I 
115TH CONGRESS 
1ST SESSION H. R. 3867 
To amend title XVIII of the Social Security Act to create care management 
demonstration programs for chronic kidney disease under the Medicare 
program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 28, 2017 
Mr. MULLIN (for himself, Mr. HOLDING, Mr. BUTTERFIELD, and Ms. 
SA´NCHEZ) introduced the following bill; which was referred to the Com-
mittee 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 create 
care management demonstration programs for chronic 
kidney disease under the Medicare program, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. CARE MANAGEMENT DEMONSTRATION PRO-
GRAMS FOR CHRONIC KIDNEY DISEASE. 
Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by inserting after section 1866E 
the following new section: 
‘‘SEC. 1866F. CARE MANAGEMENT DEMONSTRATION PRO-
GRAMS FOR CHRONIC KIDNEY DISEASE. 
‘‘(a) DEMONSTRATION PROGRAM FOR EARLIER AND 
IMPROVED DETECTION AND TREATMENT OF CHRONIC 
KIDNEY DISEASE.— 
‘‘(1) IN GENERAL.—Not later than 18 months 
after the enactment of this section, the Secretary 
shall establish a demonstration program (referred to 
in this section as the ‘CKD early detection and 
treatment demonstration program’) of the use of the 
payment system described in paragraph (2) that, 
with respect to an enrolled CKD–EDT individual (as 
defined in paragraph (8)(D)), provides to a CKD– 
EDT practitioner (as defined in paragraph (8)(A)) 
a single monthly care management payment for all 
CKD–EDT services (as defined in paragraph 
(8)(B)) furnished to such individual by such practi-
tioner in a month. 
‘‘(2) PAYMENT SYSTEM DESCRIBED.—The pay-
ment system described in this paragraph is a pay-
ment system that, with respect to all CKD–EDT 
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services furnished in a month by a CKD–EDT prac-
titioner to an enrolled CKD–EDT individual, pro-
vides a care management payment to such practi-
tioner in an amount that— 
‘‘(A) is greater than the amount of pay-
ment that such practitioner otherwise would re-
ceive pursuant to this title for furnishing such 
services to such individual if the practitioner 
had not elected to participate in the CKD early 
detection and treatment demonstration program 
(to be calculated in a manner that includes, as 
part of such amount that the practitioner other-
wise would so receive, any amounts that the 
practitioner would receive as cost-sharing 
amounts from the individual); 
‘‘(B) with respect to a fiscal year that is 
after the first fiscal year in which the CKD– 
EDT practitioner participates in the CKD early 
detection and treatment demonstration pro-
gram, is, to the extent feasible, adjusted based 
on the performance of the practitioner during 
the prior fiscal year with respect to the meas-
ures developed by the Secretary pursuant to 
paragraph (3); and 
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‘‘(C) is determined through the use of a 
computation that is developed in consultation 
with— 
‘‘(i) chronic kidney disease patient ad-
vocates; 
‘‘(ii) clinicians in the primary care 
community; and 
‘‘(iii) such other entities as the Sec-
retary determines appropriate. 
For purposes of applying subparagraph (A) 
with respect to CKD–EDT services that are 
furnished via a telecommunications system by a 
CKD–EDT practitioner to an enrolled CKD– 
EDT individual, the Secretary shall calculate 
the amount that the practitioner otherwise 
would so receive with respect to such services in 
a manner that makes such amount equal the 
amount that such practitioner otherwise would 
so receive for such services if such services had 
been furnished without the use of a tele-
communications system. 
‘‘(3) MEASURES.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (2)(B), the Secretary, in conjunction with 
stakeholders (including chronic kidney care pa-
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tient advocates, clinicians in the primary care 
community, and experts in the development or 
use of evidence-based guidelines for the detec-
tion, diagnosis, and management of chronic kid-
ney care), shall specify measures of perform-
ance with respect to the tasks described in sub-
paragraph (B). Such measures shall be in ac-
cordance with clinical guidelines in existence 
with respect to chronic kidney disease at the 
time of such specification. 
‘‘(B) TASKS DESCRIBED.—The tasks de-
scribed in this subparagraph, with respect to a 
CKD–EDT practitioner, are the following: 
‘‘(i) Administering, as appropriate, an 
annual serum creatinine and urine albumin 
testing in accordance with published chron-
ic kidney care practice guidelines to indi-
viduals for whom the practitioner is the 
primary care practitioner and that either 
are CKD–EDT individuals or are at the 
highest risk for chronic kidney disease. 
