II 

109TH CONGRESS 

1ST SESSION S. 635 

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 

MARCH 16, 2005 

Mr. SANTORUM (for himself, Mr. CONRAD, and Mrs. MURRAY) 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. 

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 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Kidney Care Quality and Improvement Act of 2005’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title. 

TITLE I—RECOGNIZING AND IMPROVING QUALITY FOR PATIENTS 
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Sec. 101. Modification of physician surgical reimbursement for dialysis access 

procedures to align incentives for cost and quality. 

Sec. 102. Demonstration project for outcomes-based ESRD reimbursement system. 

Sec. 103. Required training for patient care dialysis technicians. 

TITLE II—ENSURING QUALITY THROUGH IMPROVEMENTS IN 

THE ESRD PAYMENT SYSTEM 

Sec. 201. Establishment of annual update framework for the medicare ESRD 

composite rate. 

Sec. 202. Extension of medicare secondary payer. 

Sec. 203. GAO study and report on impact of G-codes. 

TITLE III—IMPROVING QUALITY THROUGH PATIENT EDUCATION, 

ACCESS, AND SAFETY INITIATIVES 

Sec. 301. Support of public and patient education initiatives regarding kidney 

disease. 

Sec. 302. Medicare coverage of kidney disease patient education services. 

Sec. 303. Blood flow monitoring demonstration projects. 

TITLE IV—IMPROVING QUALITY THROUGH IMPROVED COVERAGE 

Sec. 401. Improving the home dialysis benefit. 

Sec. 402. Institute of Medicine evaluation and report on home dialysis. 

Sec. 403. Establishment of an End-Stage Renal Disease (ESRD) Advisory 

committee. 

1 TITLE I—RECOGNIZING AND IM2 PROVING QUALITY FOR PA3 TIENTS 

4 SEC. 101. MODIFICATION OF PHYSICIAN SURGICAL REIM5 BURSEMENT FOR DIALYSIS ACCESS PROCE6 DURES TO ALIGN INCENTIVES FOR COST AND 

7 QUALITY. 

8 (a) FULL COVERAGE OF DIALYSIS ACCESS PROCE9 DURES IN THE AMBULATORY SURGICAL CENTER SET10 TING.—Not later than January 1, 2007, the Secretary of 

11 Health and Human Services shall— 

12 (1) review the surgical procedures specified 

13 under section 1833(i)(1) of the Social Security Act 
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1 (42 U.S.C. 1395l(i)(1)) and evaluate whether to in2 clude in such procedures the full range of dialysis 

3 access procedures, including all reasonable and nec4 essary intervention procedures for the repair and 

5 maintenance of an individual’s dialysis access, such 

6 as the placement, insertion, and maintenance serv7 ices related to fistulas, synthetic grafts, tunnel cath8 eters, and peritoneal dialysis catheters; and 

9 (2) revise such units to reflect the findings of 

10 the evaluation. 

11 (b) REVISION OF RBRVS TO REFLECT THE DIF12 FICULTY OF VASCULAR ACCESS PROCEDURES.—Not later 

13 than January 1, 2007, the Secretary of Health and 

14 Human Services shall— 

15 (1) review the relative value units determined 

16 under section 1848(c)(2) of the Social Security Act 

17 (42 U.S.C. 1395w–4(c)(2)) that are applicable with 

18 respect to physicians’ services for vascular access 

19 procedures; and 

20 (2) revise such units to accurately reflect the 

21 difficulty of such procedures. 

22 SEC. 102. DEMONSTRATION PROJECT FOR OUTCOMES23 BASED ESRD REIMBURSEMENT SYSTEM. 

24 (a) ESTABLISHMENT.—Subject to the succeeding 

25 provisions of this section, the Secretary of Health and 
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1 Human Services (in this section referred to as the ‘‘Sec2 retary’’) shall establish demonstration projects under 

3 which the Secretary shall evaluate methods that improve 

4 the quality of care provided to medicare beneficiaries with 

5 end-stage renal disease. 

