I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

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

6 2014’’. 

7 SEC. 2. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Table of contents. 


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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. 

1 TITLE I—IMPROVING UNDER2 STANDING OF CHRONIC KID3 NEY DISEASE THROUGH EX4 PANDED RESEARCH AND CO5 ORDINATION 

6 SEC. 101. IDENTIFYING GAPS IN CHRONIC KIDNEY DISEASE 

7 RESEARCH. 

8 (a) REPORT.—Not later than one year after the date 

9 of enactment of this Act, the Comptroller General of the 

10 United States shall develop and submit to the Congress 

11 a comprehensive report assessing the adequacy of Federal 

12 expenditures in chronic kidney disease research relative to 

13 Federal expenditures for chronic kidney disease care. 


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1 (b) CONTENTS.—The report required by this section 

2 shall— 

3 (1) analyze the current chronic kidney disease 

4 research projects being funded by Federal agencies; 

5 (2) identify, including by surveying the kidney 

6 care community, areas of chronic kidney disease 

7 knowledge gaps that are not part of current Federal 

8 research efforts; 

9 (3) report on the level of Federal expenditures 

10 on kidney research as compared to the amount of 

11 Federal expenditures on treating individuals with 

12 chronic kidney disease; and 

13 (4) identify areas of kidney failure knowledge 

14 gaps in research to assess treatment patterns associ15 ated with providing care to minority populations 

16 that are disproportionately affected by kidney fail17 ure. 

18 SEC. 102. COORDINATING RESEARCH ON CHRONIC KIDNEY 

19 DISEASE. 

20 (a) INTERAGENCY COMMITTEE.—The Secretary of 

21 Health and Human Services shall establish and maintain 

22 an interagency committee for the purpose of improving the 

23 coordination of chronic kidney disease research. 


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1 (b) REPORTS.—For the purpose described in sub2 section (a), the interagency committee established under 

3 such subsection shall issue public reports that— 

4 (1) include a strategic plan, including rec5 ommendations for— 

6 (A) improving communication and coordi7 nation among Federal agencies; 

8 (B) procedures for monitoring Federal 

9 chronic kidney disease research activities; and 

10 (C) ways to maximize the efficiency of the 

11 Federal chronic kidney disease research invest12 ment and minimize the potential for unneces13 sary duplication; 

14 (2) include a portfolio analysis that provides in15 formation on chronic kidney disease research 

16 projects, organized by the strategic plan objectives; 

17 and 

18 (3) address such other topics as the interagency 

19 committee determines appropriate. 

20 (c) MEETINGS.—The interagency committee estab21 lished under subsection (a) shall meet not less than semi22 annually. 


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1 SEC. 103. UNDERSTANDING THE PROGRESSION OF KIDNEY 

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

4 Not later than one year after the date of enactment 

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

6 shall— 

7 (1) complete a study on— 

8 (A) the social, behavioral, and biological 

9 factors leading to kidney disease; 

10 (B) efforts to slow the progression of kid11 ney disease in minority populations that are 

12 disproportionately affected by such disease; and 

13 (C) treatment patterns associated with 

14 providing care, under the Medicare program 

15 under title XVIII of the Social Security Act, the 

16 Medicaid program under title XIX of such Act, 

17 and through private health insurance, to minor18 ity populations that are disproportionately af19 fected by kidney failure; and 

20 (2) submit a report to the Congress on the re21 sults of such study. 


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1 TITLE II—PROMOTING ACCESS 

2 TO CHRONIC KIDNEY DIS3 EASE TREATMENTS 

4 SEC. 201. INCREASING ACCESS TO MEDICARE KIDNEY DIS5 EASE EDUCATION BENEFIT. 

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

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

8 (1) in paragraph (1)— 

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

10 stage V’’ after ‘‘stage IV’’; 

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

12 of a physician assistant, nurse practitioner, or 

13 clinical nurse specialist (as defined in section 

14 1861(aa)(5)) assisting in the treatment of the 

15 individual’s kidney condition’’ after ‘‘kidney 

16 condition’’; and 

17 (2) in paragraph (2)— 

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

19 (B) in subparagraph (A)— 

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

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

22 clause (i); 

23 (iii) by striking the period at the end 

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


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1 (iv) by redesignating clauses (i) and 

2 (ii) as subparagraphs (A) and (B), respec3 tively; and 

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

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

6 requirements of section 1881(b)(1) with per7 sonnel who— 

8 ‘‘(i) provide the services described in 

9 paragraph (1); and 

10 ‘‘(ii) is a physician (as defined in sub11 section (r)(1)) or a physician assistant, 

12 nurse practitioner, or clinical nurse spe13 cialist (as defined in subsection (aa)(5)).’’. 

