I 
108TH CONGRESS 
1ST SESSION H. R. 1004
To amend title XVIII of the Social Security Act to provide for payment 
under the Medicare Program for more frequent hemodialysis treatments. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 27, 2003
Mr. MCDERMOTT (for himself, Ms. DUNN, Mr. LEWIS of Georgia, Mr. 
CUMMINGS, Mr. DICKS, Mr. RANGEL, Mr. MCNULTY, Mr. GOODE, Mr. 
HASTINGS
of Washington, Mr. INSLEE, Mr. KIRK, and Mrs. 
CHRISTENSEN) 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 provide 
for payment under the Medicare Program for more fre-
quent hemodialysis treatments.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Kidney Patient Daily 
Dialysis Quality Act of 2003’’.
SEC. 2. COVERAGE OF MORE FREQUENT HEMODIALYSIS 
TREATMENTS. 
(a) IN GENERAL.—Section 1881(b) of the Social Se-
curity Act (42 U.S.C. 1395rr(b)) is amended—
(1) in the first sentence of paragraph (7), by 
inserting before the period the following: ‘‘, including 
payment for more frequent hemodialysis furnished to 
qualified individuals under paragraph (12)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(12)(A)(i) Not later than the date that is 1 year 
after the date of enactment of this paragraph, the Sec-
retary shall cause to have published in the Federal Reg-
ister final regulations for equivalent per treatment pro-
spective payment rates for more frequent hemodialysis 
furnished at home and furnished in a facility (commonly 
known as composite ‘Method I’ rates and ‘Method II Cap’ 
payment rates), and prospective payment rates for in-facil-
ity training for more frequent hemodialysis. 
‘‘(ii) For the year beginning more than 12 months 
after the date described in clause (i), and for each subse-
quent year, the Secretary shall provide for an appropriate 
update to the per treatment prospective payment rates de-
veloped under clause (i).
‘‘(B) In developing per treatment prospective pay-
ment rates under subparagraph (A), the Secretary shall 
consider—
‘‘(i) actual reasonable costs of operating more 
frequent hemodialysis programs; and 
‘‘(ii) data from the Health Care Financing Ad-
ministration on actual expenditures under this title 
for more frequent hemodialysis patients, compared 
to—
‘‘(I) data on expenditures for the same pa-
tients before those patients underwent more fre-
quent hemodialysis, and 
‘‘(II) data on expenditures for patients un-
dergoing hemodialysis treatment 3 times per 
week with similar clinical and demographic 
characteristics. 
‘‘(C) Not later than 1 year after the date of enact-
ment of this paragraph, the Secretary shall develop, in 
consultation with the renal community, a standard of care 
and quality standards for more frequent hemodialysis. The 
Secretary shall periodically review and update as necessary 
such standards. 
‘‘(D) The Secretary shall collect data with respect 
to—
‘‘(i) documented savings in expenditures under 
this title by reason of more frequent hemodialysis 
that are attributable to reduced medications, hos-
pitalizations, outpatient services, and such other fac-
tors as the Secretary determines appropriate; and 
‘‘(ii) the improved quality of care and improved 
outcomes more frequent hemodialysis may bring to 
patients. 
‘‘(E) In this paragraph: 
‘‘(i) The term ‘more frequent hemodialysis’ 
means hemodialysis treatment sessions, or equivalent 
therapy requiring blood access, performed at least 5 
times per week. 
‘‘(ii) The term ‘qualified individual’ means an 
individual who, in the clinical judgment of the physi-
cian of the individual, is likely to achieve better clin-
ical outcomes, quality of life outcomes, or both from 
more frequent hemodialysis.’’. 
(b) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1881(b)(8) of the Social Security Act (42 U.S.C. 
1395rr(b)(8)) is amended by inserting ‘‘and more frequent 
hemodialysis supplies and equipment’’ after ‘‘home dialy-
sis supplies and equipment’’. 
(2) Section 1881(b)(9) of such Act (42 U.S.C. 
1395rr(b)(9)) is amended by inserting ‘‘and more frequent
hemodialysis support services’’ after ‘‘self-care home dialy-
sis support services’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act and shall apply with respect to items and serv-
ices furnished on or after the date that is 1 year after 
such date of enactment.
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