6 (b) OUTCOMES-BASED ESRD REIMBURSEMENT SYS7 TEM.— 

8 (1) IN GENERAL.—Under the demonstration 

9 projects, the Secretary shall provide financial incen10 tives to providers of services and renal dialysis facili11 ties that demonstrate improved quality of care to 

12 such beneficiaries. 

13 (2) CONSIDERATION OF OUTCOMES AND CASE14 MIX.—In determining whether a provider or facility 

15 has demonstrated an improved quality of care under 

16 paragraph (1), the Secretary shall take into account 

17 the outcomes of individuals receiving services from 

18 the provider or facility and the case-mix of the pro19 vider or facility, paying particular attention to im20 proved patient safety, better vaccination rates, and 

21 improved care for diabetes. 

22 (3) INCENTIVES DESCRIBED.—The financial in23 centives provided under paragraph (1) shall— 
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1 (A) reflect the interactions of payments 

2 under parts A and B of title XVIII of the So3 cial Security Act; and 

4 (B) recognize improvements based on high 

5 quality outcomes during previous periods as 

6 well as recent changes in performance to re7 ward long-term improvements. 

8 (c) DURATION.—The Secretary shall conduct the 

9 demonstration project under this section for a period that 

10 is not longer than 5 years that begins on January 1, 2007. 

11 (d) EVALUATION AND REPORT.— 

12 (1) EVALUATION.—The Secretary shall conduct 

13 an evaluation of the demonstration projects con14 ducted under this section. 

15 (2) REPORT.—Not later than 6 months after 

16 the date on which the demonstration projects are 

17 completed, the Secretary shall submit to Congress a 

18 report on the evaluation conducted under paragraph 

19 (1) together with recommendations for such legisla20 tion and administrative action as the Secretary de21 termines appropriate. 

22 (e) WAIVER AUTHORITY.—The Secretary shall waive 

23 compliance with the requirements of title XVIII of the So24 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 
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1 and for such period as the Secretary determines is nec2 essary to conduct the demonstration projects. 

3 (f) AUTHORIZATION OF APPROPRIATIONS.— 

4 (1) IN GENERAL.—Payments for the costs of 

5 carrying out the demonstration project under this 

6 section shall be made from the Federal Supple7 mentary Medical Insurance Trust Fund under sec8 tion 1841 of such Act (42 U.S.C. 1395t). 

9 (2) AMOUNT.—There are authorized to be ap10 propriated from such Trust Fund such sums as may 

11 be necessary to carry out this section. 

12 SEC. 103. REQUIRED TRAINING FOR PATIENT CARE DIALY13 SIS TECHNICIANS. 

14 (a) IN GENERAL.—Section 1881 of the Social Secu15 rity Act (42 U.S.C. 1395rr) is amended by adding the fol16 lowing: 

17 ‘‘(h)(1) Except as provided in paragraph (3), begin18 ning January 1, 2007, a provider of services or a renal 

19 dialysis facility may not use any individual as a patient 

20 care dialysis technician for more than 4 months unless the 

21 individual— 

22 ‘‘(A) has completed a training program in the 

23 care and treatment of an individual with chronic 

24 kidney failure who is undergoing dialysis treatment; 
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1 ‘‘(B) has been certified by a nationally recog2 nized certification entity for dialysis technicians; and 

3 ‘‘(C) is competent to provide dialysis-related 

4 services. 

5 ‘‘(2) Beginning January 1, 2008, a provider of serv6 ices or a renal dialysis facility may not use on a tem7 porary, per diem, leased, or on any basis other than as 

8 a permanent employee, any individual as a patient care 

9 dialysis technician unless the individual meets the require10 ments described in subparagraphs (A), (B), and (C) of 

11 paragraph (1). 

