I 
109TH CONGRESS 
1ST SESSION H. R. 1298
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 HOUSE OF REPRESENTATIVES 
MARCH 15, 2005
Mr. CAMP 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 juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
the benefits under the Medicare Program for bene-
ficiaries with kidney disease, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Kidney Care Quality and Improvement Act of 2005’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows:
Sec. 1. Short title.
TITLE I—RECOGNIZING AND IMPROVING QUALITY FOR PATIENTS 
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 sys-
tem. 
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.
TITLE I—RECOGNIZING AND IM-
PROVING QUALITY FOR PA-
TIENTS 
SEC. 101. MODIFICATION OF PHYSICIAN SURGICAL REIM-
BURSEMENT FOR DIALYSIS ACCESS PROCE-
DURES TO ALIGN INCENTIVES FOR COST AND 
QUALITY. 
(a) FULL COVERAGE OF DIALYSIS ACCESS PROCE-
DURES IN THE AMBULATORY SURGICAL CENTER SET-
TING.—The Secretary of Health and Human Services 
shall include in the surgical procedures specified under 
section 1833(i)(1) of the Social Security Act (42 U.S.C.
1395l(i)(1)) the full range of dialysis access procedures 
when provided to individuals with end-stage renal disease 
who are entitled to benefits under part A and enrolled 
under part B of title XVIII of the Social Security Act pur-
suant to section 226A of that Act (42 U.S.C. 426). For 
purposes of the preceding sentence, the full range of dialy-
sis services includes all reasonable and necessary interven-
tion procedures for the creation, repair, and maintenance 
of an individual’s dialysis access, such as the placement, 
insertion, and maintenance services related to fistulas, 
synthetic grafts, tunnel catheters, and peritoneal dialysis 
catheters. 
(b) REVISION OF RBRVS TO REFLECT THE DIF-
FICULTY OF VASCULAR ACCESS PROCEDURES.—The Sec-
retary of Health and Human Services shall structure the 
relative value units determined under section 1848(c)(2) 
of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) that 
are applicable with respect to physicians’ services for vas-
cular access procedures to encourage clinically appropriate 
placement of natural vascular access for dialysis patients. 
SEC. 102. DEMONSTRATION PROJECT FOR OUTCOMES-
BASED ESRD REIMBURSEMENT SYSTEM. 
(a) ESTABLISHMENT.—Subject to the succeeding 
provisions of this section, the Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish demonstration projects under 
which the Secretary shall evaluate methods that improve 
the quality of care provided to medicare beneficiaries with 
end-stage renal disease. 
(b) OUTCOMES-BASED ESRD REIMBURSEMENT SYS-
TEM.—
(1) IN
GENERAL.—Under the demonstration 
projects, the Secretary shall provide financial incen-
tives to providers of services and renal dialysis facili-
ties that demonstrate improved quality of care to 
such beneficiaries. 
(2) CONSIDERATION OF OUTCOMES AND CASE-
MIX.—In determining whether a provider or facility 
has demonstrated an improved quality of care under 
paragraph (1), the Secretary shall take into account 
the outcomes of individuals receiving services from 
the provider or facility and the case-mix of the pro-
vider or facility, paying particular attention to im-
proved patient safety, better vaccination rates, and 
improved care for diabetics. 
(3) INCENTIVES DESCRIBED.—The financial in-
centives provided under paragraph (1) shall—
(A) reflect the interactions of payments 
under parts A and B of title XVIII of the So-
cial Security Act; and
(B) recognize improvements based on high 
quality outcomes during previous periods as 
well as recent changes in performance to re-
ward long-term improvements. 
(c) DURATION.—The Secretary shall conduct the 
demonstration project under this section for a period that 
is not longer than 5 years that begins on January 1, 2007. 
(d) EVALUATION AND REPORT.—
(1) EVALUATION.—The Secretary shall conduct 
an evaluation of the demonstration projects con-
ducted under this section. 
(2) REPORT.—Not later than 6 months after 
the date on which the demonstration projects are 
completed, the Secretary shall submit to Congress a 
report on the evaluation conducted under paragraph 
(1) together with recommendations for such legisla-
tion and administrative action as the Secretary de-
termines appropriate. 
(e) WAIVER AUTHORITY.—The Secretary shall waive 
compliance with the requirements of title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) to such extent 
and for such period as the Secretary determines is nec-
essary to conduct the demonstration projects. 