14 (b) PAYMENT TO RENAL DIALYSIS FACILITIES.— 

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

16 amended by adding at the end the following new para17 graph: 

18 ‘‘(15) For purposes of paragraph (14), the sin19 gle payment for renal dialysis services under such 

20 paragraph shall not take into account the amount of 

21 payment for kidney disease education services (as 

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

23 such services shall be made to the renal dialysis fa24 cility on an assignment-related basis under section 

25 1848.’’. 


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

2 this section apply to kidney disease education services fur3 nished on or after January 1, 2015. 

4 SEC. 202. IMPROVING ACCESS TO CHRONIC KIDNEY DIS5 EASE TREATMENT IN UNDERSERVED RURAL 

6 AND URBAN AREAS. 

7 (a) DEFINITION OF PRIMARY CARE SERVICES.—Sec8 tion 331(a)(3)(D) of the Public Health Service Act (42 

9 U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘and in10 cludes renal dialysis services’’ before the period at the end. 

11 (b) NATIONAL HEALTH SERVICE CORPS SCHOLAR12 SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 

13 Service Act (42 U.S.C. 254l(a)(2)) is amended by insert14 ing ‘‘, including nephrologists and non-physician practi15 tioners providing renal dialysis services’’ before the period 

16 at the end. 

17 (c) NATIONAL HEALTH SERVICE CORPS LOAN RE18 PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 

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

20 by inserting ‘‘, including nephrologists and non-physician 

21 practitioners providing renal dialysis services’’ before the 

22 period at the end. 


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1 SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREAT2 MENTS. 

3 (a) MONTHLY CAPITATION PAYMENTS.—Notwith4 standing any other provision of law, with respect to dialy5 sis services furnished on or after January 1, 2015, the 

6 Secretary of Health and Human Services shall apply with 

7 respect to visits by a physician provided within a month 

8 to an end stage renal disease patient receiving dialysis 

9 services at home, the alternative Medicare billing proce10 dures, as described in the final rule promulgated by the 

11 Secretary in the Federal Register on November 7, 2003 

12 (68 Fed. Reg. 63216), for physicians managing patients 

13 on dialysis, with respect to visits by such a physician pro14 vided within a month to an end stage renal disease patient 

15 who is hospitalized during the month. 

16 (b) TELEHEALTH.—Section 1834(m)(4)(C)(ii) of the 

17 Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is 

18 amended by adding at the end the following new sub19 clause: 

20 ‘‘(IX) A renal dialysis facility (as 

21 defined in section 1881).’’. 

22 SEC. 204. EXPAND ACCESS FOR PATIENTS WITH ACUTE KID23 NEY INJURY. 

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

25 1395rr(b)) is amended— 


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1 (1) in paragraph (1), by inserting ‘‘or acute 

2 kidney injury’’ after ‘‘individuals who have been de3 termined to have end stage renal disease’’; 

4 (2) in paragraph (2)(A), by inserting ‘‘or acute 

5 kidney injury’’ after ‘‘end stage renal disease’’; 

6 (3) in paragraph (2)(B), by inserting ‘‘or acute 

7 kidney injury’’ after ‘‘end stage renal disease’’; 

8 (4) in paragraph (3), in the matter preceding 

9 subparagraph (A), by inserting ‘‘or acute kidney in10 jury’’ after ‘‘end stage renal disease’’; 

11 (5) in paragraph (11)(A), by inserting ‘‘or 

12 acute kidney injury’’ after ‘‘end stage renal disease’’; 

13 (6) in paragraph (11)(B), by inserting ‘‘or 

14 acute kidney injury’’ after ‘‘end stage renal disease’’; 

15 (7) in paragraph (14)(B)— 

16 (A) in clause (ii), by inserting ‘‘or acute 

17 kidney injury’’ after ‘‘end stage renal disease’’; 

18 (B) in clause (iii), by inserting ‘‘or acute 

19 kidney injury’’ after ‘‘end stage renal disease’’; 

20 and 

21 (C) in clause (iv), by inserting ‘‘or acute 

22 kidney injury’’ after ‘‘end stage renal disease’’; 

23 and 

24 (8) in paragraph (14)(H)(i), by inserting ‘‘or 

25 acute kidney injury’’ after ‘‘end stage renal disease’’. 