12 ‘‘(3) A provider of services or a renal dialysis facility 

13 may permit an individual enrolled in a training program 

14 described in paragraph (1)(A) to serve as a patient care 

15 dialysis technician while they are so enrolled. 

16 ‘‘(4) For purposes of paragraph (1), if, since the most 

17 recent completion by an individual of a training program 

18 described in paragraph (1)(A), there has been a period 

19 of 24 consecutive months during which the individual has 

20 not performed dialysis-related services for monetary com21 pensation, such individual shall be required to complete 

22 a new training program or become re-certified as described 

23 in paragraph (1)(B). 

24 ‘‘(5) A provider of services or a renal dialysis facility 

25 shall provide such regular performance review and regular 
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1 in-service education as assures that individuals serving as 

2 patient care dialysis technicians for the provider or facility 

3 are competent to perform dialysis-related services.’’. 

4 TITLE II—ENSURING QUALITY 

5 THROUGH IMPROVEMENTS IN 

6 THE ESRD PAYMENT SYSTEM 

7 SEC. 201. ESTABLISHMENT OF ANNUAL UPDATE FRAME8 WORK FOR THE MEDICARE ESRD COMPOSITE 

9 RATE. 

10 (a) IN GENERAL.—Section 1881(b)(12)(F) of the So11 cial Security Act (42 U.S.C. 1395rr(b)(12)(F)) is amend12 ed to read as follows: 

13 ‘‘(F) Beginning with 2006, the Secretary shall annu14 ally increase the basic case-mix adjusted payment amounts 

15 established under this paragraph— 

16 ‘‘(i) with respect to the component of the basic 

17 case-mix adjusted system described in clause (ii) of 

18 subparagraph (B), by— 

19 ‘‘(I) applying the estimated growth in ex20 penditures for drugs and biologicals (including 

21 erythropoietin) that are separately billable to 

22 such component; and 

23 ‘‘(II) converting the amount determined in 

24 subclause (I) to an increase applicable to the 
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1 basic case-mix adjusted payment amounts es2 tablished under such subparagraph; and 

3 ‘‘(ii) with respect to the composite rate compo4 nent of the basic case-mix adjusted system described 

5 in subparagraph (B)(i), for dialysis services fur6 nished— 

7 ‘‘(I) during 2006, by 2.5 percent above 

8 such payment amounts for such services fur9 nished on December 31, 2005; 

10 ‘‘(II) during 2007 through 2014, by an 

11 amount equal to 1 percent of the ESRD market 

12 basket percentage increase (as defined in para13 graph (14)(A), and including any additional 

14 factors that may increase costs described in 

15 paragraph (14)(B)) above such composite rate 

16 payment amounts for such services furnished on 

17 December 31 of the previous year; and 

18 ‘‘(III) during 2015 and subsequent years, 

19 by the ESRD market basket percentage in20 crease (as defined in paragraph (14)(A) and in21 cluding any additional factors that may increase 

22 costs described in paragraph (14)(B)) above 

23 such composite rate payment amounts for such 

24 services furnished on December 31 of the pre25 vious year.’’. 
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1 (b) ESRD MARKET BASKET PERCENTAGE INCREASE

2 DEFINED.—Section 1881(b) of the Social Security Act 

3 (42 U.S.C. 1395rr(b)) is amended by adding at the end 

4 the following new paragraph: 

5 ‘‘(14)(A) For purposes of this title, the term ‘ESRD 

6 market basket percentage increase’ means, with respect to 

7 a calendar year, the percentage (estimated by the Sec8 retary before the beginning of such year) by which— 

9 ‘‘(i) the cost of the mix of goods and services 

10 included in the provision of dialysis services (includ11 ing the costs described in subparagraph (D)) that is 

12 determined based on an index of appropriately 

13 weighted indicators of changes in wages and prices 

14 which are representative of the mix of goods and 

15 services included in such dialysis services for the cal16 endar year; exceeds 

17 ‘‘(ii) the cost of such mix of goods and services 

18 for the preceding calendar year. 