‘‘(ii) Ensuring that, when appropriate, 
individuals that are enrolled CKD–EDT 
individuals with respect to the practitioner 
receive timely consultations, in accordance 
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with published chronic kidney care practice 
guidelines, with nephrologists located in 
the geographic area in which the individual 
resides. 
‘‘(C) FLEXIBILITY IN MEASURE SPECIFICA-
TION.—For purposes of subparagraph (A), the 
Secretary may specify measures that the Sec-
retary develops for purposes of such subpara-
graph or that the Secretary did not develop for 
such purposes. 
‘‘(4) WAIVING
OF
COST-SHARING.—A CKD– 
EDT practitioner that participates in the CKD early 
detection and treatment demonstration program 
shall, with respect to any CKD–EDT services for 
which payment is made under the payment system 
described in paragraph (2), accept any payment 
made under such paragraph for such services as 
payment in full for such services, and may not col-
lect any amount of cost-sharing (including any 
amount of deductible, coinsurance, or copayment) 
from an enrolled CKD–EDT individual for the fur-
nishing of such services to such individual. 
‘‘(5) GEOGRAPHIC
DISTRIBUTION
OF
PRO-
VIDERS.—To the extent practicable, the Secretary 
shall ensure (including through targeted outreach to 
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physicians, nurse practitioners, and physician assist-
ants that are primary care practitioners with respect 
to enrolled CKD–EDT individuals) that the individ-
uals who receive CKD–EDT services for which pay-
ment is provided under the CKD early detection and 
treatment demonstration program are evenly distrib-
uted— 
‘‘(A) in different regions of the United 
States; 
‘‘(B) in urban and rural areas; and 
‘‘(C) among appropriate facilities, includ-
ing— 
‘‘(i) federally qualified health centers; 
and 
‘‘(ii) community health centers that 
receive assistance under section 330 of the 
Public Health Service Act. 
‘‘(6) DURATION AND SCOPE OF DEMONSTRA-
TION.— 
‘‘(A) THREE-YEAR MINIMUM.—Subject to 
subparagraph (C), the Secretary shall conduct 
the CKD early detection and treatment dem-
onstration program for a period of three years. 
‘‘(B) SCOPE.—Subject to subparagraph 
(C), the Secretary shall enroll, subject to para-
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graph (10), not more than 5,000 CKD–EDT 
individuals for participation in the demonstra-
tion program. Such an individual may partici-
pate in the demonstration program on a vol-
untary basis and may terminate participation at 
any time. 
‘‘(C) OPTION TO EXTEND.—The Secretary 
may, through rulemaking, expand (including 
implementation on a nationwide basis) the du-
ration and the scope of the CKD early detection 
and treatment demonstration program, to the 
extent determined appropriate by the Secretary, 
if— 
‘‘(i) the Secretary determines that 
such expansion is expected to— 
‘‘(I) reduce spending under this 
title without reducing the quality of 
care; or 
‘‘(II) improve the quality of pa-
tient care without increasing spending 
under this title; 
‘‘(ii) the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies 
that such expansion would reduce (or 
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would not result in any increase in) net 
program spending under this title; and 
‘‘(iii) the Secretary determines that 
such expansion would not deny or limit the 
coverage or provision of benefits under this 
title for applicable individuals. 
‘‘(7) CONSULTATION WITH STAKEHOLDERS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
consult with stakeholders regarding the estab-
lishment and implementation of the CKD early 
detection and treatment demonstration pro-
gram. 
‘‘(B) TIMING
OF
CONSULTATION.—The 
Secretary shall begin to consult with stake-
holders pursuant to subparagraph (A) not later 
than six months after the date of the enactment 
of this section. 