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1 TITLE III—CREATING ECONOMIC 

2 STABILITY FOR PROVIDERS 

3 CARING FOR INDIVIDUALS 

4 WITH CHRONIC KIDNEY DIS5 EASE 

6 SEC. 301. STABILIZING MEDICARE PAYMENTS FOR SERV7 ICES PROVIDED TO BENEFICIARIES WITH 

8 STAGE V CHRONIC KIDNEY DISEASE RECEIV9 ING DIALYSIS SERVICES. 

10 Section 1881(b)(14) of the Social Security Act (42 

11 U.S.C. 1395rr(b)(14)) is amended— 

12 (1) in subparagraph (D), in the matter pre13 ceding clause (i), by striking ‘‘Such system’’ and in14 serting ‘‘Subject to subparagraph (J), such system’’; 

15 and 

16 (2) by adding at the end the following new sub17 paragraph: 

18 ‘‘(J)(i) For payment for renal dialysis services fur19 nished on or after January 1, 2015, under the system 

20 under this paragraph— 

21 ‘‘(I) the payment adjustment described in 

22 clause (i) of subparagraph (D) shall not take into 

23 account comorbidities; 


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1 ‘‘(II) the payment adjustment described in 

2 clause (ii) of such subparagraph shall not be in3 cluded; 

4 ‘‘(III) the standardization factor described in 

5 the final rule published in the Federal Register on 

6 November 8, 2012 (77 Fed. Reg. 67470), shall be 

7 established using the most currently available data 

8 (and not historical data) and adjusted on an annual 

9 basis, based on such available data, to account for 

10 any change in utilization of drugs and any modifica11 tion in adjustors applied under this paragraph; and 

12 ‘‘(IV) the Secretary shall take into account rea13 sonable costs consistent with paragraph (2)(B) when 

14 calculating such payments. 

15 ‘‘(ii) Not later than January 1, 2015, the Secretary 

16 shall amend the ESRD facility cost report to— 

17 ‘‘(I) include the per treatment network fee (as 

18 described in paragraph (7)) as an allowable cost; 

19 and 

20 ‘‘(II) eliminate the limitation for reporting med21 ical director fees on such reports in order to take 

22 into account the wages of a board-certified 

23 nephrologist.’’. 


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1 SEC. 302. ALLOWING INDIVIDUALS WITH KIDNEY FAILURE 

2 TO RETAIN ACCESS TO PRIVATE INSURANCE. 

3 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So4 cial Security Act (42 U.S.C.1395y(b)(1)(C) is amended— 

5 (1) in the last sentence, by inserting ‘‘and be6 fore January 1, 2015’’ after ‘‘prior to such date’’; 

7 and 

8 (2) by adding at the end the following new sen9 tence: ‘‘Effective for items and services furnished on 

10 or after January 1, 2015 (with respect to periods 

11 beginning on or after the date that is 42 months 

12 prior to such date), clauses (i) and (ii) shall be ap13 plied by substituting ‘42-month’ for ‘12-month’ each 

14 place it appears.’’. 

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

16 this subsection shall take effect on the date of enactment 

17 of this Act. For purposes of determining an individual’s 

18 status under section 1862(b)(1)(C) of the Social Security 

19 Act (42 U.S.C. 1395y(b)(1)(C)), as amended by sub20 section (a), an individual who is within the coordinating 

21 period as of the date of enactment of this Act shall have 

22 that period extended to the full 42 months described in 

23 the last sentence of such section, as added by the amend24 ment made by subsection (a)(2). 


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1 SEC. 303. PROVIDING INDIVIDUALS WITH KIDNEY FAILURE 

2 ACCESS TO MANAGED CARE AND COORDI3 NATED CARE PROGRAMS. 

4 (a) EXPANDING ACCESS TO MEDICARE ADVAN5 TAGE.— 

6 (1) ELIGIBILITY UNDER MEDICARE ADVAN7 TAGE.— 

8 (A) IN GENERAL.—Section 1851(a)(3) of 

9 the Social Security Act (42 U.S.C. 1395w– 

10 21(a)(3)) is amended— 

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

12 (ii) by striking ‘‘ELIGIBLE INDI13 VIDUAL.—’’ and all that follows through 

14 ‘‘In this title’’ and inserting ‘‘ELIGIBLE IN15 DIVIDUAL.—In this title’’. 