19 ‘‘(B) In addition to determining the percentage up20 date under subparagraph (A), the Secretary shall also take 

21 into account any change in the costs of furnishing the mix 

22 of goods and services described in such subparagraph re23 sulting from— 

24 ‘‘(i) the adoption of scientific and technological 

25 innovations used to provide dialysis services; 
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1 ‘‘(ii) changes in the manner or method of deliv2 ering dialysis services; 

3 ‘‘(iii) productivity improvements in the provi4 sion of dialysis services; and 

5 ‘‘(iv) any other relevant factor. 

6 ‘‘(C) The Secretary shall annually review and update 

7 the items and services included in the mix of goods and 

8 services used to determine the percentage under subpara9 graph (A). 

10 ‘‘(D) The costs described in this subparagraph in11 clude— 

12 ‘‘(i) labor costs, including direct patient care 

13 costs and administrative labor costs, vacation and 

14 holiday pay, payroll taxes, and employee benefits; 

15 ‘‘(ii) other direct costs, including drugs, sup16 plies, and laboratory fees; 

17 ‘‘(iii) overhead costs, including medical director 

18 fees, temporary services, general and administrative 

19 costs, interest expenses, and bad debt; 

20 ‘‘(iv) capital costs, including rent, real estate 

21 taxes, depreciation, utilities, repairs, and mainte22 nance; and 

23 ‘‘(v) such other allowable costs as the Secretary 

24 may specify.’’. 
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1 SEC. 202. EXTENSION OF MEDICARE SECONDARY PAYER. 

2 Section 1862(b)(1)(C) of the Social Security Act (42 

3 U.S.C. 1395y(b)(1)(C)) is amended— 

4 (1) in the last sentence, by inserting ‘‘, and be5 fore January 1, 2006’’ after ‘‘prior to such date)’’; 

6 and 

7 (2) by adding at the end the following new sen8 tence: ‘‘Effective for items and services furnished on 

9 or after January 1, 2006 (with respect to periods 

10 beginning on or after the date that is 30 months 

11 prior to such date), clauses (i) and (ii) shall be ap12 plied by substituting ‘33-month’ for ‘12-month’ each 

13 place it appears in the first sentence.’’. 

14 SEC. 203. GAO STUDY AND REPORT ON IMPACT OF G15 CODES. 

16 (a) STUDY.—The Comptroller General of the United 

17 States shall conduct a study on the impact of the tem18 porary codes for nephrologists’ services applicable under 

19 the fee schedule for physicians’ services under section 

20 1848 of the Social Security Act (42 U.S.C. 1395w–4) 

21 (commonly known as ‘‘G-codes’’). 

22 (b) REPORT.—Not later than the date that is 6 

23 months after the date of enactment of this Act, the Comp24 troller General shall submit to Congress a report on the 

25 study conducted under subsection (a) together with rec-
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1 ommendations for such legislation and administrative ac2 tion as the Comptroller General determines appropriate. 

3 TITLE III—IMPROVING QUALITY 

4 THROUGH PATIENT EDU5 CATION, ACCESS, AND SAFETY 

6 INITIATIVES 

7 SEC. 301. SUPPORT OF PUBLIC AND PATIENT EDUCATION 

8 INITIATIVES REGARDING KIDNEY DISEASE. 

9 (a) CHRONIC KIDNEY DISEASE DEMONSTRATION

10 PROJECTS.— 

11 (1) IN GENERAL.—The Secretary of Health and 

12 Human Services (in this section referred to as the 

13 ‘‘Secretary’’) shall establish demonstration projects 

14 to— 

15 (A) increase public awareness about the 

16 factors that lead to chronic kidney disease, how 

17 to prevent it, how to treat it, and how to avoid 

18 kidney failure; and 

19 (B) enhance surveillance systems and ex20 pand research to better assess the prevalence 

21 and incidence of chronic kidney disease. 

