I
107TH CONGRESS
2D SESSION
H. R. 4729
To amend the Social Security Act to provide for coverage under the Medicare
Program of chronic kidney disease patients who are not end-stage renal
disease patients.
IN THE HOUSE OF REPRESENTATIVES
MAY 14, 2002
Mr. STARK (for himself, Mr. MCDERMOTT, Mrs. THURMAN, and Mrs.
CHRISTENSEN) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on En-
ergy and Commerce, 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 the Social Security Act to provide for coverage
under the Medicare Program of chronic kidney disease
patients who are not end-stage renal disease patients.
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 ‘‘Medicare Chronic Kid-
ney Disease Management Act of 2002’’.
SEC. 2. DELAYING ONSET OF ESRD.
(a) MEDICARE COVERAGE OF CHRONIC KIDNEY DIS-
EASE PATIENTS.—
(1) IN GENERAL.—Section 226A of the Social
Security Act (42 U.S.C. 426–1) is amended—
(A) by redesignating the last subsection as
subsection (e); and
(B) by inserting after subsection (c) the
following new subsection:
‘‘(d)(1)(A) Notwithstanding any provision to the con-
trary in section 226 or title XVIII, every qualified chronic
kidney disease patient (as defined in paragraph (2)) shall,
in accordance with the succeeding provisions of this sec-
tion, be entitled to benefits under part A and eligible to
enroll under part B of title XVIII, subject to the deduct-
ible, premium, and coinsurance provisions of that title.
‘‘(B) No qualified chronic kidney disease patient may
enroll under part C of title XVIII.
‘‘(2) For purposes of this subsection, the term ‘‘quali-
fied chronic kidney disease patient’’ means an individual—
‘‘(A) who would otherwise be described in sub-
section (a) but for paragraph (2) of that subsection;
‘‘(B) who has been diagnosed with chronic kid-
ney disease;
‘‘(C) with respect to whom, a physician certifies
that—
‘‘(i) the individual, under generally accept-
ed clinical standards, will likely need dialysis
treatments or a kidney transplant within the
two-year period beginning on the date of certifi-
cation; and
‘‘(ii) the individual may benefit from a pro-
gram of pre-ESRD services (as defined in sec-
tion 1861(ww)(1)); and
‘‘(D) who certifies that the individual does not
have health insurance coverage.’’.
(2) CONFORMING AMENDMENTS.—Section 1811
of such Act (42 U.S.C. 1395c) is amended by insert-
ing before the period the following: ‘‘or who are
qualified chronic kidney disease patient (as defined
in section 226A(d)(2))’’.
(3) EFFECTIVE DATE.—The amendments made by
this subsection shall take effect January 1, 2004.
(b) COVERAGE OF PRE-ESRD SERVICES.—
(1) IN
GENERAL.—Section 1861(s)(2) of the
Social Security Act (42 U.S.C. 1395x(s)(2)) is
amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (U);
(B) by inserting ‘‘and’’ at the end of sub-
paragraph (V); and
(C) by adding at the end the following new
subparagraph:
‘‘(W) pre-ESRD services (as defined in sub-
section (ww)(1)) for an individual who has been di-
agnosed with chronic kidney disease and, with re-
spect to whom, a physician certifies that—
‘‘(i) the individual, under generally accept-
ed clinical standards, will likely need dialysis
treatments within the two-year period beginning
on the date of certification; and
‘‘(ii) the individual may benefit from a pro-
gram of pre-ESRD services;’’.
(2) SERVICES DESCRIBED.—Section 1861 of
the Social Security Act (42 U.S.C. 1395x) is amend-
ed by adding at the end the following new sub-
section:
‘‘Pre-ESRD Services
‘‘(ww)(1) The term ‘pre-ESRD Services’ means any
or all of the following services:
‘‘(A) Individual and group nutritional coun-
seling services for the purpose of chronic kidney dis-
ease management that are furnished by a registered
dietitian or nutrition professional (as defined in sub-
section (vv)(2)) pursuant to a referral by a physician
(as defined in subsection (r)(1)).
‘‘(B) Counseling furnished by qualified health
care providers that—
‘‘(i) provides comprehensive information
regarding the management of comorbidities,
and the prevention of uremic complications;
‘‘(ii) ensures active participation of the in-
dividual in the choice of therapy or therapies;
and
‘‘(iii) provides comprehensive information
regarding modalities of treatment for kidney
disease and end-stage renal disease, including
organ transplantation, hemodialysis, peritoneal
dialysis, and home dialysis.
‘‘(C) Counseling, items and services, including
tissue typing, furnished by qualified health care pro-
viders for preparation of possible organ transplan-
tation.
‘‘(D) Items and services furnished by qualified
health care providers for the preparation of vascular
access required for dialysis treatment.
‘‘(E) Such other services as the Secretary deter-
mines appropriate, in consultation with national or-
ganizations representing individuals and entities who
furnish pre-ESRD services and patients receiving
such services.
‘‘(2) The Secretary shall establish such criteria as the
Secretary determines appropriate for qualifications re-
quired for individuals to furnish pre-ESRD services under
paragraph (1).’’.
(3) PAYMENT AMOUNT.—
(A) IN GENERAL.—Section 1833(a)(1) of
the Social Security Act (42 U.S.C. 1395l(a)(1))
is amended—
(i) by striking ‘‘and’’ before ‘‘(U)’’;
and
(ii) by inserting before the semicolon
at the end the following: ‘‘, and (V) with
respect to pre-ESRD services, the amount
paid shall be 80 percent of the amount de-
termined under the fee schedule estab-
lished under section 1834(e)’’.
(B) ESTABLISHMENT
OF
FEE
SCHED-
ULE.—Section 1834 of such Act (42 U.S.C.
1395m) is amended by inserting after sub-
section (d) the following new subsection:
‘‘(e) FEE SCHEDULE FOR PRE-ESRD SERVICES.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a fee schedule for payment for pre-ESRD serv-
ices in accordance with the requirements of this sub-
section.