16 (B) CONFORMING AMENDMENT.—Section 

17 1852(b)(1) of the Social Security Act (42 

18 U.S.C. 1395w–22(b)(1)) is amended— 

19 (i) by striking subparagraph (B); and 

20 (ii) by striking ‘‘BENEFICIARIES.—’’ 

21 and all that follows through ‘‘A 

22 Medicare+Choice organization’’ and in23 serting ‘‘BENEFICIARIES.—A Medicare Ad24 vantage organization’’. 

25 (C) EFFECTIVE DATE.—The amendments 

26 made by this paragraph shall apply with respect 


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1 to plan years beginning on or after January 1, 

2 2015. 

3 (2) EDUCATION.—Section 1851(d)(2)(A)(iii) of 

4 the Social Security Act (42 U.S.C. 1395w– 

5 21(d)(2)(A)(iii)) is amended by inserting before the 

6 period at the end the following ‘‘, including any ad7 ditional information that individuals determined to 

8 have end stage renal disease may need to make in9 formed decisions with respect to such an election’’. 

10 (3) QUALITY METRICS.—Section 1852(e)(3)(A) 

11 of the Social Security Act (42 U.S.C. 1395w– 

12 22(e)(3)(A)) is amended by adding at the end the 

13 following new clause: 

14 ‘‘(v) REQUIREMENTS WITH RESPECT

15 TO INDIVIDUALS WITH ESRD.—In addition 

16 to the data required to be collected, ana17 lyzed, and reported under clause (i) and 

18 notwithstanding the limitations under sub19 paragraph (B), as part of the quality im20 provement program under paragraph (1), 

21 each MA organization shall provide for the 

22 collection, analysis, and reporting of data, 

23 determined in consultation with the kidney 

24 care community, that permits the measure25 ment of health outcomes and other indices 


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1 of quality with respect to individuals deter2 mined to have end stage renal disease.’’. 

3 (b) PERMANENT EXTENSION OF MEDICARE ADVAN4 TAGE ESRD SPECIAL NEEDS PLANS AUTHORITY.—Sec5 tion 1859(f)(1) of the Social Security Act (42 U.S.C. 

6 1395w–28(f)(1)) is amended by inserting ‘‘, in the case 

7 of a specialized MA plan for special needs individuals who 

8 have not been determined to have end stage renal dis9 ease,’’ before ‘‘for periods before January 1, 2017’’. 

10 (c) VOLUNTARY ESRD COORDINATED CARE

11 GAINSHARING PROGRAM.— 

12 (1) IN GENERAL.—Section 1881(b) of the So13 cial Security Act (42 U.S.C. 1395rr(b)) is amended 

14 by adding at the end the following new paragraph: 

15 ‘‘(15)(A) Not later than January 1, 2016, the Sec16 retary shall, in accordance with this paragraph, establish 

17 an ESRD Care Coordination gainsharing program for 

18 nephrologists, renal dialysis facilities, and providers of 

19 services that develop coordinated care organizations to 

20 provide a full range of clinical and supportive services (as 

21 described in subparagraph (D)) to individuals determined 

22 to have end stage renal disease. 

23 ‘‘(B) Under such program, subject to subparagraph 

24 (C), the payment amounts renal dialysis facilities and pro25 viders of services described in subparagraph (A) would 


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1 otherwise receive under paragraph (14) and nephrologists 

2 described in subparagraph (A) would otherwise receive 

3 under section 1848 with respect to dialysis services fur4 nished by such a facility, provider, or nephrologist during 

5 a year, shall be increased by a portion of the amount (as 

6 determined by the Secretary) of actual reductions in ex7 penditure under this title attributable to the coordinated 

8 care organization developed by such facility, provider, or 

9 nephrologist involved, taking into account non-dialysis ex10 penditures under parts A and B, during the preceding cal11 endar year. The payment amount under this subparagraph 

12 shall be provided to a nephrologist, renal dialysis facility, 

13 and provider of services that developed the coordinated 

14 care organization no later than March 31 of the year after 

15 the year during which such services are provided by such 

16 nephrologist, facility, or provider. 

17 ‘‘(C) The aggregate incentive payment amounts pro18 vided under such program for a year may not exceed the 

19 amount equal to 2 percent less than the estimated total 

20 amount of non-dialysis expenditures under parts A and 

21 B for 2016 for items and services that are not related 

22 to dialysis or transplant services. 

23 ‘‘(D) For purposes of subparagraph (A), the full 

24 range of clinical and supportive services includes at least 

25 the following: 


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1 ‘‘(i) Primary care and other preventative serv2 ices. 

3 ‘‘(ii) Specialty care for co-morbidities or non4 renal acute conditions, including at least podiatry, 

5 cardiology, and orthopedics. 