(f) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—Payments for the costs of 
carrying out the demonstration project under this 
section shall be made from the Federal Supple-
mentary Medical Insurance Trust Fund under sec-
tion 1841 of such Act (42 U.S.C. 1395t). 
(2) AMOUNT.—There are authorized to be ap-
propriated from such Trust Fund such sums as may 
be necessary to carry out this section. 
SEC. 103. REQUIRED TRAINING FOR PATIENT CARE DIALY-
SIS TECHNICIANS. 
(a) IN GENERAL.—Section 1881 of the Social Secu-
rity Act (42 U.S.C. 1395rr) is amended by adding the fol-
lowing: 
‘‘(h)(1) Except as provided in paragraph (3), begin-
ning January 1, 2007, a provider of services or a renal 
dialysis facility may not use any individual as a patient 
care dialysis technician for more than 4 months unless the 
individual—
‘‘(A) has completed a training program in the 
care and treatment of an individual with chronic 
kidney failure who is undergoing dialysis treatment; 
‘‘(B) has been certified by a nationally recog-
nized certification entity for dialysis technicians; and 
‘‘(C) is competent to provide dialysis-related 
services.
‘‘(2) Beginning January 1, 2008, a provider of serv-
ices or a renal dialysis facility may not use on a tem-
porary, per diem, leased, or on any basis other than as 
a permanent employee, any individual as a patient care 
dialysis technician unless the individual meets the require-
ments described in subparagraphs (A), (B), and (C) of 
paragraph (1). 
‘‘(3) A provider of services or a renal dialysis facility 
may permit an individual enrolled in a training program 
described in paragraph (1)(A) to serve as a patient care 
dialysis technician while they are so enrolled. 
‘‘(4) For purposes of paragraph (1), if, since the most 
recent completion by an individual of a training program 
described in paragraph (1)(A), there has been a period 
of 24 consecutive months during which the individual has 
not performed dialysis-related services for monetary com-
pensation, such individual shall be required to complete 
a new training program or become re-certified as described 
in paragraph (1)(B). 
‘‘(5) A provider of services or a renal dialysis facility 
shall provide such regular performance review and regular 
in-service education as assures that individuals serving as 
patient care dialysis technicians for the provider or facility 
are competent to perform dialysis-related services.’’.
TITLE 
II—ENSURING 
QUALITY 
THROUGH IMPROVEMENTS IN 
THE ESRD PAYMENT SYSTEM 
SEC. 201. ESTABLISHMENT OF ANNUAL UPDATE FRAME-
WORK FOR THE MEDICARE ESRD COMPOSITE 
RATE. 
(a) IN GENERAL.—Section 1881(b)(12)(F) of the So-
cial Security Act (42 U.S.C. 1395rr(b)(12)(F)) is amend-
ed to read as follows: 
‘‘(F) Beginning with 2006, the Secretary shall annu-
ally increase the basic case-mix adjusted payment amounts 
established under this paragraph—
‘‘(i) with respect to the component of the basic 
case-mix adjusted system described in clause (ii) of 
subparagraph (B), by—
‘‘(I) applying the estimated growth in ex-
penditures for drugs and biologicals (including 
erythropoietin) that are separately billable to 
such component; and 
‘‘(II) converting the amount determined in 
subclause (I) to an increase applicable to the 
basic case-mix adjusted payment amounts es-
tablished under such subparagraph; and 
‘‘(ii) with respect to the composite rate compo-
nent of the basic case-mix adjusted system described
in subparagraph (B)(i), for dialysis services fur-
nished—
‘‘(I) during 2006, by 2.5 percent above 
such payment amounts for such services fur-
nished on December 31, 2005; 
‘‘(II) during 2007 through 2014, by an 
amount equal to 1 percent of the ESRD market 
basket percentage increase (as defined in para-
graph (14)(A) and including any additional fac-
tors that may increase costs described in para-
graph (14)(B)) above such composite rate pay-
ment amounts for such services furnished on 
December 31 of the previous year; and 
‘‘(III) during 2015 and subsequent years, 
by the ESRD market basket percentage in-
crease (as defined in paragraph (14)(A) and in-
cluding any additional factors that may increase 
costs described in paragraph (14)(B)) above 
such composite rate payment amounts for such 
services furnished on December 31 of the pre-
vious year.’’. 