22 (2) SCOPE AND DURATION.— 

23 (A) SCOPE.—The Secretary shall select at 

24 least 3 States in which to conduct demonstra25 tion projects under this subsection. In selecting 
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1 the States under this subparagraph, the Sec2 retary shall take into account the size of the 

3 population of medicare beneficiaries with end4 stage renal disease and ensure the participation 

5 of individuals who reside in rural and urban 

6 areas. 

7 (B) DURATION.—The demonstration 

8 projects under this subsection shall be con9 ducted for a period that is not longer than 5 

10 years that begins on January 1, 2007. 

11 (3) EVALUATION AND REPORT.— 

12 (A) EVALUATION.—The Secretary shall 

13 conduct an evaluation of the demonstration 

14 projects conducted under this subsection. 

15 (B) REPORT.—Not later than 6 months 

16 after the date on which the demonstration 

17 projects under this subsection are completed, 

18 the Secretary shall submit to Congress a report 

19 on the evaluation conducted under subpara20 graph (A) together with recommendations for 

21 such legislation and administrative action as the 

22 Secretary determines appropriate. 

23 (4) AUTHORIZATION OF APPROPRIATIONS.— 

24 There are authorized to be appropriated to carry out 
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1 this subsection $2,000,000 for each of fiscal years 

2 2007 through 2011. 

3 (b) ESRD SELF-MANAGEMENT DEMONSTRATION

4 PROJECTS.— 

5 (1) IN GENERAL.—The Secretary shall establish 

6 demonstration projects to enable individuals with 

7 end-stage renal disease to develop self-management 

8 skills. 

9 (2) SCOPE AND DURATION.— 

10 (A) SCOPE.—The Secretary shall select at 

11 least 3 States in which to conduct demonstra12 tion projects under this subsection. In selecting 

13 the States under this subparagraph, the Sec14 retary shall take into account the size of the 

15 population of medicare beneficiaries with end16 stage renal disease and ensure the participation 

17 of individuals who reside in rural and urban 

18 areas. 

19 (B) DURATION.—The demonstration 

20 projects under this section shall be conducted 

21 for a period that is not longer than 5 years that 

22 begins on January 1, 2007. 

23 (3) EVALUATION AND REPORT.— 
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1 (A) EVALUATION.—The Secretary shall 

2 conduct an evaluation of the demonstration 

3 projects conducted under this subsection. 

4 (B) REPORT.—Not later than 6 months 

5 after the date on which the demonstration 

6 projects under this subsection are completed, 

7 the Secretary shall submit to Congress a report 

8 on the evaluation conducted under subpara9 graph (A) together with recommendations for 

10 such legislation and administrative action as the 

11 Secretary determines appropriate. 

12 (4) AUTHORIZATION OF APPROPRIATIONS.— 

13 There are authorized to be appropriated to carry out 

14 this subsection $2,000,000 for each of fiscal years 

15 2007 through 2011. 

16 SEC. 302. MEDICARE COVERAGE OF KIDNEY DISEASE PA17 TIENT EDUCATION SERVICES. 

18 (a) COVERAGE OF KIDNEY DISEASE EDUCATION

19 SERVICES.— 

20 (1) COVERAGE.—Section 1861(s)(2) of the So21 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend22 ed— 

23 (A) in subparagraph (Y), by striking 

24 ‘‘and’’ after the semicolon at the end; 
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1 (B) in subparagraph (Z), by adding ‘‘and’’ 

2 after the semicolon at the end; and 

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

4 subparagraph: 

5 ‘‘(AA) kidney disease education services (as de6 fined in subsection (bbb));’’. 