‘‘(8) DEFINITIONS.—For purposes of this sec-
tion, the following definitions apply: 
‘‘(A) CKD–EDT PRACTITIONER.—Subject 
to paragraph (9), the term ‘CKD–EDT practi-
tioner’ means, with respect to an enrolled 
CKD–EDT individual, a physician, nurse prac-
titioner, or physician assistant who— 
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‘‘(i) is the primary care practitioner 
for such individual; 
‘‘(ii) agrees, with respect to each fiscal 
year in which the practitioner participates 
in the CKD early detection and treatment 
demonstration program, to— 
‘‘(I) assess the at-risk patient 
populations of such physician, nurse 
practitioner, or physician assistant (as 
applicable) for chronic kidney disease 
pursuant to published clinical practice 
guidelines with respect to chronic kid-
ney disease; and 
‘‘(II) submit to the Secretary the 
results of the assessments described in 
subclause (I); 
‘‘(iii) uses certified EHR technology 
(as defined in section 1833(o)(4)); 
‘‘(iv) elects to participate in the CKD 
early detection and treatment demonstra-
tion program with respect to all enrolled 
CKD–EDT individuals for whom such phy-
sician, nurse practitioner, or physician as-
sistant (as applicable) is the primary care 
practitioner; 
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‘‘(v) agrees, with respect to each fiscal 
year in which the practitioner participates 
in the demonstration program, to assess 
annually (pursuant to established clinical 
guidelines with respect to the monitoring 
of the progression of chronic kidney dis-
ease) all enrolled CKD–EDT individuals 
for whom such physician, nurse practi-
tioner, or physician assistant (as applica-
ble) is the primary care practitioner and 
that are either— 
‘‘(I) confirmed to have chronic 
kidney disease; or 
‘‘(II) at the highest risk of be-
coming an individual with confirmed 
chronic kidney disease; 
‘‘(vi) agrees to provide to each en-
rolled CKD–EDT individual for whom 
such physician, nurse practitioner, or phy-
sician assistant (as applicable) is the pri-
mary care practitioner— 
‘‘(I) educational materials that 
provide background information about 
chronic kidney disease and that are 
developed by credible organizations, as 
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specified by the Secretary, with exper-
tise in the development of clinical 
guidelines and patient educational ma-
terials with respect to chronic kidney 
disease; and 
‘‘(II) a notification of the poten-
tial benefits that the individual may 
receive as a result of the practitioner 
participating in the CKD early detec-
tion and treatment demonstration 
program; and 
‘‘(vii) agrees to comply with the re-
quirements of paragraph (10). 
‘‘(B) CKD–EDT SERVICES.— 
‘‘(i) IN GENERAL.—The term ‘CKD– 
EDT services’ means administration and 
evaluation of such services as the Secretary 
may specify that are screening services and 
care management services for chronic kid-
ney disease and for which, subject to 
clause (iv), payment may otherwise be 
made under this title. 
‘‘(ii) CONSULTATION
REQUIRED.—In 
determining which services to specify for 
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purposes of clause (i), the Secretary shall 
consult with— 
‘‘(I) chronic kidney disease pa-
tient advocates; 
‘‘(II) clinicians in the primary 
care nephrologist community; and 
‘‘(III) experts in the development 
of evidence-based guidelines for the 
detection, diagnosis, and management 
of chronic kidney disease. 
‘‘(iii) 
CONSIDERED
SERVICES.—In 
specifying services for purposes of clause 
(i), the Secretary may, in addition to con-
sidering other services and patient bene-
fits, consider the following services with re-
spect to the screening, care, and manage-
ment of chronic kidney disease: 
‘‘(I) Blood pressure management. 
‘‘(II) Lipid management. 
‘‘(III) Assessment for bone and 
mineral 
metabolism 
abnormalities, 
anemia, nutritional needs, mental 
health, and availability of family and 
other social support networks. 
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‘‘(IV) Delivery of patient edu-
cation on self-management strategies 
for chronic kidney disease. 
‘‘(V) Development of care plans 
with respect to chronic kidney disease. 
‘‘(VI) Medication reconciliation 
and dosage adjustments. 
‘‘(VII) Review of laboratory tests. 
‘‘(VIII) Medical nutrition ther-
apy. 
‘‘(iv) PERMISSIBLE
INCLUSION
OF 
TELEHEALTH
SERVICES.—The 
term 
‘CKD–EDT services’ may include services 
that are furnished via a telecommuni-
cations system by a CKD–EDT practi-
tioner to an enrolled CKD–EDT individual 
and that would have been CKD–EDT serv-
ices under clause (i) if such services had 
been furnished without the use of a tele-
communications system. 
