IIB 
114TH CONGRESS 
2D SESSION 
H. R. 5659 
IN THE SENATE OF THE UNITED STATES 
SEPTEMBER 22, 2016 
Received; read twice and referred to the Committee on Finance 
AN ACT 
To amend title XVIII of the Social Security Act with respect 
to expanding Medicare Advantage coverage for individ-
uals with end-stage renal disease (ESRD). 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Expanding Seniors Re-
ceiving Dialysis Choice Act of 2016’’ or as the ‘‘ESRD 
Choice Act of 2016’’. 
SEC. 2. EXPANDING MEDICARE ADVANTAGE COVERAGE 
FOR INDIVIDUALS WITH END-STAGE RENAL 
DISEASE (ESRD). 
(a) EXPANDED MA ELIGIBILITY.— 
(1) IN GENERAL.—Section 1851(a)(3) of the 
Social Security Act (42 U.S.C. 1395w–21(a)(3)) is 
amended— 
(A) by striking subparagraph (B); and 
(B) by striking ‘‘ELIGIBLE
INDIVIDUAL’’ 
and all that follows through ‘‘In this title, sub-
ject to subparagraph (B),’’ and inserting ‘‘ELI-
GIBLE INDIVIDUAL.—In this title,’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1852(b)(1) of the Social Secu-
rity Act (42 U.S.C. 1395w–22(b)(1)) is amend-
ed— 
(i) by striking subparagraph (B); and 
(ii) by striking ‘‘BENEFICIARIES’’ and 
all 
that 
follows 
through 
‘‘A 
Medicare+Choice organization’’ and in-
serting ‘‘BENEFICIARIES.—A Medicare Ad-
vantage organization’’. 
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(B) Section 1859(b)(6) of the Social Secu-
rity Act (42 U.S.C. 1395w–28(b)(6)) is amend-
ed by striking ‘‘may waive’’ and all that follows 
through ‘‘subparagraph and’’. 
(b) EXCLUDING COSTS FOR KIDNEY ACQUISITIONS 
FROM MA BENCHMARK.—Section 1853 of the Social Se-
curity Act (42 U.S.C. 1395w–23) is amended— 
(1) in subsection (k)— 
(A) in paragraph (1)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘paragraphs (2) 
and (4)’’ and inserting ‘‘paragraphs (2), 
(4), and (5)’’; and 
(ii) in subparagraph (B)(i), by strik-
ing ‘‘paragraphs (2) and (4)’’ and insert-
ing ‘‘paragraphs (2), (4), and (5)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) EXCLUSION OF COSTS FOR KIDNEY ACQUI-
SITIONS
FROM
CAPITATION
RATES.—After deter-
mining the applicable amount for an area for a year 
under paragraph (1) (beginning with 2019), the Sec-
retary shall adjust such applicable amount to ex-
clude from such applicable amount the Secretary’s 
estimate of the standardized costs for payments for 
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organ acquisitions for kidney transplants covered 
under this title (including expenses covered under 
section 1881(d)) in the area for the year.’’; and 
(2) in subsection (n)(2)— 
(A) in subparagraph (A)(i), by inserting 
‘‘and, for 2019 and subsequent years, the exclu-
sion of payments for organ acquisitions for kid-
ney transplants from the capitation rate as de-
scribed in subsection (k)(5)’’ before the semi-
colon at the end; 
(B) in subparagraph (E), in the matter 
preceding clause (i), by striking ‘‘subparagraph 
(F)’’ and inserting ‘‘subparagraphs (F) and 
(G)’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(G) APPLICATION
OF
KIDNEY
ACQUISI-
TIONS
ADJUSTMENT.—The 
base 
payment 
amount specified in subparagraph (E) for a 
year (beginning with 2019) shall be adjusted in 
the same manner under paragraph (5) of sub-
section (k) as the applicable amount is adjusted 
under such subsection.’’. 
(c) FFS COVERAGE OF KIDNEY ACQUISITIONS.— 
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(1) IN GENERAL.—Section 1852(a)(1)(B)(i) of 
the Social Security Act (42 U.S.C. 1395w– 
22(a)(1)(B)(i)) is amended by inserting ‘‘or coverage 
for organ acquisitions for kidney transplants, includ-
ing as covered under section 1881(d)’’ after ‘‘hospice 
care’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1851(i) of the Social Security Act (42 U.S.C. 
1395w–21(i)) is amended by adding at the end the 
following new paragraph: 
‘‘(3) FFS PAYMENT FOR EXPENSES FOR KID-
NEY ACQUISITIONS.—Paragraphs (1) and (2) do not 
apply with respect to expenses for organ acquisitions 
for 
kidney 
transplants 
described 
in 
section 
1852(a)(1)(B)(i).’’. 
(d) SENSE OF CONGRESS REGARDING APPLICATION 
OF APPROPRIATE MEDICARE ADVANTAGE RISK ADJUST-
MENT FOR PAYMENT FOR INCREASED ESRD ENROLL-
EES.—It is the sense of Congress that in implementing 
the policies under this section, the Centers for Medicare 
& Medicaid Services should provide, in an accurate and 
transparent manner, for risk adjustment to payment 
under the Medicare Advantage program to account for the 
increased enrollment in Medicare Advantage plans of indi-
viduals with end-stage renal disease. 
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(e) 
EXPANDED
MA 
EDUCATION.—Section 
1851(d)(2)(A)(iii) of the Social Security Act (42 U.S.C. 
1395w–21(d)(2)(A)(iii)) is amended by inserting before 
the period at the end the following: ‘‘, including any addi-
tional information that individuals determined to have 
end-stage renal disease may need to make informed deci-
sions with respect to such an election’’. 
(f) REPORT.—Not later than April 1, 2022, the Ad-
ministrator of the Centers for Medicare & Medicaid Serv-
ices shall submit to Congress a report on the impact of 
the amendments made by this section on spending under 
the traditional Medicare fee-for-service program under 
parts A and B of title XVIII of the Social Security Act 
as well as on spending under parts C and D of such title. 
The report shall include an assessment of the risk adjust-
ment payment methodologies under such parts C and D 
and their adequacy with respect to individuals with end- 
stage renal disease and such recommendations as the Ad-
ministrator deems appropriate. 
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