I 

110TH CONGRESS 

1ST SESSION H. R. 1245 

To amend title XVIII of the Social Security Act to provide coverage for 

kidney disease education services under the Medicare Program, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 28, 2007 

Mr. KIRK (for himself and Mr. MCDERMOTT) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

coverage for kidney disease education services under the 

Medicare Program, 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 ‘‘Kidney Disease Edu5 cational Benefits Act of 2007’’. 


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1 SEC. 2. MEDICARE COVERAGE OF KIDNEY DISEASE EDU2 CATION SERVICES. 

3 (a) COVERAGE OF KIDNEY DISEASE EDUCATION

4 SERVICES.— 

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

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

7 (A) in subsection (s)(2)— 

8 (i) in subparagraph (Z), by striking 

9 ‘‘and’’ at the end; 

10 (ii) in subparagraph (AA), by adding 

11 ‘‘and’’ at the end; and 

12 (iii) by adding at the end the fol13 lowing new subparagraph: 

14 ‘‘(BB) kidney disease education services (as de15 fined in subsection (ccc));’’; and 

16 (B) by adding at the end the following new 

17 subsection: 

18 ‘‘(ccc) KIDNEY DISEASE EDUCATION SERVICES.—(1) 

19 The term ‘kidney disease education services’ means edu20 cational services that are— 

21 ‘‘(A) furnished to an individual with kidney dis22 ease who, according to accepted clinical guidelines 

23 identified by the Secretary, will require dialysis or a 

24 kidney transplant; 


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1 ‘‘(B) furnished, upon the referral of the physi2 cian managing the individual’s kidney condition, by 

3 a qualified person (as defined in paragraph (2)); and 

4 ‘‘(C) designed— 

5 ‘‘(i) to provide comprehensive information 

6 regarding— 

7 ‘‘(I) the management of comorbidities; 

8 ‘‘(II) the prevention of uremic com9 plications; and 

10 ‘‘(III) each option for renal replace11 ment therapy (including home and in-cen12 ter, as well as vascular access options and 

13 transplantation); and 

14 ‘‘(ii) to ensure that the individual has the 

15 opportunity to actively participate in the choice 

16 of therapy. 

17 ‘‘(2) The term ‘qualified person’ means— 

18 ‘‘(A) a physician (as described in subsection 

19 (r)(1)); 

20 ‘‘(B) an individual who— 

21 ‘‘(i) is— 

22 ‘‘(I) a registered nurse; 

23 ‘‘(II) a registered dietitian or nutri24 tion professional (as defined in subsection 

25 (vv)(2)); 


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1 ‘‘(III) a clinical social worker (as de2 fined in subsection (hh)(1)); 

3 ‘‘(IV) a physician assistant, nurse 

4 practitioner, or clinical nurse specialist (as 

5 those terms are defined in subsection 

6 (aa)(5)); or 

7 ‘‘(V) a transplant coordinator; and 

8 ‘‘(ii) meets such requirements related to 

9 experience and other qualifications that the 

10 Secretary finds necessary and appropriate for 

11 furnishing the services described in paragraph 

12 (1); or 

13 ‘‘(C) a renal dialysis facility subject to the re14 quirements of section 1881(b)(1) with personnel 

15 who— 

16 ‘‘(i) provide the services described in para17 graph (1); and 

18 ‘‘(ii) meet the requirements of subpara19 graph (A) or (B). 

20 ‘‘(3) The Secretary shall develop the requirements 

21 under paragraph (2)(B)(ii) after consulting with physi22 cians, health educators, professional organizations, accred23 iting organizations, kidney patient organizations, dialysis 

24 facilities, transplant centers, network organizations deVerDate Aug 31 2005 18:43 Mar 03, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1245.IH H1245

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1 scribed in section 1881(c)(2), and other knowledgeable 

2 persons. 

3 ‘‘(4) In promulgating regulations to carry out this 

4 subsection, the Secretary shall ensure that each bene5 ficiary who is entitled to kidney disease education services 

6 under this title receives such services in a timely manner 

7 that ensures that the beneficiary receives the maximum 

8 benefit of those services. 

9 ‘‘(5) The Secretary shall monitor the implementation 

10 of this subsection to ensure that beneficiaries who are eli11 gible for kidney disease education services receive such 

12 services in the manner described in paragraph (4). 

13 ‘‘(6) No individual shall be eligible to be provided 

14 more than 6 sessions of kidney disease education services 

15 under this title.’’. 

16 (2) PAYMENT UNDER PHYSICIAN FEE SCHED17 ULE.—Section 1848(j)(3) of the Social Security Act 

18 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

19 ‘‘(2)(BB),’’, after ‘‘(2)(AA),’’. 

20 (3) PAYMENT TO RENAL DIALYSIS FACILI21 TIES.—Section 1881(b) of the Social Security Act 

22 (42 U.S.C. 1395rr(b)) is amended by adding at the 

23 end the following new paragraph: 

24 ‘‘(14) For purposes of paragraph (12), the sin25 gle composite weighted formulas determined under 


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1 such paragraph shall not take into account the 

2 amount of payment for kidney disease education 

3 services (as defined in section 1861(ccc)). Instead, 

4 payment for such services shall be made to the renal 

5 dialysis facility on an assignment-related basis under 

6 section 1848.’’. 

7 (4) LIMITATION ON NUMBER OF SESSIONS.— 

8 Section 1862(a)(1) of the Social Security Act (42 

9 U.S.C. 1395y(a)(1)) is amended— 

10 (A) by striking ‘‘and’’ at the end of sub11 paragraph (M); 

12 (B) by striking the semicolon at the end of 

13 subparagraph (N) and inserting ‘‘, and’’; and 

14 (C) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(O) in the case of kidney disease education 

17 services (as defined in section 1861(ccc)), which are 

18 performed in excess of the number of sessions cov19 ered under such section;’’. 

20 (5) ANNUAL REPORT TO CONGRESS.—Not later 

21 than April 1, 2008, and annually thereafter, the 

22 Secretary of Health and Human Services shall sub23 mit to Congress a report on the number of medicare 

24 beneficiaries who are entitled to kidney disease edu25 cation services (as defined in section 1861(ccc) of 


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1 the Social Security Act, as added by paragraph (1)) 

2 under title XVIII of such Act and who receive such 

3 services, together with such recommendations for 

4 legislative and administrative action as the Secretary 

5 determines to be appropriate to fulfill the legislative 

6 intent that resulted in the enactment of that sub7 section. 

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

9 this section shall apply to services furnished on or after 

10 January 1, 2008. 

Æ 


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