‘‘(C) CKD–EDT INDIVIDUAL.—The term 
‘CKD–EDT individual’ means an individual 
who— 
‘‘(i) is not under the care of a 
nephrologist or nephrology practitioner; 
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‘‘(ii) is an individual with confirmed 
chronic kidney disease at a stage equal to, 
or greater than, stage 3; and 
‘‘(iii) is entitled to benefits under part 
A and enrolled under part B. 
‘‘(D) ENROLLED CKD–EDT INDIVIDUAL.— 
The term ‘enrolled CKD–EDT individual’ 
means a CKD–EDT individual who is enrolled 
to participate in the demonstration program 
under paragraph (6). 
‘‘(9) INTEGRATED CARE STRATEGY.— 
‘‘(A) IN GENERAL.—Under the demonstra-
tion, a CKD–EDT practitioner, with respect to 
enrolled CKD–EDT individuals, shall develop 
and submit for the Secretary’s approval, subject 
to subparagraphs (B) and (C), a CKD–EDT in-
tegrated care strategy. 
‘‘(B) INTEGRATED
CARE
STRATEGY.—In 
assessing a CKD–EDT integrated care strat-
egy, the Secretary shall consider the extent to 
which the strategy includes elements, such as 
the following: 
‘‘(i) Interdisciplinary care teams led 
by at least one nephrologist, and comprised 
of registered nurses, social workers, and 
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other representatives from alternative set-
tings described in clause (vi). 
‘‘(ii) Health risk and other assess-
ments to determine the physical, psycho-
social, nutrition, language, cultural, and 
other needs of enrolled CKD–EDT individ-
uals involved. 
‘‘(iii) Development and at least annual 
updating of individualized care plans that 
incorporate at least the medical, social, 
and functional needs, preferences, and care 
goals of enrolled CKD–EDT individuals. 
‘‘(iv) Coordination and delivery of 
non-clinical services, such as transpor-
tation, aimed at improving the adherence 
of enrolled CKD–EDT individuals with 
care recommendations. 
‘‘(v) Services, such as transplant eval-
uation and vascular access care. 
‘‘(vi) In the case of an individual who, 
while enrolled in the demonstration, re-
ceives confirmation that a kidney trans-
plant is imminent, the provision by an 
interdisciplinary care team described in 
clause (i) of counseling services to such in-
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dividual on preparation for and potential 
challenges surrounding such transplant. 
‘‘(vii) Delivery of benefits and services 
in alternative settings, such as the home of 
the enrolled CKD–EDT individuals, in co-
ordination with the provider or other ap-
propriate stakeholder involved in such de-
livery serving on an interdisciplinary care 
team described in clause (i). 
‘‘(viii) Use of patient reminder sys-
tems. 
‘‘(ix) Education programs for pa-
tients, families, and caregivers. 
‘‘(x) Use of health care advice re-
sources, such as nurse advice lines. 
‘‘(xi) Use of team-based health care 
delivery models that provide comprehensive 
and continuous medical care, such as med-
ical homes. 
‘‘(xii) Co-location of providers and 
services. 
‘‘(xiii) Use of a demonstrated capacity 
to share electronic health record informa-
tion across sites of care. 
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‘‘(xiv) Use of programs to promote 
better adherence to recommended treat-
ment regimens by individuals, including by 
addressing barriers to access to care by 
such individuals. 
‘‘(xv) Other services, strategies, and 
approaches identified by the CKD–EDT 
practitioner to improve care coordination 
and delivery. 
‘‘(C) REQUIREMENTS.—The Secretary may 
not approve a CKD–EDT integrated care strat-
egy of a CKD–EDT practitioner unless under 
such strategy the pracitioner— 
‘‘(i) provides services to enrolled 
CKD–EDT individuals through a com-
prehensive, multidisciplinary health and so-
cial services delivery system which inte-
grates acute and long-term care services 
pursuant to regulations; and 
‘‘(ii) specifies the covered items and 
services that will not be provided directly 
by the practitioner, and to arrange for de-
livery of those items and services through 
contracts meeting the requirements of reg-
ulations. 
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‘‘(10) BENEFICIARY PROTECTIONS.— 
‘‘(A) ANTIDISCRIMINATION.—In the case 
of a CKD–EDT practitioner that participates 
in the CKD early detection and treatment dem-
onstration program that is treating a CKD– 
EDT individual and such individual elects for 
the practitioner not to so participate in such 
demonstration program with respect to such in-
dividual, such practitioner may not participate 
in such demonstration program with respect to 
such individual (but may so participate with re-
spect to other CKD–EDT individuals). 