6 ‘‘(iii) Vascular access. 

7 ‘‘(iv) Laboratory testing and diagnostic imag8 ing. 

9 ‘‘(v) Pharmacy care management. 

10 ‘‘(vi) Patient, family, and caregiver education. 

11 ‘‘(vii) Psychiatric, behavioral therapy, and coun12 seling services. 

13 ‘‘(E) In providing payment incentive amounts under 

14 such program, the Secretary shall apply a risk adjustment 

15 methodology that— 

16 ‘‘(i) uses risk adjuster factors applied under 

17 part C; and 

18 ‘‘(ii) adjusts such payments to exclude the top 

19 2 percent of outliers. 

20 ‘‘(F) In establishing such program, the Secretary 

21 shall ensure that each of the following is satisfied: 

22 ‘‘(i) The program allows for all types and sizes 

23 of renal dialysis facilities and providers of services 

24 described in subparagraph (A), including profit and 

25 not-for-profit, urban and rural, as well as all other 


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1 types and sizes of such facilities and providers, to 

2 participate. 

3 ‘‘(ii) The program rewards high quality, effi4 cient facilities and providers through gain-sharing. 

5 ‘‘(iii) For purposes of determining the actual 

6 reductions in expenditures under this title attrib7 utable to a coordinated care organization described 

8 in subparagraph (A), the program includes a mar9 ket-based benchmark system that will not be rebased 

10 against which such expenditures shall be compared. 

11 ‘‘(iv) The program results in reductions of ex12 penditures under parts A and B for services that are 

13 not dialysis-related services. 

14 ‘‘(v) The program allows new applicants to par15 ticipate in the program after the initial implementa16 tion period. 

17 ‘‘(vi) The program establishes clear quality 

18 metrics in consultation with the kidney care commu19 nity. 

20 ‘‘(vii) The program provides for waivers of Fed21 eral laws or requirements, in consultation with inter22 ested stakeholders. 

23 ‘‘(viii) Under such program the Secretary at24 tributes individuals described in subparagraph (A) 

25 who receive treatment through a care coordination 


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1 organization described in such subparagraph to such 

2 organization rather than to any other payment 

3 model that requires beneficiary attribution. 

4 ‘‘(ix) Under such program the Secretary pro5 vides quarterly Medicare parts A and B claims data 

6 to facilities and providers described in subparagraph 

7 (A) participating in such program. 

8 ‘‘(G) Not later than three years after the date of the 

9 implementation of the ESRD Care Coordination 

10 gainsharing program, the Secretary shall submit to the 

11 Congress a report on the waivers granted under subpara12 graph (F)(vii) and the effectiveness of such waivers in al13 lowing the coordination of care.’’. 

14 (2) CONFORMING AMENDMENTS.— 

15 (A) SECTION 1881.—Section 1881(b) of the 

16 Social Security Act (42 U.S.C. 1395rr(b)) is 

17 amended— 

18 (i) in each of paragraphs (12)(A) and 

19 (13)(A), by striking ‘‘paragraph (14)’’ and 

20 inserting ‘‘paragraphs (14) and (15)’’; and 

21 (ii) in paragraph (14)(A)(i), by insert22 ing ‘‘and paragraph (15)’’ after ‘‘Subject 

23 to subparagraph (E)’’. 

24 (B) SECTION 1848.—Section 1848 of the 

25 Social Security Act (42 U.S.C. 1395w–4) is 


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1 amended by adding at the end the following 

2 new subsection: 

3 ‘‘(q) VOLUNTARY ESRD COORDINATED CARE PRO4 GRAM.—For provisions related to incentive payment 

5 amounts to nephrologists under the ESRD Care Coordina6 tion gainsharing program, see section 1881(b)(15).’’. 

7 (d) PATIENT INFORMATION REQUIREMENT.—The 

8 Secretary of Health and Human Services shall require 

9 hospitals that furnish items and services to individuals en10 titled to benefits under part A of title XVIII of the Social 

11 Security Act or eligible for benefits under part B of such 

12 title and who subsequently receive dialysis services at a 

13 renal dialysis facility (as defined in section 1881 of such 

14 Act (42 U.S.C. 1395rr)) to provide to such facility health 

15 information with respect to such individual, including a 

16 discharge summary and co-morbidity information, upon 

17 request of the facility, not later than 7 days after notifica18 tion by the hospital of the provision of such services to 

19 such individual or of the determination that such indi20 vidual has end stage renal disease, as applicable. 

Æ 


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