‘‘(i) uses risk adjuster factors applied under 
part C; and 
‘‘(ii) adjusts such payments to exclude the top 
2 percent of outliers. 
‘‘(F) In establishing such program, the Secretary 
shall ensure that each of the following is satisfied: 
‘‘(i) The program allows for all types and sizes 
of renal dialysis facilities and providers of services 
described in subparagraph (A), including profit and 
not-for-profit, urban and rural, as well as all other 
types and sizes of such facilities and providers, to 
participate. 
‘‘(ii) The program rewards high quality, effi-
cient facilities and providers through gain-sharing. 
‘‘(iii) For purposes of determining the actual 
reductions in expenditures under this title attrib-
utable to a coordinated care organization described 
in subparagraph (A), the program includes a mar-
ket-based benchmark system that will not be rebased 
against which such expenditures shall be compared. 
‘‘(iv) The program results in reductions of ex-
penditures under parts A and B for services that are 
not dialysis-related services. 
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‘‘(v) The program allows new applicants to par-
ticipate in the program after the initial implementa-
tion period. 
‘‘(vi) The program establishes clear quality 
metrics in consultation with the kidney care commu-
nity. 
‘‘(vii) The program provides for waivers of Fed-
eral laws or requirements, in consultation with inter-
ested stakeholders. 
‘‘(viii) Under such program the Secretary at-
tributes individuals described in subparagraph (A) 
who receive treatment through a care coordination 
organization described in such subparagraph to such 
organization rather than to any other payment 
model that requires beneficiary attribution. 
‘‘(ix) Under such program the Secretary pro-
vides quarterly Medicare parts A and B claims data 
to facilities and providers described in subparagraph 
(A) participating in such program. 
‘‘(G) Not later than three years after the date of the 
implementation 
of 
the 
ESRD 
Care 
Coordination 
gainsharing program, the Secretary shall submit to the 
Congress a report on the waivers granted under subpara-
graph (F)(vii) and the effectiveness of such waivers in al-
lowing the coordination of care.’’. 
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(2) CONFORMING AMENDMENTS.— 
(A) SECTION 1881.—Section 1881(b) of the 
Social Security Act (42 U.S.C. 1395rr(b)) is 
amended— 
(i) in each of paragraphs (12)(A) and 
(13)(A), by striking ‘‘paragraph (14)’’ and 
inserting ‘‘paragraphs (14) and (15)’’; and 
(ii) in paragraph (14)(A)(i), by insert-
ing ‘‘and paragraph (15)’’ after ‘‘Subject 
to subparagraph (E)’’. 
(B) SECTION 1848.—Section 1848 of the 
Social Security Act (42 U.S.C. 1395w–4) is 
amended by adding at the end the following 
new subsection: 
‘‘(q) VOLUNTARY ESRD COORDINATED CARE PRO-
GRAM.—For provisions related to incentive payment 
amounts to nephrologists under the ESRD Care Coordina-
tion gainsharing program, see section 1881(b)(15).’’. 
(d) PATIENT INFORMATION REQUIREMENT.—The 
Secretary of Health and Human Services shall require 
hospitals that furnish items and services to individuals en-
titled to benefits under part A of title XVIII of the Social 
Security Act or eligible for benefits under part B of such 
title and who subsequently receive dialysis services at a 
renal dialysis facility (as defined in section 1881 of such 
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Act (42 U.S.C. 1395rr)) to provide to such facility health 
information with respect to such individual, including a 
discharge summary and co-morbidity information, upon 
request of the facility, not later than 7 days after notifica-
tion by the hospital of the provision of such services to 
such individual or of the determination that such indi-
vidual has end stage renal disease, as applicable. 
Æ 
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