‘‘(B) NO IMPACT ON QUALITY OF CARE.— 
A CKD–EDT practitioner that participates in 
the CKD early detection and treatment dem-
onstration program may not allow the participa-
tion of such practitioner in such program to af-
fect the quality of services furnished under this 
title to an individual, regardless of whether the 
practitioner participates in such demonstration 
program with respect to such individual. 
‘‘(C) QUALITY ASSURANCE; PATIENT SAFE-
GUARDS.—The Secretary shall require that each 
CKD–EDT practitioner that participates in the 
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CKD early detection and treatment demonstra-
tion program has in effect— 
‘‘(i) a written plan of quality assur-
ance and improvement with respect to 
CKD–EDT services for which payment is 
made under such demonstration program, 
and procedures implementing such plan, in 
accordance with regulations; and 
‘‘(ii) written safeguards of the rights 
of enrolled CKD–EDT individuals for 
whom such practitioner is the primary care 
practitioner (including a patient bill of 
rights and procedures for grievances and 
appeals) in accordance with regulations 
and with other requirements of this title 
and Federal and State law that are de-
signed for the protection of patients. 
‘‘(b) DEMONSTRATION PROGRAM
FOR ADVANCED 
CHRONIC KIDNEY DISEASE.— 
‘‘(1) IN GENERAL.—Not later than 18 months 
after the enactment of this section, the Secretary 
shall establish a demonstration program (referred to 
in this section as the ‘advanced CKD demonstration 
program’) of the use of the payment system de-
scribed in paragraph (2) that, with respect to an in-
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dividual entitled to benefits under part A or enrolled 
under part B with confirmed chronic kidney disease 
at a stage equal to, or greater than, stage 4 (as con-
firmed by testing serum creatinine and urine albu-
min in alignment with evidence-based chronic kidney 
disease clinical guidelines), provides to an advanced 
CKD practitioner (as defined in paragraph (5)(A)) 
a single care management payment for all advanced 
CKD services (as defined in paragraph (5)(B)) fur-
nished to such individual by such practitioner in a 
month. 
‘‘(2) PAYMENT SYSTEM DESCRIBED.—The pay-
ment system described in this paragraph is a pay-
ment system that, with respect to all advanced CKD 
services furnished in a month by an advanced CKD 
practitioner to an individual described in paragraph 
(1), provides a care management payment to such 
practitioner in an amount that— 
‘‘(A) is greater than the amount of pay-
ment that such practitioner otherwise would re-
ceive pursuant to title XVIII for furnishing 
such services to such individual if the practi-
tioner had not elected to participate in the ad-
vanced CKD demonstration program (to be cal-
culated in a manner that includes, as part of 
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such amount that the practitioner otherwise 
would so receive, any amounts that the practi-
tioner would receive as cost-sharing amounts 
from the individual); 
‘‘(B) with respect to a fiscal year that is 
after the first fiscal year in which the advanced 
CKD practitioner participates in the advanced 
CKD demonstration program, is adjusted based 
on the performance of the practitioner during 
the prior fiscal year with respect to the meas-
ures developed by the Secretary pursuant to 
paragraph (3); 
‘‘(C) is determined through the use of a 
computation that is developed in consultation 
with— 
‘‘(i) chronic kidney disease patient ad-
vocates; 
‘‘(ii) clinicians in the nephrology com-
munity; 
‘‘(iii) experts in the development of 
evidence-based guidelines for the detection, 
diagnosis, and management of chronic kid-
ney disease; and 
‘‘(iv) such other entities as the Sec-
retary determines appropriate. 
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For purposes of applying subparagraph (A)(i) 
with respect to advanced CKD services that are 
furnished via a telecommunications system by 
an advanced CKD practitioner to an individual 
described in paragraph (1), the Secretary shall 
calculate the amount that the practitioner oth-
erwise would so receive with respect to such 
services in a manner that makes such amount 
equal the amount that such practitioner other-
wise would so receive for such services if such 
services had been furnished without the use of 
a telecommunications system. 
