I
104TH CONGRESS
1ST SESSION
H. R. 1068
To direct the Secretary of Health and Human Services to conduct a dem-
onstration project under which payment shall be made under the medi-
care program for renal disease management services furnished to individ-
uals at risk for end stage renal disease to accurately assess whether
those management services can prevent the progression of renal disease
to renal failure and thereby delay the onset of dialysis and cause savings
for the medicare program.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 27, 1995
Mr. STARK introduced the following bill; which was referred to the Committee
on 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 direct the Secretary of Health and Human Services to
conduct a demonstration project under which payment
shall be made under the medicare program for renal
disease management services furnished to individuals at
risk for end stage renal disease to accurately assess
whether those management services can prevent the pro-
gression of renal disease to renal failure and thereby
delay the onset of dialysis and cause savings for the
medicare program.
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 
1. 
ESTABLISHMENT 
OF 
DEMONSTRATION
PROJECT.
(a) IN GENERAL.—Not later than six months after
the date of the enactment of this Act, the Secretary of
Health and Human Services (hereafter referred to as the
‘‘Secretary’’) shall conduct a demonstration project under
which the Secretary shall make payment under the medi-
care program for renal disease management services fur-
nished to eligible individuals participating in the project
to accurately assess whether those management services
can prevent the progression of renal disease to renal fail-
ure and thereby delay the onset of dialysis and cause sav-
ings for the medicare program.
(b) SELECTION OF SITES.—The Secretary shall con-
duct the demonstration project under this Act at two sites
selected by the Secretary in accordance with such criteria
as the Secretary may establish.
SEC. 2. DESCRIPTION OF ELIGIBLE INDIVIDUALS AND
COVERED SERVICES.
(a) ELIGIBLE INDIVIDUALS.—An individual is an eli-
gible individual for purposes of participation in the dem-
onstration project if—
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(1) the individual’s attending physician certifies
that the individual is at risk for, but does not suffer
from, end stage renal disease (in accordance with
criteria established by the Secretary);
(2) the individual is not entitled to benefits
under Part A or enrolled under part B of the medi-
care program; and
(3) the individual meets such other require-
ments as the Secretary may impose.
(b) RENAL DISEASE MANAGEMENT SERVICES DE-
SCRIBED.—For purposes of this Act, ‘‘renal disease man-
agement services’’ are services designed to prevent the
onset of end stage renal disease, including—
(1) dietary counseling and improvement in nu-
tritional status;
(2) the management of diabetes, hypertension,
and other conditions associated with the onset of end
stage renal disease;
(3) reduction of cardiovascular risk factors;
(4) correction of metabolic, endocrinologic, and
hematologic abnormalities;
(5) improvements in patient education of the
causes and course of the disease;
(6) the evaluation and control of environmental
nephrotoxins; and
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(7) such other services as the Secretary consid-
ers appropriate.
SEC. 3. DETERMINATION OF AMOUNT OF PAYMENT FOR
COVERED SERVICES.
(a) APPLICATION OF MEDICARE PAYMENT METH-
ODOLOGIES.—To the extent that a renal disease manage-
ment service for which payment may be made under the
demonstration project is a service for which payment may
be made under title XVIII of the Social Security Act, the
amount of payment made for the service under the dem-
onstration project shall be determined in accordance with
the methodology used to determine the amount of payment
for the service under such title.
(b) PAYMENT FOR SERVICES NOT COVERED UNDER
MEDICARE.—To the extent that a renal disease manage-
ment service for which payment may be made under the
demonstration project is not a service for which payment
may be made under title XVIII of the Social Security Act,
the amount of payment made for the service under the
demonstration project shall be determined in accordance
with such methodology as the Secretary may establish.
SEC. 4. INDEPENDENT MONITORING OF PROJECT.
The Secretary shall enter into a contract with an en-
tity not otherwise participating in or affiliated with the
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demonstration project to monitor the project and to assess
and make public the extent to which—
(1) the implementation of renal disease man-
agement services produces increased job retention,
preservation of meaningful and taxable income, or
improvement in the quality of life as measured by
health status questionnaires or other tools as estab-
lished by the Secretary;
(2) renal disease management services affect
the patient’s functional outcome and/or natural his-
tory of their kidney disease as compared to a well-
matched control group and measured by variables as
the Secretary may establish; and
(3) the implementation of renal disease man-
agement services in eligible individuals as a means
to aggressively manage the factors contributing to
kidney disease has delayed the progression of renal
disease and, therefore, the onset of dialysis.
SEC. 5. TERMINATION OF PROJECT.
The demonstration project conducted under this Act
shall terminate upon the expiration of the three-year pe-
riod which begins on the first date on which the project
is in effect.
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