(b) ESRD MARKET BASKET PERCENTAGE INCREASE 
DEFINED.—Section 1881(b) of the Social Security Act 
(42 U.S.C. 1395rr(b)) is amended by adding at the end 
the following new paragraph:
‘‘(14)(A) For purposes of this title, the term ‘ESRD 
market basket percentage increase’ means, with respect to 
a calendar year, the percentage (estimated by the Sec-
retary before the beginning of such year) by which—
‘‘(i) the cost of the mix of goods and services 
included in the provision of dialysis services (includ-
ing the costs described in subparagraph (D)) that is 
determined based on an index of appropriately 
weighted indicators of changes in wages and prices 
which are representative of the mix of goods and 
services included in such dialysis services for the cal-
endar year; exceeds 
‘‘(ii) the cost of such mix of goods and services 
for the preceding calendar year. 
‘‘(B) In addition to determining the percentage up-
date under subparagraph (A), the Secretary shall also take 
into account any change in the costs of furnishing the mix 
of goods and services described in such subparagraph re-
sulting from—
‘‘(i) the adoption of scientific and technological 
innovations used to provide dialysis services; 
‘‘(ii) changes in the manner or method of deliv-
ering dialysis services; 
‘‘(iii) productivity improvements in the provi-
sion of dialysis services; and
‘‘(iv) any other relevant factor. 
‘‘(C) The Secretary shall annually review and update 
the items and services included in the mix of goods and 
services used to determine the percentage under subpara-
graph (A). 
‘‘(D) The costs described in this subparagraph in-
clude—
‘‘(i) labor costs, including direct patient care 
costs and administrative labor costs, vacation and 
holiday pay, payroll taxes, and employee benefits; 
‘‘(ii) other direct costs, including drugs, sup-
plies, and laboratory fees; 
‘‘(iii) overhead costs, including medical director 
fees, temporary services, general and administrative 
costs, interest expenses, and bad debt; 
‘‘(iv) capital costs, including rent, real estate 
taxes, depreciation, utilities, repairs, and mainte-
nance; and 
‘‘(v) such other allowable costs as the Secretary 
may specify.’’. 
SEC. 202. EXTENSION OF MEDICARE SECONDARY PAYER. 
Section 1862(b)(1)(C) of the Social Security Act (42 
U.S.C. 1395y(b)(1)(C)) is amended—
(1) in the last sentence, by inserting ‘‘, and be-
fore January 1, 2006’’ after ‘‘prior to such date)’’; 
and 
(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2006 (with respect to periods 
beginning on or after the date that is 30 months 
prior to such date), clauses (i) and (ii) shall be ap-
plied by substituting ‘33-month’ for ‘12-month’ each 
place it appears in the first sentence.’’. 
SEC. 203. GAO STUDY AND REPORT ON IMPACT OF G-
CODES. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study on the impact of the tem-
porary codes for nephrologists’ services applicable under 
the fee schedule for physicians’ services under section 
1848 of the Social Security Act (42 U.S.C. 1395w-4) 
(commonly known as ‘‘G-codes’’). 
(b) REPORT.—Not later than the date that is 6 
months after the date of enactment of this Act, the Comp-
troller General shall submit to Congress a report on the 
study conducted under subsection (a) together with rec-
ommendations for such legislation and administrative ac-
tion as the Comptroller General determines appropriate.
TITLE III—IMPROVING QUALITY 
THROUGH 
PATIENT 
EDU-
CATION, ACCESS, AND SAFETY 
INITIATIVES 
SEC. 301. SUPPORT OF PUBLIC AND PATIENT EDUCATION 
INITIATIVES REGARDING KIDNEY DISEASE. 
(a) CHRONIC KIDNEY DISEASE DEMONSTRATION 
PROJECTS.—
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall establish demonstration projects 
to—
(A) increase public awareness about the 
factors that lead to chronic kidney disease, how 
to prevent it, how to treat it, and how to avoid 
kidney failure; and 
(B) enhance surveillance systems and ex-
pand research to better assess the prevalence 
and incidence of chronic kidney disease. 
(2) SCOPE AND DURATION.—
(A) SCOPE.—The Secretary shall select at 
least 3 States in which to conduct demonstra-
tion projects under this subsection. In selecting 
the States under this subparagraph, the Sec-
retary shall take into account the size of the
population of medicare beneficiaries with end-
stage renal disease and ensure the participation 
of individuals who reside in rural and urban 
areas. 
(B) 
DURATION.—The 
demonstration 
projects under this subsection shall be con-
ducted for a period that is not longer than 5 
years that begins on January 1, 2007. 
