I 

118TH CONGRESS 

1ST SESSION H. R. 5027 

To improve the understanding of, and promote access to treatment for, 

chronic kidney disease, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 27, 2023 

Mrs. MILLER of West Virginia (for herself and Ms. SEWELL) introduced the 

following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and Commerce, 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; TABLE OF CONTENTS. 

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

6 2023’’. 


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1 TITLE I—PREVENTING KIDNEY 

2 DISEASE AND EXPANDING 

3 AWARENESS AND EDUCATION 

4 SEC. 101. EXPANDING MEDICARE ANNUAL WELLNESS BEN5 EFIT TO INCLUDE KIDNEY DISEASE SCREEN6 ING. 

7 (a) IN GENERAL.—Section 1861(ww)(2) of the Social 

8 Security Act (42 U.S.C. 1395x(ww)(2)) is amended— 

9 (1) by redesignating subparagraph (O) as sub10 paragraph (P); and 

11 (2) by inserting after subparagraph (N) the fol12 lowing new subparagraph: 

13 ‘‘(O) Chronic kidney disease screening as 

14 defined by the Secretary.’’. 

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

16 this section apply to items and services furnished on or 

17 after January 1, 2022. 

18 SEC. 102. INCREASING ACCESS TO MEDICARE KIDNEY DIS19 EASE EDUCATION BENEFIT. 

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

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

22 (1) in paragraph (1)— 

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

24 stage V’’ after ‘‘stage IV’’; and 


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

2 of a physician assistant, nurse practitioner, or 

3 clinical nurse specialist (as defined in section 

4 1861(aa)(5)) assisting in the treatment of the 

5 individual’s kidney condition’’ after ‘‘kidney 

6 condition’’; and 

7 (2) in paragraph (2)— 

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

9 (B) in subparagraph (A)— 

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

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

12 clause (i); 

13 (iii) by striking the period at the end 

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

15 (iv) by redesignating clauses (i) and 

16 (ii) as subparagraphs (A) and (B), respec17 tively; and 

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

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

20 requirements of section 1881(b)(1) with per21 sonnel who— 

22 ‘‘(i) provide the services described in 

23 paragraph (1); and 

24 ‘‘(ii) is a physician (as defined in sub25 section (r)(1)) or a physician assistant, 


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1 nurse practitioner, or clinical nurse spe2 cialist (as defined in subsection (aa)(5)).’’. 

3 (b) PAYMENT TO RENAL DIALYSIS FACILITIES.— 

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

5 1395rr(b)) is amended by adding at the end the following 

6 new paragraph: 

7 ‘‘(15) For purposes of paragraph (14), the sin8 gle payment for renal dialysis services under such 

9 paragraph shall not take into account the amount of 

10 payment for kidney disease education services (as 

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

12 such services shall be made to the renal dialysis fa13 cility on an assignment-related basis under section 

14 1848.’’. 

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

16 this section apply to kidney disease education services fur17 nished on or after January 1, 2022. 

18 TITLE II—INCENTIVIZING 

19 KIDNEY CARE INNOVATION 

20 SEC. 201. REFINING THE END-STAGE RENAL DISEASE PAY21 MENT SYSTEM TO IMPROVE ACCURACY IN 

22 PAYMENT AND SUPPORT THERAPIES. 

23 (a) IN GENERAL.—Section 1881(b)(14) of the Social 

24 Security Act (42 U.S.C. 1395ww(b)(14)) is amended by 

25 adding the following new subparagraph: 


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1 ‘‘(J) PAYMENT FOR NEW AND INNOVATIVE

2 DRUGS, BIOLOGICALS, AND DEVICES THAT ARE

3 RENAL DIALYSIS SERVICES.— 

4 ‘‘(i) IN GENERAL.—For drugs or 

5 biologicals defined as within a functional 

6 category and furnished on or after Janu7 ary 1, 2024, the Secretary shall implement 

8 an add-on adjustment for claims that in9 clude such drugs or biologicals that, among 

10 other things, shall— 

11 ‘‘(I) calculate a per-treatment 

12 cost using the most recent cost and 

13 utilization data collected during a 

14 transitional payment period of not less 

15 than 3 years by dividing the total 

16 spending for such drug or biological 

17 during such transitional period by the 

18 total number of treatments for which 

19 such drug or biological was listed on 

20 such claim during such period of time; 

21 ‘‘(II) offset the amount of the 

22 add-on adjustment by an amount that 

23 corresponds with the reduction in ex24 penditures for other formerly sepa25 rately billed renal dialysis drugs that 


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1 were directly the result of the inclu2 sion of the new product; 

3 ‘‘(III) update the add-on adjust4 ment annually to account for infla5 tionary changes; and 

6 ‘‘(IV) be applied immediately 

7 upon the expiration of the TDAPA 

8 period for a product to avoid a gap 

9 between the TDAPA and availability 

10 of the post-TDAPA add-on adjust11 ment. 

