii) Vascular access.
            ``(iv) Laboratory testing and diagnostic imaging.
            ``(v) Pharmacy care management.
            ``(vi) Patient, family, and caregiver education.
            ``(vii) Psychiatric, behavioral therapy, and counseling 
        services.
    ``(E) In providing payment incentive amounts under such program, 
the Secretary shall apply a risk adjustment methodology that--
            ``(i) uses risk adjuster factors applied under part C; and
            ``(ii) adjusts such payments to exclude the top 2 percent 
        of outliers.
    ``(F) In establishing such program, the Secretary shall ensure that 
each of the following is satisfied:
            ``(i) The program allows for all types and sizes of renal 
        dialysis facilities and providers of services described in 
        subparagraph (A), including profit and not-for-profit, urban 
        and rural, as well as all other types and sizes of such 
        facilities and providers, to participate.
            ``(ii) The program rewards high quality, efficient 
        facilities and providers through gain-sharing.
            ``(iii) For purposes of determining the actual reductions 
        in expenditures under this title attributable to a coordinated 
        care organization described in subparagraph (A), the program 
        includes a market-based benchmark system that will not be 
        rebased against which such expenditures shall be compared.
            ``(iv) The program results in reductions of expenditures 
        under parts A and B for services that are not dialysis-related 
        services.
            ``(v) The program allows new applicants to participate in 
        the program after the initial implementation period.
            ``(vi) The program establishes clear quality metrics in 
        consultation with the kidney care community.
            ``(vii) The program provides for waivers of Federal laws or 
        requirements, in consultation with interested stakeholders.
            ``(viii) Under such program the Secretary attributes 
        individuals described in subparagraph (A) who receive treatment 
        through a care coordination organization described in such 
        subparagraph to such organization rather than to any other 
        payment model that requires beneficiary attribution.
            ``(ix) Under such program the Secretary provides quarterly 
        Medicare parts A and B claims data to facilities and providers 
        described in subparagraph (A) participating in such program.
    ``(G) Not later than three years after the date of the 
implementation of the ESRD Care Coordination gainsharing program, the 
Secretary shall submit to the Congress a report on the waivers granted 
under subparagraph (F)(vii) and the effectiveness of such waivers in 
allowing the coordination of care.''.
            (2) Conforming amendments.--
                    (A) Section 1881.--Section 1881(b) of the Social 
                Security Act (42 U.S.C. 1395rr(b)) is amended--
                            (i) in each of paragraphs (12)(A) and 
                        (13)(A), by striking ``paragraph (14)'' and 
                        inserting ``paragraphs (14) and (15)''; and
                            (ii) in paragraph (14)(A)(i), by inserting 
                        ``and paragraph (15)'' after ``Subject to 
                        subparagraph (E)''.
                    (B) Section 1848.--Section 1848 of the Social 
                Security Act (42 U.S.C. 1395w-4) is amended by adding 
                at the end the following new subsection:
    ``(q) Voluntary ESRD Coordinated Care Program.--For provisions 
related to incentive payment amounts to nephrologists under the ESRD 
Care Coordination gainsharing program, see section 1881(b)(15).''.
    (d) Patient Information Requirement.--The Secretary of Health and 
Human Services shall require hospitals that furnish items and services 
to individuals entitled to benefits under part A of title XVIII of the 
Social Security Act or eligible for benefits under part B of such title 
and who subsequently receive dialysis services at a renal dialysis 
facility (as defined in section 1881 of such Act (42 U.S.C. 1395rr)) to 
provide to such facility health information with respect to such 
individual, including a discharge summary and co-morbidity information, 
upon request of the facility, not later than 7 days after notification 
by the hospital of the provision of such services to such individual or 
of the determination that such individual has end stage renal disease, 
as applicable.
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