(3) EVALUATION AND REPORT.—
(A) EVALUATION.—The Secretary shall 
conduct an evaluation of the demonstration 
projects conducted under this subsection. 
(B) REPORT.—Not later than 6 months 
after the date on which the demonstration 
projects under this subsection are completed, 
the Secretary shall submit to Congress a report 
on the evaluation conducted under subpara-
graph (A) together with recommendations for 
such legislation and administrative action as the 
Secretary determines appropriate. 
(4) AUTHORIZATION
OF
APPROPRIATIONS.—
There are authorized to be appropriated to carry out 
this subsection $2,000,000 for each of fiscal years 
2007 through 2011.
(b) ESRD SELF-MANAGEMENT
DEMONSTRATION 
PROJECTS.—
(1) IN GENERAL.—The Secretary shall establish 
demonstration projects to enable individuals with 
end-stage renal disease to develop self-management 
skills. 
(2) SCOPE AND DURATION.—
(A) SCOPE.—The Secretary shall select at 
least 3 States in which to conduct demonstra-
tion projects under this subsection. In selecting 
the States under this subparagraph, the Sec-
retary shall take into account the size of the 
population of medicare beneficiaries with end-
stage renal disease and ensure the participation 
of individuals who reside in rural and urban 
areas. 
(B) 
DURATION.—The 
demonstration 
projects under this section shall be conducted 
for a period that is not longer than 5 years that 
begins on January 1, 2007. 
(3) EVALUATION AND REPORT.—
(A) EVALUATION.—The Secretary shall 
conduct an evaluation of the demonstration 
projects conducted under this subsection.
(B) REPORT.—Not later than 6 months 
after the date on which the demonstration 
projects under this subsection are completed, 
the Secretary shall submit to Congress a report 
on the evaluation conducted under subpara-
graph (A) together with recommendations for 
such legislation and administrative action as the 
Secretary determines appropriate. 
(4) AUTHORIZATION
OF
APPROPRIATIONS.—
There are authorized to be appropriated to carry out 
this subsection $2,000,000 for each of fiscal years 
2007 through 2011. 
SEC. 302. MEDICARE COVERAGE OF KIDNEY DISEASE PA-
TIENT EDUCATION SERVICES. 
(a) COVERAGE
OF KIDNEY DISEASE EDUCATION 
SERVICES.—
(1) COVERAGE.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed—
(A) in subparagraph (Y), by striking 
‘‘and’’ after the semicolon at the end; 
(B) in subparagraph (Z), by adding ‘‘and’’ 
after the semicolon at the end; and 
(C) by adding at the end the following new 
subparagraph:
‘‘(AA) kidney disease education services (as de-
fined in subsection (bbb));’’. 
(2) SERVICES
DESCRIBED.—Section 1861 of 
the Social Security Act (42 U.S.C. 1395x) is amend-
ed by adding at the end the following new sub-
section: 
‘‘Kidney Disease Education Services 
‘‘(bbb)(1) The term ‘kidney disease education serv-
ices’ means educational services that are—
‘‘(A) furnished to an individual with kidney dis-
ease who, according to accepted clinical guidelines 
identified by the Secretary, will require dialysis or a 
kidney transplant; 
‘‘(B) furnished, upon the referral of the physi-
cian managing the individual’s kidney condition, by 
a qualified person (as defined in paragraph (2)); and 
‘‘(C) designed—
‘‘(i) to provide comprehensive information 
regarding—
‘‘(I) the management of comorbidities; 
‘‘(II) the prevention of uremic com-
plications; and 
‘‘(III) each option for renal replace-
ment therapy (including home and in-cen-
ter as well as vascular access options and 
transplantation); and 
‘‘(ii) to ensure that the individual has the 
opportunity to actively participate in the choice 
of therapy. 
‘‘(2) The term ‘qualified person’ means—
‘‘(A) a physician (as described in subsection 
(r)(1)); 
‘‘(B) an individual who—
‘‘(i) is—
‘‘(I) a registered nurse; 
‘‘(II) a registered dietitian or nutri-
tion professional (as defined in subsection 
(vv)(2)); 
‘‘(III) a clinical social worker (as de-
fined in subsection (hh)(1)); 
‘‘(IV) a physician assistant, nurse 
practitioner, or clinical nurse specialist (as 
those terms are defined in subsection 
(aa)(5)); or 
‘‘(V) a transplant coordinator; and 
‘‘(ii) meets such requirements related to 
experience and other qualifications that the 
Secretary finds necessary and appropriate for
furnishing the services described in paragraph 
(1); or 
‘‘(C) a renal dialysis facility subject to the re-
quirements of section 1881(b)(1) with personnel 
who—
‘‘(i) provide the services described in para-
graph (1); and 
‘‘(ii) meet the requirements of subpara-
graph (A) or (B). 
