I 
112TH CONGRESS 
2D SESSION 
H. R. 6011 
To amend title XVIII of the Social Security Act to improve Medicare benefits 
for individuals with kidney disease, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 21, 2012 
Mr. LEWIS of Georgia 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 jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
Medicare benefits for individuals 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 Disease Equitable Access, Prevention, and Re-
search Act of 2012’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
TITLE I—PROVIDING EQUITABLE ACCESS TO CARE FOR 
INDIVIDUALS WITH KIDNEY DISEASE 
Sec. 101. Improving access to care through improvements in the initial survey 
process for renal dialysis facilities. 
Sec. 102. Providing choice in primary insurer. 
Sec. 103. Protecting individuals with kidney failure from unfair practices. 
TITLE II—SUPPORTING RESEARCH TO IMPROVE ACCESS TO 
HIGH-QUALITY KIDNEY CARE 
Sec. 201. Understanding the progression of kidney disease in minority popu-
lations. 
Sec. 202. Recommendations on dialysis quality and care management research 
gaps. 
Sec. 203. GAO study on transportation barriers to access kidney care. 
TITLE III—IMPROVING ACCESS TO PREVENTIVE CARE FOR 
INDIVIDUALS WITH KIDNEY DISEASE 
Sec. 301. Improving access to medicare kidney disease education. 
TITLE I—PROVIDING EQUITABLE 
ACCESS TO CARE FOR INDI-
VIDUALS WITH KIDNEY DIS-
EASE 
SEC. 101. IMPROVING ACCESS TO CARE THROUGH IM-
PROVEMENTS IN THE INITIAL SURVEY PROC-
ESS FOR RENAL DIALYSIS FACILITIES. 
Section 1864 of the Social Security Act (42 U.S.C. 
1395aa) is amended— 
(1) by redesignating subsection (e) as sub-
section (f); 
(2) by inserting after subsection (d) the fol-
lowing new subsection: 
‘‘(e)(1) If the Secretary has entered into an agree-
ment with any State under this section under which the 
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appropriate State or local agency that performs any sur-
vey related to determining the compliance of a renal dialy-
sis facility subject to the requirements of section 1881(b) 
and the State licensure survey requirements are consistent 
with or exceed such Federal requirements, the Secretary 
must accept the results of the State licensure survey for 
purposes of determining Federal certification of compli-
ance. In the case of such an initial survey of a renal dialy-
sis facility, the Secretary may allow any State to waive 
the reimbursement for conducting the survey under this 
section if it requests such a waiver. 
‘‘(2) In the case of a renal dialysis facility that has 
waited for more than 6 months to receive the results of 
an initial survey under this section, the Secretary shall 
establish a specific timetable for completing and reporting 
the results of the survey.’’; and 
(3) in subsection (f), as so redesignated— 
(A) by striking ‘‘Notwithstanding any 
other provision of law,’’ and inserting ‘‘(1) Not-
withstanding any other provision of law and ex-
cept as provided in paragraph (2)’’; and 
(B) by adding at the end the following: 
‘‘(2) The Secretary may assess and collect fees for 
the initial Medicare survey from a renal dialysis facility 
subject to the requirements of section 1881(b) in an 
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amount not to exceed a reasonable fee necessary to cover 
the costs of initial surveys conducted for purposes of deter-
mining the compliance of a renal dialysis facility with the 
requirements of section 1881(b). Fees may be assessed 
and collected under this paragraph only in such manner 
as would result in an aggregate amount of fees collected 
during any fiscal year being equal to the aggregate 
amount of costs for such fiscal year for initial surveys of 
such facilities under this section. A renal dialysis facility’s 
liability for such fees shall be reasonably based on the pro-
portion of the survey costs which relate to such facility. 
Any funds collected under this paragraph shall be used 
only to conduct the initial survey of the facilities providing 
the fees. 
‘‘(3) Fees authorized under paragraph (2) shall be 
collected by the Secretary and available only to the extent 
and in the amount provided in advance in appropriations 
Acts and upon request of the Secretary, subject to the 
amount and usage limitations of such paragraph. Such 
fees so collected are authorized to remain available until 
expended.’’. 
SEC. 102. PROVIDING CHOICE IN PRIMARY INSURER. 
(a) PROVIDING PATIENT CHOICE IN MEDICARE.— 
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(1) IN GENERAL.—Section 1862(b)(1)(C) of the 
Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is 
amended— 
(A) in the last sentence, by inserting ‘‘and 
before January 1, 2013,’’ after ‘‘prior to such 
date)’’; and 
(B) by adding at the end the following new 
sentence: ‘‘Effective for items and services fur-
nished on or after January 1, 2013 (with re-
spect to periods beginning on or after the date 
that is 42 months prior to such date), clauses 
(i) and (ii) shall be applied by substituting ‘42- 
month’ for ‘12-month’ each place it appears in 
the first sentence.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on the date of en-
actment of this Act. For purposes of determining an 
individual’s status under section 1862(b)(1)(C) of 
the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), 
as amended by paragraph (1), an individual who is 
within the coordinating period as of the date of en-
actment of this Act shall have that period extended 
to the full 42 months described in the last sentence 
of such section, as added by the amendment made 
by paragraph (1)(B). 