‘‘(3) MEASURES.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (2)(B), the Secretary, in conjunction with 
stakeholders (including chronic kidney care pa-
tient advocates, clinicians in the nephrology 
community, experts in the development of evi-
dence-based guidelines for the detection, diag-
nosis, and management of chronic kidney care, 
and such other entities as the Secretary deter-
mines appropriate), shall specify measures of 
performance with respect to the tasks described 
in subparagraph (B). Such measures shall be in 
accordance with clinical guidelines in existence 
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with respect to chronic kidney disease at the 
time of such specification. 
‘‘(B) TASKS DESCRIBED.—The tasks de-
scribed in this subparagraph are the following: 
‘‘(i) Reducing costs associated with 
hospitalizations of individuals described in 
paragraph (1) that are furnished CKD– 
EDT services by such practitioner. 
‘‘(ii) Providing education to such indi-
viduals regarding the importance of avoid-
ance of non-steroidal anti-inflammatory 
drugs for patients with confirmed chronic 
kidney disease. 
‘‘(iii) Providing appropriate prescrip-
tion of kidney-protective blood pressure 
medications to such individuals for such 
chronic kidney disease (unless contra-indi-
cated for individuals with confirmed chron-
ic kidney disease), elevated urine albumin, 
and elevated blood pressure in alignment 
with evidence-based guidelines. 
‘‘(iv) Providing such individuals, as 
appropriate, with planned starts of renal 
replacement therapy through the receipt by 
such individuals of preemptive kidney 
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transplants, the initiation of home dialysis, 
the initiation of outpatient in-center hemo-
dialysis through arteriovenuous fistula or 
arteriovenous graft, or supportive care. 
‘‘(C) FLEXIBILITY IN MEASURE SPECIFICA-
TION.—For purposes of subparagraph (A), the 
Secretary may specify measures that the Sec-
retary develops for purposes of such subpara-
graph or that the Secretary did not develop for 
such purposes. 
‘‘(4) APPLICATION OF EARLY DETECTION AND 
TREATMENT
DEMONSTRATION
PROGRAM
PROVI-
SIONS.—The Secretary shall, under this subsection, 
apply the provisions of paragraphs (4), (5), (6), (7), 
and (10) of subsection (a) to the advanced CKD 
demonstration program, advanced CKD practi-
tioners, advanced CKD services, and individuals de-
scribed in paragraph (1) to the same extent that 
such provisions apply under subsection (a) to the 
CKD early detection and treatment demonstration 
program, CKD–EDT practitioners, CKD–EDT serv-
ices, and enrolled CKD–EDT individuals, respec-
tively. 
‘‘(5) DEFINITIONS.—For purposes of this sec-
tion, the following definitions apply: 
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‘‘(A) ADVANCED
CKD
PRACTITIONER.— 
Subject to paragraph (6), the term ‘advanced 
CKD practitioner’ means, with respect to an in-
dividual 
described 
in 
paragraph 
(1), 
a 
nephrologist who— 
‘‘(i) participates in the Medicare pro-
gram under this title; 
‘‘(ii) subject to subsection (a)(10)(A) 
as applied pursuant to paragraph (4), 
elects to participate in the advanced CKD 
demonstration program with respect to all 
individuals described in paragraph (1) who 
receive care from the nephrologist; 
‘‘(iii) agrees to provide to each indi-
vidual described in paragraph (1) who re-
ceives care from the nephrologist— 
‘‘(I) educational materials that 
provide background information about 
chronic kidney disease and that are 
developed by credible organizations 
with expertise in the development of 
clinical guidelines and patient edu-
cational materials with respect to 
chronic kidney disease; and 
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‘‘(II) a notification of the poten-
tial benefits that the individual may 
receive as a result of the practitioner 
participating in the advanced CKD 
demonstration program; and 
‘‘(iv) agrees to comply with the re-
quirements of subsection (a)(10), as ap-
plied pursuant to paragraph (4). 
‘‘(B) ADVANCED CKD SERVICES.— 
‘‘(i) IN
GENERAL.—The term ‘ad-
vanced CKD services’ means, with respect 
to individuals described in paragraph (1), 
such services as the Secretary may specify 
that are care and management services for 
chronic kidney disease and that, subject to 
clause (iv), are services for which payment 
may otherwise be made under this title. 
‘‘(ii) CONSULTATION
REQUIRED.—In 
determining which services to specify for 
purposes of clause (i), the Secretary shall 
consult with— 
‘‘(I) chronic kidney disease pa-
tient advocates; 
‘‘(II) clinicians in the nephrology 
community; 
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‘‘(III) experts in the development 
of evidence-based guidelines for the 
detection, diagnosis, and management 
of chronic kidney disease; and 
‘‘(IV) such other entities as the 
Secretary determines appropriate. 