‘‘(3) The Secretary shall develop the requirements 
under paragraphs (1)(C)(i) and (2)(B)(ii) after consulting 
with physicians, health educators, professional organiza-
tions, accrediting organizations, kidney patient organiza-
tions, dialysis facilities, transplant centers, network orga-
nizations described in section 1881(c)(2), and other 
knowledgeable persons. 
‘‘(4) In promulgating regulations to carry out this 
subsection, the Secretary shall ensure that each bene-
ficiary who is entitled to kidney disease education services 
under this title receives such services in a timely manner 
to maximize the benefit of those services. 
‘‘(5) The Secretary shall monitor the implementation 
of this subsection to ensure that beneficiaries who are eli-
gible for kidney disease education services receive such 
services in the manner described in paragraph (4).
‘‘(6) No individual shall be eligible to be provided 
more than 6 sessions of kidney disease education services 
under this title.’’. 
(3) PAYMENT
UNDER
THE
PHYSICIAN
FEE 
SCHEDULE.—Section 1848(j)(3) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(j)(3)) is amended by 
inserting ‘‘(2)(AA),’’ after ‘‘(2)(W),’’. 
(4) PAYMENT
TO
RENAL
DIALYSIS
FACILI-
TIES.—Section 1881(b) of the Social Security Act 
(42 U.S.C. 1395rr(b)), as amended by section 
201(b), is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(15) For purposes of paragraph (12), the single 
composite weighted formulas determined under such para-
graph shall not take into account the amount of payment 
for kidney disease education services (as defined in section 
1861(bbb)). Instead, payment for such services shall be 
made to the renal dialysis facility on an assignment-re-
lated basis under section 1848.’’. 
(5) LIMITATION ON NUMBER OF SESSIONS.—
Section 1862(a)(1) of the Social Security Act (42 
U.S.C. 1395y(a)(1)) is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (L);
(B) by striking the semicolon at the end of 
subparagraph (M) and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(N) in the case of kidney disease education 
services (as defined in section 1861(bbb)), which are 
performed in excess of the number of sessions cov-
ered under such section;’’. 
(6) ANNUAL REPORT TO CONGRESS.—Not later 
than April 1, 2007, and annually thereafter, the 
Secretary of Health and Human Services (in this 
section referred to as the ‘‘Secretary’’) shall submit 
to Congress a report on the number of medicare 
beneficiaries who are entitled to kidney disease edu-
cation services (as defined in section 1861(bbb) of 
the Social Security Act, as added by paragraph (2)) 
under title XVIII of such Act and who receive such 
services, together with such recommendations for 
legislative and administrative action as the Secretary 
determines to be appropriate to fulfill the legislative 
intent that resulted in the enactment of that sub-
section. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on and after 
January 1, 2007.
SEC. 303. BLOOD FLOW MONITORING DEMONSTRATION 
PROJECTS. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish demonstration projects to evaluate 
how blood flow monitoring affects the quality and cost of 
care for medicare beneficiaries with end-stage renal dis-
ease. 
(b) DURATION.—The demonstration projects under 
this section shall be conducted for a period of not longer 
than 5 years that begins on January 1, 2007. 
(c) EVALUATION AND REPORT.—
(1) EVALUATION.—The Secretary shall conduct 
an evaluation of the demonstration projects con-
ducted under this section. 
(2) REPORT.—Not later than 6 months after 
the date on which the demonstration projects under 
this section are completed, the Secretary shall sub-
mit to Congress a report on the evaluation con-
ducted under paragraph (1) together with rec-
ommendations for such legislation and administra-
tive action as the Secretary determines appropriate. 
(d) WAIVER AUTHORITY.—The Secretary shall waive 
compliance with the requirements of title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) to such extent
and for such period as the Secretary determines is nec-
essary to conduct the demonstration projects. 
(e) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—Payments for the costs of 
carrying out the demonstration project under this 
section shall be made from the Federal Supple-
mentary Medical Insurance Trust Fund under sec-
tion 1841 of such Act (42 U.S.C. 1395t). 