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(b) PROVIDING EQUITABLE ACCESS TO INSURANCE 
FOR INDIVIDUALS WITH KIDNEY FAILURE.— 
(1) APPLICATION
OF
ESRD
MEDICARE
SEC-
ONDARY
PAYER
RULES
TO
HEALTH
INSURANCE 
ISSUERS.— 
(A) IN GENERAL.—Section 1862(b) of the 
Social Security Act (42 U.S.C. 1395y(b)) is 
amended— 
(i) in paragraph (1)(C), in the matter 
before clause (i), by inserting ‘‘and health 
insurance coverage (as defined in section 
2791(b) of the Public Health Service Act) 
that is a qualified health plan (as defined 
in section 1301 of the Patient Protection 
and Affordable Care Act)’’ after ‘‘subpara-
graph (A)(v))’’; 
(ii) in paragraph (2)(A), in the matter 
after clause (ii), by inserting ‘‘a group 
health plan, large group health plan, or 
health insurance coverage (as defined in 
section 2791(b) of the Public Health Serv-
ice Act) that is a qualified health plan (as 
defined in section 1301 of the Patient Pro-
tection and Affordable Care Act) to the ex-
tent that clause (i) applies pursuant to the 
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application of paragraph (1)(C),’’ after ‘‘to 
the extent that clause (i) applies,’’; 
(iii) in paragraph (3)(C), by striking 
‘‘or a large group health plan’’ and insert-
ing ‘‘, a large group health plan, or health 
insurance coverage (as defined in section 
2791(b) of the Public Health Service Act) 
that is a qualified health plan (as defined 
in section 1301 of the Patient Protection 
and Affordable Care Act)’’; and 
(iv) in paragraph (7), by adding at 
the end the following new subparagraph: 
‘‘(E) APPLICATION TO CERTAIN HEALTH 
INSURANCE
ISSUERS.—The provisions of the 
previous subparagraphs of this paragraph shall 
apply to a health insurance issuer offering 
health insurance coverage (as defined in section 
2791(b) of the Public Health Service Act) that 
is a qualified health plan (as defined in section 
1301 of the Patient Protection and Affordable 
Care Act) in the same manner as such provi-
sions apply to an entity, a plan administrator, 
or a fiduciary described in subparagraph (A), 
except that in applying such provisions— 
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‘‘(i) the reference under subparagraph 
(A) to the date of the enactment of this 
paragraph shall be deemed a reference to 
the date of the enactment of this subpara-
graph; and 
‘‘(ii) the reference under subpara-
graph (A)(i) to a primary plan shall be 
deemed a reference to a primary plan to 
the extent that paragraph (2)(A)(i) applies 
pursuant to the application of paragraph 
(1)(C).’’. 
(B) EFFECTIVE DATE.—The amendments 
made by subparagraph (A) shall apply with re-
spect to plan years beginning on or after the 
date of the enactment of this Act. 
(2) TREATMENT
OF
CERTAIN
INDIVIDUALS 
WITH
END
STAGE
RENAL
DISEASE
FOR
DETER-
MINING MINIMUM ESSENTIAL COVERAGE.—Such sec-
tion is further amended in paragraph (2), by adding 
at the end the following new subparagraph: 
‘‘(D) TREATMENT
OF
CERTAIN
INDIVID-
UALS WITH END STAGE RENAL DISEASE FOR 
DETERMINING
MINIMUM
ESSENTIAL
COV-
ERAGE.—In determining a coverage month 
under subsection (c)(2)(B)(i) of section 36B of 
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the Internal Revenue Code of 1986, with re-
spect to an individual described in paragraph 
(1)(C), for purposes of the premium assistance 
credit under such section and the application of 
subsection (f)(2) of section 1402 of the Patient 
Protection and Affordable Care Act for deter-
mining eligibility for the reduction of cost-shar-
ing under such section, such individual shall not 
be treated as having minimum essential cov-
erage described in section 5000A(f)(1)(A)(i) 
(relating to coverage under Medicare) for each 
month that a group health plan or health insur-
ance issuer may not take into account the indi-
vidual’s eligibility or entitlement under this title 
pursuant to such paragraph (1)(C).’’. 
SEC. 103. PROTECTING INDIVIDUALS WITH KIDNEY FAIL-
URE FROM UNFAIR PRACTICES. 
(a) IN GENERAL.—Section 1862(b)(1)(C)(ii) of the 
Social Security Act (42 U.S.C. 1395y(b)(1)(C)(ii)) is 
amended to read as follows: 
‘‘(ii) may not differentiate in the ben-
efits it provides between individuals having 
end stage renal disease and other individ-
uals covered by such plan or issuer on the 
basis of the existence of end stage renal 
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disease, the need for renal dialysis, or in 
any other manner, and such plan— 
‘‘(I) shall provide adequate, ad-
vanced, written notification to pa-
tients regarding changes to benefits 
for dialysis services, new restrictions 
on out-of-network access, or reduc-
tions in rates paid for out-of-network 
benefits for such services; 
‘‘(II) shall allow patients to con-
tinue using their existing provider or 
facility of such services for at least 24 
months following the date of notice of 
any change by the plan or issuer in 
the dialysis services network of the 
plan or issuer; 
‘‘(III) shall hold patients harm-
less from provider network changes 
with respect to such services if such 
changes require unreasonable drive 
time or disrupt the physician-patient 
relationship; 
‘‘(IV) may not restrict the dura-
tion or number of dialysis sessions for 
patients, such as based on a fixed 
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