I
104TH CONGRESS
1ST SESSION
H. R. 1067
To amend title XVIII of the Social Security Act to require renal dialysis
facilities to meet hemodialysis standards as a condition of receiving
payment for renal hemodialysis services furnished under 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 amend title XVIII of the Social Security Act to require
renal dialysis facilities to meet hemodialysis standards
as 
a 
condition 
of 
receiving 
payment 
for 
renal
hemodialysis services furnished under the Medicare Pro-
gram.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. HEMODIALYSIS STANDARDS FOR MEDICARE
RENAL DIALYSIS FACILITIES.
(a) REQUIRING FACILITIES TO MEET STANDARDS.—
Section 1881(b)(1) of the Social Security Act (42 U.S.C.
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1395rr(b)(1)) is amended by striking the period at the end
of the second sentence and inserting ‘‘, and requirements
for adequate hemodialysis in accordance with standards
under paragraph (12).’’.
(b) STANDARDS DESCRIBED.—Section 1881(b) of
such Act (42 U.S.C. 1395rr(b)) is amended by adding at
the end the following new paragraph:
‘‘(12)(A) For purposes of paragraph (1), a pro-
vider of services or renal dialysis facility meets the
standards for adequate hemodialysis under this
paragraph for a cost reporting period if, during the
preceding cost reporting period, it certifies that for
not less than 50 percent of all the individuals receiv-
ing hemodialysis services from the facility during the
reporting period—
‘‘(i) KT/V, defined as a fraction of body
water cleared of urea during dialysis, was not
less than 1.2, where ‘K’ equals the urea clear-
ance, ‘T’ equals the duration of the dialysis,
and ‘V’ equals the volume of distribution of
urea;
‘‘(ii) in the case of a provider of services
or facility which the Secretary finds may be un-
able to implement the formula described in
clause (i) without incurring additional costs, the
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urea reduction ratio (URR) was not less than
0.65, where the URR is defined as the
predialysis 
urea 
concentration 
minus 
the
postdialysis urea concentration divided by the
predialysis urea concentration, or
‘‘(iii) the provider of services or facility
maintains appropriate documentation of blood
clearance in each patient’s medical records file
and makes such data available for review by the
appropriate end stage renal disease network.
‘‘(B) At any time, the Secretary may apply al-
ternative standards for adequate blood clearance
under this paragraph for a cost reporting period if
the Secretary certifies to Congress that the alter-
native standards are more medically appropriate
than the standards described in subparagraph (A)
for determining the quality of hemodialysis services
furnished to individuals under this title.
‘‘(C) For reporting periods after January 1,
1998, the 50 percent requirement in subparagraph
(A) shall be increased to 75 percent.’’.
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SEC. 2. EFFECTIVE DATE.
The amendments made by section 1 shall apply to
services furnished during portions of cost reporting peri-
ods beginning on or after January 1, 1997.
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