7 (2) SERVICES DESCRIBED.—Section 1861 of 

8 the Social Security Act (42 U.S.C. 1395x) is amend9 ed by adding at the end the following new sub10 section: 

11 ‘‘Kidney Disease Education Services 

12 ‘‘(bbb)(1) The term ‘kidney disease education serv13 ices’ means educational services that are— 

14 ‘‘(A) furnished to an individual with kidney dis15 ease who, according to accepted clinical guidelines 

16 identified by the Secretary, will require dialysis or a 

17 kidney transplant; 

18 ‘‘(B) furnished, upon the referral of the physi19 cian managing the individual’s kidney condition, by 

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

21 ‘‘(C) designed— 

22 ‘‘(i) to provide comprehensive information 

23 regarding— 

24 ‘‘(I) the management of comorbidities; 
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1 ‘‘(II) the prevention of uremic com2 plications; and 

3 ‘‘(III) each option for renal replace4 ment therapy (including home and in-cen5 ter as well as vascular access options and 

6 transplantation); and 

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

8 opportunity to actively participate in the choice 

9 of therapy. 

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

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

12 (r)(1)); 

13 ‘‘(B) an individual who— 

14 ‘‘(i) is— 

15 ‘‘(I) a registered nurse; 

16 ‘‘(II) a registered dietitian or nutri17 tion professional (as defined in subsection 

18 (vv)(2)); 

19 ‘‘(III) a clinical social worker (as de20 fined in subsection (hh)(1)); 

21 ‘‘(IV) a physician assistant, nurse 

22 practitioner, or clinical nurse specialist (as 

23 those terms are defined in subsection 

24 (aa)(5)); or 

25 ‘‘(V) a transplant coordinator; and 
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1 ‘‘(ii) meets such requirements related to 

2 experience and other qualifications that the 

3 Secretary finds necessary and appropriate for 

4 furnishing the services described in paragraph 

5 (1); or 

6 ‘‘(C) a renal dialysis facility subject to the re7 quirements of section 1881(b)(1) with personnel 

8 who— 

9 ‘‘(i) provide the services described in para10 graph (1); and 

11 ‘‘(ii) meet the requirements of subpara12 graph (A) or (B). 

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

14 under paragraphs (1)(C)(i) and (2)(B)(ii) after consulting 

15 with physicians, health educators, professional organiza16 tions, accrediting organizations, kidney patient organiza17 tions, dialysis facilities, transplant centers, network orga18 nizations described in section 1881(c)(2), and other 

19 knowledgeable persons. 

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

21 subsection, the Secretary shall ensure that each bene22 ficiary who is entitled to kidney disease education services 

23 under this title receives such services in a timely manner 

24 to maximize the benefit of those services. 
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1 ‘‘(5) The Secretary shall monitor the implementation 

2 of this subsection to ensure that beneficiaries who are eli3 gible for kidney disease education services receive such 

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

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

6 more than 6 sessions of kidney disease education services 

7 under this title.’’. 

8 (3) PAYMENT UNDER THE PHYSICIAN FEE

9 SCHEDULE.—Section 1848(j)(3) of the Social Secu10 rity Act (42 U.S.C. 1395w–4(j)(3)) is amended by 

11 inserting ‘‘(2)(AA),’’ after ‘‘(2)(W),’’. 

12 (4) PAYMENT TO RENAL DIALYSIS FACILI13 TIES.—Section 1881(b) of the Social Security Act 

14 (42 U.S.C. 1395rr(b)), as amended by section 

15 201(b), is amended by adding at the end the fol16 lowing new paragraph: 

17 ‘‘(15) For purposes of paragraph (12), the single 

18 composite weighted formulas determined under such para19 graph shall not take into account the amount of payment 

20 for kidney disease education services (as defined in section 

21 1861(bbb)). Instead, payment for such services shall be 

22 made to the renal dialysis facility on an assignment-re23 lated basis under section 1848.’’. 
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1 (5) LIMITATION ON NUMBER OF SESSIONS.— 

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

3 U.S.C. 1395y(a)(1)) is amended— 

4 (A) by striking ‘‘and’’ at the end of sub5 paragraph (L); 

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

7 subparagraph (M) and inserting ‘‘, and’’; and 

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

9 subparagraph: 

10 ‘‘(N) in the case of kidney disease education 

11 services (as defined in section 1861(bbb)), which are 

12 performed in excess of the number of sessions cov13 ered under such section;’’. 

