II 

109TH CONGRESS 

1ST SESSION S. 717 

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 SENATE OF THE UNITED STATES 

APRIL 6, 2005 

Mrs. LINCOLN (for herself and Ms. COLLINS) 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 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 2005’’. 

6 SEC. 2. MEDICARE COVERAGE OF KIDNEY DISEASE EDU7 CATION SERVICES. 

8 (a) COVERAGE OF KIDNEY DISEASE EDUCATION

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

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

3 (A) in subsection (s)(2)— 

4 (i) in subparagraph (Y), by striking 

5 ‘‘and’’ at the end; 

6 (ii) in subparagraph (Z), by adding 

7 ‘‘and’’ at the end; and 

8 (iii) by adding at the end the fol9 lowing new subparagraph: 

10 ‘‘(AA) kidney disease education services (as de11 fined in subsection (bbb));’’; and 

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

13 subsection: 

14 ‘‘Kidney Disease Education Services 

15 ‘‘(bbb)(1) The term ‘kidney disease education serv16 ices’ means educational services that are— 

17 ‘‘(A) furnished to an individual with kidney dis18 ease who, according to accepted clinical guidelines 

19 identified by the Secretary, will require dialysis or a 

20 kidney transplant; 

21 ‘‘(B) furnished, upon the referral of the physi22 cian managing the individual’s kidney condition, by 

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

24 ‘‘(C) designed— 
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1 ‘‘(i) to provide comprehensive information 

2 regarding— 

3 ‘‘(I) the management of comorbidities; 

4 ‘‘(II) the prevention of uremic com5 plications; and 

6 ‘‘(III) each option for renal replace7 ment therapy (including home and in-cen8 ter, as well as vascular access options and 

9 transplantation); and 

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

11 opportunity to actively participate in the choice 

12 of therapy. 

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

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

15 (r)(1)); 

16 ‘‘(B) an individual who— 

17 ‘‘(i) is— 

18 ‘‘(I) a registered nurse; 

19 ‘‘(II) a registered dietitian or nutri20 tion professional (as defined in subsection 

21 (vv)(2)); 

22 ‘‘(III) a clinical social worker (as de23 fined in subsection (hh)(1)); 

24 ‘‘(IV) a physician assistant, nurse 

25 practitioner, or clinical nurse specialist (as 
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1 those terms are defined in subsection 

2 (aa)(5)); or 

3 ‘‘(V) a transplant coordinator; and 

4 ‘‘(ii) meets such requirements related to 

5 experience and other qualifications that the 

6 Secretary finds necessary and appropriate for 

7 furnishing the services described in paragraph 

8 (1); or 

9 ‘‘(C) a renal dialysis facility subject to the re10 quirements of section 1881(b)(1) with personnel 

11 who— 

12 ‘‘(i) provide the services described in para13 graph (1); and 

14 ‘‘(ii) meet the requirements of subpara15 graph (A) or (B). 

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

17 under paragraph (2)(B)(ii) after consulting with physi18 cians, health educators, professional organizations, accred19 iting organizations, kidney patient organizations, dialysis 

20 facilities, transplant centers, network organizations de21 scribed in section 1881(c)(2), and other knowledgeable 

22 persons. 

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

24 subsection, the Secretary shall ensure that each bene25 ficiary who is entitled to kidney disease education services 
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1 under this title receives such services in a timely manner 

2 that ensures that the beneficiary receives the maximum 

3 benefit of those services. 

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

5 of this subsection to ensure that beneficiaries who are eli6 gible for kidney disease education services receive such 

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

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

9 more than 6 sessions of kidney disease education services 

10 under this title.’’. 

11 (2) PAYMENT UNDER PHYSICIAN FEE SCHED12 ULE.—Section 1848(j)(3) of the Social Security Act 

13 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

14 ‘‘(2)(AA),’’, after ‘‘(2)(W),’’. 

15 (3) PAYMENT TO RENAL DIALYSIS FACILI16 TIES.—Section 1881(b) of the Social Security Act 

17 (42 U.S.C. 1395rr(b)) is amended by adding at the 

18 end the following new paragraph: 

19 ‘‘(14) For purposes of paragraph (12), the sin20 gle composite weighted formulas determined under 

21 such paragraph shall not take into account the 

22 amount of payment for kidney disease education 

23 services (as defined in section 1861(bbb)). Instead, 

24 payment for such services shall be made to the renal 
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1 dialysis facility on an assignment-related basis under 

2 section 1848.’’. 

3 (4) LIMITATION ON NUMBER OF SESSIONS.— 

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

5 U.S.C. 1395y(a)(1)) is amended— 

6 (A) by striking ‘‘and’’ at the end of sub7 paragraph (L); 

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

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

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

11 subparagraph: 

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

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

14 performed in excess of the number of sessions cov15 ered under such section;’’. 

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

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

18 Secretary of Health and Human Services shall sub19 mit to Congress a report on the number of medicare 

20 beneficiaries who are entitled to kidney disease edu21 cation services (as defined in section 1861(bbb) of 

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

23 under title XVIII of such Act and who receive such 

24 services, together with such recommendations for 

25 legislative and administrative action as the Secretary 
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1 determines to be appropriate to fulfill the legislative 

2 intent that resulted in the enactment of that sub3 section. 

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

5 this section shall apply to services furnished on or after 

6 January 1, 2007. 

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