ceding sentence shall not apply to a measure that 
the entity with a contract under section 1890(a) (or 
a similar entity) considered but failed to endorse.’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(iii) 
COMPOSITE
MEASURES.— 
Clauses (i) and (ii) shall apply to com-
posite measures in the same manner as 
such clauses apply to individual meas-
ures.’’. 
(c) REQUIREMENTS FOR DIALYSIS FACILITY COM-
PARE STAR RATING PROGRAM.—Section 1881(h)(6) of 
the Social Security Act (42 U.S.C. 1395rr(h)(6)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(E) REQUIREMENTS FOR ANY DIALYSIS 
FACILITY COMPARE STAR RATING PROGRAM.— 
To the extent that the Secretary maintains a 
dialysis facility compare star rating program, 
under such a program the Secretary— 
‘‘(i) shall assign stars using the same 
methodology and total performance score 
results from the quality incentive program 
under this subsection; 
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‘‘(ii) shall determine the stars using 
the same methodology used under such 
quality incentive program; and 
‘‘(iii) shall not use a forced bell curve 
when determining the stars or rebaselining 
the stars.’’. 
(d) INCENTIVE PAYMENTS.—Section 1881(h)(1) of 
the Social Security Act (42 U.S.C. 1395rr(h)(1)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(D) INCENTIVE PAYMENTS.— 
‘‘(i) IN GENERAL.—In the case of a 
provider of services or a renal dialysis fa-
cility that the Secretary determines exceeds 
the attainment performance standards 
under paragraph (4) with respect to a 
year, the Secretary may make a bonus 
payment to the provider or facility (pursu-
ant to a process established by the Sec-
retary). 
‘‘(ii) FUNDING.—The total amount of 
bonus payments under clause (i) in a year 
shall be equal to the total amount of re-
duced payments in a year under subpara-
graph (A). 
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‘‘(iii) NO
EFFECT
IN
SUBSEQUENT 
YEARS.—The provisions of subparagraph 
(C) shall apply to a bonus payment under 
this subparagraph in the same manner 
subparagraph (C) applies to a reduction 
under such subparagraph.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2022. 
TITLE IV—EMPOWERING 
PATIENTS 
SEC. 401. MEDIGAP COVERAGE FOR BENEFICIARIES WITH 
END-STAGE RENAL DISEASE. 
(a) GUARANTEED AVAILABILITY OF MEDIGAP POLI-
CIES TO ALL ESRD MEDICARE BENEFICIARIES.— 
(1) IN GENERAL.—Section 1882(s) of the So-
cial Security Act (42 U.S.C. 1395ss(s)) is amend-
ed— 
(A) in paragraph (2)— 
(i) in subparagraph (A), by striking 
‘‘is 65’’ and all that follows through the 
period and inserting the following: ‘‘is— 
‘‘(i) 65 years of age or older and is enrolled for 
benefits under part B; or 
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‘‘(ii) entitled to benefits under 226A(b) and is 
enrolled for benefits under part B.’’; and 
(ii) in subparagraph (D), in the mat-
ter preceding clause (i), by inserting ‘‘(or 
is entitled to benefits under 226A(b))’’ 
after ‘‘is 65 years of age or older’’; and 
(B) in paragraph (3)(B)— 
(i) in clause (ii), by inserting ‘‘(or is 
entitled to benefits under 226A(b))’’ after 
‘‘is 65 years of age or older’’; and 
(ii) in clause (vi), by inserting ‘‘(or 
under 226A(b))’’ after ‘‘at age 65’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to Medicare supple-
mental policies effective on or after January 1, 
2022. 
(b) ADDITIONAL ENROLLMENT PERIOD FOR CER-
TAIN INDIVIDUALS.— 
(1) ONE-TIME ENROLLMENT PERIOD.— 
(A) IN GENERAL.—In the case of an indi-
vidual described in subparagraph (B), the Sec-
retary of Health and Human Services shall es-
tablish a one-time enrollment period during 
which such an individual may enroll in any 
Medicare supplemental policy under section 
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1882 of the Social Security Act (42 U.S.C. 
1395ss) of the individual’s choosing. 
(B) ENROLLMENT
PERIOD.—The enroll-
ment period established under subparagraph 
(A) shall begin on January 1, 2023, and shall 
end June 30, 2023. 
(2) INDIVIDUAL DESCRIBED.—An individual de-
scribed in this paragraph is an individual who— 
(A) is entitled to hospital insurance bene-
fits under part A of title XVIII of the Social 
Security Act under section 226A(b) of such Act 
(42 U.S.C. 426–1); 
(B) is enrolled for benefits under part B of 
such title XVIII; and 
(C) would not, but for the provisions of, 
and amendments made by, subsection (a) be eli-
gible for the guaranteed issue of a Medicare 
supplemental policy under paragraph (2) or (3) 
of section 1882(s) of such Act (42 U.S.C. 
1395ss(s)). 
SEC. 402. NETWORK ADEQUACY STANDARDS FOR DIALYSIS 
SERVICES. 
Section 1852(d) of the Social Security Act (42 U.S.C. 
1395w–22(d)) is amended by adding at the end the fol-
lowing new paragraph: 
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‘‘(7) NETWORK ADEQUACY REQUIREMENTS FOR 
DIALYSIS SERVICES.—For plan year 2022 and sub-
sequent plan years, the Secretary shall apply the 
network adequacy standards under this subsection 
with respect to access to dialysis services— 
‘‘(A) using the time and distance stand-
ards in effect for plan year 2020; and 
‘‘(B) without regard to the final rule titled 
‘Medicare Program; Contract Year 2021 Policy 
and Technical Changes to the Medicare Advan-
tage Program, Medicare Prescription Drug 
Benefit Program, and Medicare Cost Plan Pro-
gram’ (85 Fed. Reg. 33796).’’. 
SEC. 403. ALLOWING INDIVIDUALS WITH KIDNEY FAILURE 
TO RETAIN ACCESS TO PRIVATE INSURANCE. 
(a) IN GENERAL.—Section 1862(b)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend-
ed— 
(1) in the last sentence, by inserting ‘‘and be-
fore January 1, 2022’’ 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, 2022 (with respect to periods 
beginning on or after the date that is 42 months 
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