14 (6) ANNUAL REPORT TO CONGRESS.—Not later 

15 than April 1, 2007, and annually thereafter, the 

16 Secretary of Health and Human Services (in this 

17 section referred to as the ‘‘Secretary’’) shall submit 

18 to Congress a report on the number of medicare 

19 beneficiaries who are entitled to kidney disease edu20 cation services (as defined in section 1861(bbb) of 

21 the Social Security Act, as added by paragraph (2)) 

22 under title XVIII of such Act and who receive such 

23 services, together with such recommendations for 

24 legislative and administrative action as the Secretary 

25 determines to be appropriate to fulfill the legislative 
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1 intent that resulted in the enactment of that sub2 section. 

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

4 this section shall apply to services furnished on and after 

5 January 1, 2007. 

6 SEC. 303. BLOOD FLOW MONITORING DEMONSTRATION 

7 PROJECTS. 

8 (a) ESTABLISHMENT.—The Secretary of Health and 

9 Human Services (in this section referred to as the ‘‘Sec10 retary’’) shall establish demonstration projects to evaluate 

11 how blood flow monitoring affects the quality and cost of 

12 care for medicare beneficiaries with end-stage renal dis13 ease. 

14 (b) DURATION.—The demonstration projects under 

15 this section shall be conducted for a period of not longer 

16 than 5 years that begins on January 1, 2007. 

17 (c) EVALUATION AND REPORT.— 

18 (1) EVALUATION.—The Secretary shall conduct 

19 an evaluation of the demonstration projects con20 ducted under this section. 

21 (2) REPORT.—Not later than 6 months after 

22 the date on which the demonstration projects under 

23 this section are completed, the Secretary shall sub24 mit to Congress a report on the evaluation con25 ducted under paragraph (1) together with rec-
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1 ommendations for such legislation and administra2 tive action as the Secretary determines appropriate. 

3 (d) WAIVER AUTHORITY.—The Secretary shall waive 

4 compliance with the requirements of title XVIII of the So5 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

6 and for such period as the Secretary determines is nec7 essary to conduct the demonstration projects. 

8 (e) AUTHORIZATION OF APPROPRIATIONS.— 

9 (1) IN GENERAL.—Payments for the costs of 

10 carrying out the demonstration project under this 

11 section shall be made from the Federal Supple12 mentary Medical Insurance Trust Fund under sec13 tion 1841 of such Act (42 U.S.C. 1395t). 

14 (2) AMOUNT.—There are authorized to be ap15 propriated from such Trust Fund $1,000,000 for 

16 each of fiscal years 2007 through 2011 to carry out 

17 this section. 

18 TITLE IV—IMPROVING QUALITY 

19 THROUGH IMPROVED COV20 ERAGE 

21 SEC. 401. IMPROVING THE HOME DIALYSIS BENEFIT. 

22 (a) IN GENERAL.—The Secretary of Health and 

23 Human Services (in this section referred to as the ‘‘Sec24 retary’’) shall provide appropriate incentives to improve 

25 the home dialysis benefit for individuals on behalf of whom 
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1 payment may be made under section 1881 of the Social 

2 Security Act (42 U.S.C. 1395rr). 

3 (b) CONSIDERATIONS.—In developing the incentives 

4 under subsection (a), the Secretary shall consider revising 

5 the fee schedule for physicians’ services under section 

6 1848 of the Social Security Act (42 U.S.C. 1395w–4) so 

7 that the amount paid for services related to end-stage 

8 renal disease furnished to home dialysis patients is equal 

9 to the amount paid for services related to end-stage renal 

10 disease furnished to other patients with 4 or more face11 to-face physician visits per month. 