‘‘(iii) 
CONSIDERED
SERVICES.—In 
specifying services for purposes of clause 
(i), the Secretary may, in addition to con-
sidering other services, consider the fol-
lowing services with respect to the care 
and management of chronic kidney disease: 
‘‘(I) Kidney disease education 
benefit sessions. 
‘‘(II) Patient care planning (in-
cluding patient choice of renal re-
placement therapy or palliative or ad-
vanced care planning). 
‘‘(III) Comorbidities assessment 
and management (with respect to con-
ditions such as anemia, bone and min-
eral abnormalities, and cardiovascular 
disease). 
‘‘(IV) Mental health assessment 
and referral. 
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‘‘(V) 
Practitioner 
consultation 
and coordination with cardiologists, 
endocrinologists, mental health spe-
cialists, primary care practitioners, 
and other appropriate health care pro-
viders and suppliers. 
‘‘(VI) Vascular or peritoneal di-
alysis access assessments and coordi-
nations with surgeons. 
‘‘(VII) Referrals and coordina-
tions with transplant centers. 
‘‘(VIII) 
Medication 
reconcili-
ations and coordinations with phar-
macists. 
‘‘(IX) Medical nutrition therapy 
administered by dieticians. 
‘‘(iv) PERMISSIBLE
INCLUSION
OF 
TELEHEALTH
SERVICES.—The term ‘ad-
vanced CKD services’ may include services 
that are furnished via a telecommuni-
cations system by an advanced CKD prac-
titioner to an individual described in para-
graph (1) and that would have been ad-
vanced CKD services under clause (i) if 
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such services had been furnished without 
the use of a telecommunications system. 
‘‘(6) PARTICIPATION OF CARE TEAMS.— 
‘‘(A) IN GENERAL.—With respect to an in-
dividual 
described 
in 
paragraph 
(1), 
a 
nephrologist for such individual may participate 
in a care team described in subparagraph (B) 
that, with respect to the furnishing of advanced 
CKD services to such individual, participates in 
the advanced CKD demonstration program as 
an advanced CKD practitioner. In applying this 
subsection, such group shall be treated as such 
an advanced CKD practitioner. 
‘‘(B) CARE
TEAM
DESCRIBED.—A care 
team described in this subparagraph, with re-
spect to an individual described in paragraph 
(1), is, subject to subparagraph (C), a group of 
providers— 
‘‘(i) each of which participates in the 
Medicare program under this title; 
‘‘(ii) each of which elects to partici-
pate in the advanced CKD demonstration 
program with respect to all individuals de-
scribed in paragraph (1) for whom the 
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nephrologist described in subparagraph (A) 
is the nephrologist; and 
‘‘(iii) that agrees to provide to each 
individual described in paragraph (1) for 
whom the nephrologist described in sub-
paragraph (A) is the nephrologist— 
‘‘(I) educational materials that 
provide background information about 
chronic kidney disease and that are 
developed by credible organizations 
with expertise in the development of 
clinical guidelines and patient edu-
cational materials with respect to 
chronic kidney disease; and 
‘‘(II) a notification of the poten-
tial benefits that the individual may 
receive as a result of the practitioner 
participating in the advanced CKD 
demonstration program. 
‘‘(C) PERMISSIBLE ASSEMBLY AND ADMIN-
ISTRATION
BY
THIRD
PARTY-ADMINISTRATOR 
ORGANIZATIONS.— 
‘‘(i) IN GENERAL.—A care team de-
scribed in subparagraph (B) may be as-
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sembled and administered by a third party- 
administrator organization. 
‘‘(ii) THIRD
PARTY-ADMINISTRATOR 
ORGANIZATION.—For 
purposes 
of 
this 
paragraph, the term ‘third party-adminis-
trator organization’ means the following: 
‘‘(I) A Medicare Advantage plan 
described in section 1851(a)(2) or a 
Medicare Advantage organization of-
fering such a plan. 
‘‘(II) A prescription drug plan 
(as 
defined 
in 
section 
1860D– 
41(a)(14)). 
‘‘(III) A medicaid managed care 
organization (as defined in section 
1903(m)).’’. 
Æ 
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