(2) AMOUNT.—There are authorized to be ap-
propriated from such Trust Fund $1,000,000 for 
each of fiscal years 2007 through 2011 to carry out 
this section. 
TITLE IV—IMPROVING QUALITY 
THROUGH 
IMPROVED 
COV-
ERAGE 
SEC. 401. IMPROVING THE HOME DIALYSIS BENEFIT. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall provide appropriate incentives to improve 
the home dialysis benefit for individuals on behalf of whom 
payment may be made under section 1881 of the Social 
Security Act (42 U.S.C. 1395rr). 
(b) CONSIDERATIONS.—In developing the incentives 
under subsection (a), the Secretary shall consider revising 
the fee schedule for physicians’ services under section
1848 of the Social Security Act (42 U.S.C. 1395w–4) so 
that the amount paid for services related to end-stage 
renal disease furnished to home dialysis patients is equal 
to the amount paid for services related to end-stage renal 
disease furnished to other patients with 4 or more face-
to-face physician visits per month. 
SEC. 402. INSTITUTE OF MEDICINE EVALUATION AND RE-
PORT ON HOME DIALYSIS. 
(a) EVALUATION.—
(1) IN GENERAL.—Not later than the date that 
is 2 months after the date of enactment of this Act, 
the Secretary of Health and Human Services (in this 
section referred to as the ‘‘Secretary’’) shall enter 
into an arrangement under which the Institute of 
Medicine of the National Academy of Sciences (in 
this section referred to as the ‘‘Institute’’) shall con-
duct an evaluation of the barriers that exist to in-
creasing the number of individuals with end-stage 
renal disease who elect to receive home dialysis serv-
ices under the medicare program under title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.). 
(2) SPECIFIC MATTERS EVALUATED.—In con-
ducting the evaluation under paragraph (1), the In-
stitute shall—
(A) compare current medicare home dialy-
sis costs and payments with current in-center 
and hospital dialysis costs and payments; 
(B) catalogue and evaluate the incentives 
and disincentives in the current reimbursement 
system that influence whether patients receive 
home dialysis services; 
(C) evaluate patient education services and 
how such services impact the treatment choices 
made by patients; and 
(D) consider such other matters as the In-
stitute determines appropriate. 
(3) SCOPE
OF
REVIEW.—The Institute shall 
consider a variety of perspectives, including the per-
spectives of physicians, other health care profes-
sionals, hospitals, dialysis facilities, health plans, 
purchasers, and patients. 
(b) REPORT.—Not later than the date that is 18 
months after the date of enactment of this Act, the Insti-
tute shall submit to the Secretary and appropriate com-
mittees of Congress a report on the evaluation conducted 
under subsection (a)(1) describing the findings of such 
evaluation and recommendations for implementing incen-
tives to encourage patients to elect to receive home dialysis 
services under the medicare program.
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary for the purposes of conducting the evaluation 
and preparing the report required by this section. 
SEC. 403. END-STAGE RENAL DISEASE (ESRD) ADVISORY 
COMMITTEE. 
(a) ESTABLISHMENT.—Pursuant to section 222 of 
the Public Health Service Act (42 U.S.C. 217a), the Sec-
retary of Health and Human Services shall establish with-
in 1 year of the date of enactment of this Act an inde-
pendent, multidisciplinary, nonpartisan End-Stage Renal 
Disease Advisory Committee (in this section referred to 
as the ‘‘Committee’’). 
(b) MEMBERSHIP.—The Committee shall consist of 
such members as the Secretary may appoint who shall 
serve for such term as the Secretary may specify. In ap-
pointing members of the Committee, the Secretary shall 
consult with the dialysis community and shall include indi-
viduals drawn from diverse backgrounds, such as medi-
cine, nursing, health care policy, the dialysis patient com-
munity, the dialysis provider community, and health eco-
nomics. 
(c) PURPOSE OF THE COMMITTEE.—
(1) DUTIES.—The Committee shall provide a 
forum for expert discussion and deliberation and the
formulation of advice and recommendations to the 
Secretary about medicare coverage for End-Stage 
Renal Disease patients, as described under section 
1881 of the Social Security Act (42 U.S.C. 1395rr). 
(2) REPORT.—The Committee shall provide the 
Secretary with periodic reports that summarize the 
Committee’s activities and its recommendations for 
such legislation and administrative action as it con-
siders appropriate. 
(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out the purposes of this section.
Æ