12 SEC. 402. INSTITUTE OF MEDICINE EVALUATION AND RE13 PORT ON HOME DIALYSIS. 

14 (a) EVALUATION.— 

15 (1) IN GENERAL.—Not later than the date that 

16 is 2 months after the date of enactment of this Act, 

17 the Secretary of Health and Human Services (in this 

18 section referred to as the ‘‘Secretary’’) shall enter 

19 into an arrangement under which the Institute of 

20 Medicine of the National Academy of Sciences (in 

21 this section referred to as the ‘‘Institute’’) shall con22 duct an evaluation of the barriers that exist to in23 creasing the number of individuals with end-stage 

24 renal disease who elect to receive home dialysis serv-
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1 ices under the medicare program under title XVIII 

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

3 (2) SPECIFIC MATTERS EVALUATED.—In con4 ducting the evaluation under paragraph (1), the In5 stitute shall— 

6 (A) compare current medicare home dialy7 sis costs and payments with current in-center 

8 and hospital dialysis costs and payments; 

9 (B) catalogue and evaluate the incentives 

10 and disincentives in the current reimbursement 

11 system that influence whether patients receive 

12 home dialysis services; 

13 (C) evaluate patient education services and 

14 how such services impact the treatment choices 

15 made by patients; and 

16 (D) consider such other matters as the In17 stitute determines appropriate. 

18 (3) SCOPE OF REVIEW.—The Institute shall 

19 consider a variety of perspectives, including the per20 spectives of physicians, other health care profes21 sionals, hospitals, dialysis facilities, health plans, 

22 purchasers, and patients. 

23 (b) REPORT.—Not later than the date that is 18 

24 months after the date of enactment of this Act, the Insti25 tute shall submit to the Secretary and appropriate com-
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1 mittees of Congress a report on the evaluation conducted 

2 under subsection (a)(1) describing the findings of such 

3 evaluation and recommendations for implementing incen4 tives to encourage patients to elect to receive home dialysis 

5 services under the medicare program. 

6 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated such sums as may be 

8 necessary for the purposes of conducting the evaluation 

9 and preparing the report required by this section. 

10 SEC. 403. END-STAGE RENAL DISEASE (ESRD) ADVISORY 

11 COMMITTEE. 

12 (a) ESTABLISHMENT.—Pursuant to section 222 of 

13 the Public Health Service Act (42 U.S.C. 217a), the Sec14 retary of Health and Human Services shall establish with15 in 1 year of the date of enactment of this Act an inde16 pendent, multidisciplinary, nonpartisan End-Stage Renal 

17 Disease Advisory Committee (in this section referred to 

18 as the ‘‘Committee’’). 

19 (b) MEMBERSHIP.—The Committee shall consist of 

20 such members as the Secretary may appoint who shall 

21 serve for such term as the Secretary may specify. In ap22 pointing members of the Committee, the Secretary shall 

23 consult with the dialysis community and shall include indi24 viduals drawn from diverse backgrounds, such as medi25 cine, nursing, health care policy, the dialysis patient com-
27 

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1 munity, the dialysis provider community, and health eco2 nomics. 

3 (c) PURPOSE OF THE COMMITTEE.— 

4 (1) DUTIES.—The Committee shall provide a 

5 forum for expert discussion and deliberation and the 

6 formulation of advice and recommendations to the 

7 Secretary about medicare coverage for End-Stage 

8 Renal Disease patients, as described under section 

9 1881 of the Social Security Act (42 U.S.C. 1395rr). 

10 (2) REPORT.—The Committee shall provide the 

11 Secretary with periodic reports that summarize the 

12 Committee’s activities and its recommendations for 

13 such legislation and administrative action as it con14 siders appropriate. 

15 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated such sums as may be 

17 necessary to carry out the purposes of this section. 

Æ