12 ‘‘(ii) IMPLEMENTATION.—This policy 

13 shall not be implemented in a budget neu14 tral manner.’’. 

15 (b) NEW DEVICES AND OTHER TECHNOLOGIES.—As 

16 part of the promulgation of the annual rule for the Medi17 care end-stage renal disease prospective payment system 

18 under section 1881(b)(14) of the Social Security Act (42 

19 U.S.C. 1395rr(b)(14)) for calendar year 2022, and in con20 sultation with stakeholders, the Secretary of Health and 

21 Human Services (in this section referred to as the ‘‘Sec22 retary’’) shall ensure that the single payment amount is 

23 adequate to cover the cost of the new innovative device 

24 or other technology with substantial clinical improvement 

25 and increase the single payment amount if the Secretary 


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1 determines such payment amount is not adequate to cover 

2 such cost. In carrying out the preceding sentence, the Sec3 retary shall use the cost and utilization data collected dur4 ing a 3-year transitional payment period, as otherwise de5 scribed in the final regulation published on November 9, 

6 2020 (85 Fed. Reg. 71398 et seq.). 

7 SEC. 202. ENSURING MEDICARE ADVANTAGE SUPPORTS 

8 KIDNEY CARE INNOVATIVE THERAPIES. 

9 Section 1853(c) of the Social Security Act (42 U.S.C. 

10 1395ww–23(c)) is amended by adding the following new 

11 paragraph: 

12 ‘‘(8) ADJUSTMENT FOR INNOVATIVE PRODUCTS

13 FOR ENROLLES WITH END STAGE RENAL DIS14 EASE.—If the Secretary makes a determination with 

15 respect to the application of the End Stage Renal 

16 Disease Transitional Drug Add-On Payment Adjust17 ment or the Transitional Add-on Payment Adjust18 ment for New and Innovative Equipment and Sup19 plies to a product under this title that will result in 

20 an increase in the costs to Medicare+Choice of pro21 viding benefits under contracts under this part for 

22 the period of the Transitional Drug Add-On Pay23 ment Adjustment or the Transitional Add-on Pay24 ment Adjustment for New and Innovative Equip25 ment and Supplies, the Secretary shall directly make 


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1 the payments adjustments to providers of services or 

2 independent dialysis facilities consistent with the ap3 plication of such adjustments under the ESRD pro4 spective payment system outlined in section 

5 1881(b)(14) of this title for the complete duration 

6 that the adjustment applies under such section. 

7 After the duration of such adjustment, the Secretary 

8 shall adjust appropriately the payments to such or9 ganizations under this part. 

10 ‘‘(9) POST-TDAPA PAYMENT ADD-ON ADJUST11 MENT.—The Secretary shall require providers of 

12 services or independent dialysis facilities to apply the 

13 adjustment required under subparagraph (J) of sec14 tion 1881(b)(14) to payments made under this 

15 part.’’. 

16 SEC. 203. IMPROVING PATIENT LIVES AND QUALITY OF 

17 CARE THROUGH RESEARCH AND INNOVA18 TION. 

19 (a) STUDY.—The Secretary of Health and Human 

20 Services (in this section referred to as the ‘‘Secretary’’) 

21 shall conduct a study on increasing kidney transplantation 

22 rates. Such study shall include an analysis of each of the 

23 following: 

24 (1) Any disincentives in the payment systems 

25 under the Medicare program under title XVIII of 


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

2 that create barriers to kidney transplants and post3 transplant care for beneficiaries with end-stage renal 

4 disease. 

5 (2) The practices used by States with higher 

6 than average donation rates and whether those prac7 tices and policies could be successfully utilized in 

8 other States. 

9 (3) Practices and policies that could increase 

10 deceased donation rates of minority populations. 

11 (4) Whether cultural and policy barriers exist to 

12 increasing living donation rates, including an exam13 ination of how to better facilitate chained donations. 

14 (5) Other areas determined appropriate by the 

15 Secretary. 

16 (b) REPORT.—Not later than 18 months after the 

17 date of the enactment of this Act, the Secretary shall sub18 mit to Congress a report on the study conducted under 

19 subsection (a), together with such recommendations as the 

20 Secretary determines to be appropriate. 


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1 TITLE III—ADDRESSING THE 

2 KIDNEY CARE WORKFORCE 

3 CRISIS 

4 SEC. 301. ENSURING ACCURACY AND STABILITY IN KIDNEY 

5 CARE PAYMENT. 

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

7 U.S.C. 1395ww(b)(14)) is amended by adding the fol8 lowing new subparagraph: 

9 ‘‘(K) Beginning with calendar year 2024, 

10 the Secretary shall compute an adjustment to 

11 the annual update of the previous calendar 

12 year’s rate to account for forecast error. The 

13 initial adjustment (in calendar year 2024) to 

14 the update of the previous calendar year’s rate 

15 will take into account the cumulative forecast 

16 error between calendar years 2021 and 2022. 

17 Subsequent adjustments in succeeding fiscal 

18 years will take into account the forecast error 

19 from the most recently available calendar year 

20 for which there is final data. The forecast error 

21 adjustment shall apply whenever the difference 

22 between the forecasted and actual percentage 

23 change in the ESRD market basket index ex24 ceeds the threshold of 0.5 percentage points.’’. 


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1 SEC. 302. ENCOURAGING KIDNEY CARE WORKFORCE IN 

2 UNDER SERVED AREAS. 

3 (a) DEFINITION OF PRIMARY CARE SERVICES.—Sec4 tion 331(a)(3)(D) of the Public Health Service Act (42 

5 U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘renal di6 alysis,’’ after ‘‘dentistry,’’. 

7 (b) NATIONAL HEALTH SERVICE CORPS SCHOLAR8 SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 

9 Service Act (42 U.S.C. 254l(a)(2)) is amended by insert10 ing ‘‘, which may include nephrology health professionals’’ 

11 before the period at the end. 

12 (c) NATIONAL HEALTH SERVICE CORPS LOAN RE13 PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 

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

15 by inserting ‘‘, which may include nephrology health pro16 fessionals’’ before the period at the end. 

17 TITLE IV—EXPANDING PATIENT 

18 CHOICE OF COVERAGE 

19 SEC. 401. MEDIGAP COVERAGE FOR BENEFICIARIES WITH 

20 END-STAGE RENAL DISEASE. 

21 (a) GUARANTEED AVAILABILITY OF MEDIGAP POLI22 CIES TO ALL ESRD MEDICARE BENEFICIARIES.— 

23 (1) IN GENERAL.—Section 1882(s) of the So24 cial Security Act (42 U.S.C. 1395ss(s)) is amend25 ed— 

26 (A) in paragraph (2)— 


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1 (i) in subparagraph (A), by striking 

2 ‘‘is 65’’ and all that follows through the 

3 period and inserting the following: ‘‘is— 

4 ‘‘(i) 65 years of age or older and is 

5 enrolled for benefits under part B; or 

6 ‘‘(ii) entitled to benefits under 

7 226A(b) and is enrolled for benefits under 

8 part B.’’; and 

9 (ii) in subparagraph (D), in the mat10 ter preceding clause (i), by inserting ‘‘(or 

11 is entitled to benefits under 226A(b))’’ 

12 after ‘‘is 65 years of age or older’’; and 

13 (B) in paragraph (3)(B)— 

14 (i) in clause (ii), by inserting ‘‘(or is 

15 entitled to benefits under 226A(b))’’ after 

16 ‘‘is 65 years of age or older’’; and 

17 (ii) in clause (vi), by inserting ‘‘(or 

18 under 226A(b))’’ after ‘‘at age 65’’. 

19 (2) EFFECTIVE DATE.—The amendments made 

20 by paragraph (1) shall apply to Medicare supple21 mental policies effective on or after January 1, 

22 2022. 

23 (b) ADDITIONAL ENROLLMENT PERIOD FOR CER24 TAIN INDIVIDUALS.— 

25 (1) ONE-TIME ENROLLMENT PERIOD.— 


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1 (A) IN GENERAL.—In the case of an indi2 vidual described in subparagraph (B), the Sec3 retary of Health and Human Services shall es4 tablish a one-time enrollment period during 

5 which such an individual may enroll in any 

6 Medicare supplemental policy under section 

7 1882 of the Social Security Act (42 U.S.C. 

8 1395ss) of the individual’s choosing. 

9 (B) ENROLLMENT PERIOD.—The enroll10 ment period established under subparagraph 

11 (A) shall begin on January 1, 2023, and shall 

12 end June 30, 2023. 

13 (2) INDIVIDUAL DESCRIBED.—An individual de14 scribed in this paragraph is an individual who— 

15 (A) is entitled to hospital insurance bene16 fits under part A of title XVIII of the Social 

17 Security Act under section 226A(b) of such Act 

18 (42 U.S.C. 426–1); 

19 (B) is enrolled for benefits under part B of 

20 such title XVIII; and 

21 (C) would not, but for the provisions of, 

22 and amendments made by, subsection (a) be eli23 gible for the guaranteed issue of a Medicare 

24 supplemental policy under paragraph (2) or (3) 


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1 of section 1882(s) of such Act (42 U.S.C. 

2 1395ss(s)). 

Æ 


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