I 
115TH CONGRESS 
1ST SESSION H. R. 4143 
To establish a demonstration program to provide integrated care for Medicare 
beneficiaries with end-stage renal disease, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 26, 2017 
Mr. SMITH of Missouri (for himself, Mr. BLUMENAUER, Mrs. MCMORRIS 
RODGERS, and Mr. CA´RDENAS) 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 de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To establish a demonstration program to provide integrated 
care for Medicare beneficiaries with end-stage renal dis-
ease, and for other purposes. 
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 ‘‘Dialysis Patient Access 
To Integrated-care, Empowerment, Nephrologists, Treat-
ment, and Services Demonstration Act of 2017’’ or the 
‘‘Dialysis PATIENTS Demonstration Act of 2017’’. 
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SEC. 2. DEMONSTRATION PROGRAM TO PROVIDE INTE-
GRATED 
CARE 
FOR 
MEDICARE 
BENE-
FICIARIES WITH END-STAGE RENAL DISEASE. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act is amended by inserting after section 1866E the fol-
lowing new section: 
‘‘DEMONSTRATION
PROGRAM
TO
PROVIDE
INTEGRATED 
CARE
FOR
MEDICARE
BENEFICIARIES
WITH
END- 
STAGE RENAL DISEASE 
‘‘SEC. 1866F. (a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—The Secretary shall con-
duct under this section the ESRD Integrated Care 
Demonstration Program (in this section referred to 
as the ‘Program’) which is voluntary for patients 
and providers to assess the effects of alternative care 
delivery models and payment methodologies on pa-
tient care improvements under this title for Pro-
gram-eligible beneficiaries (as defined in paragraph 
(2)). Under the Program— 
‘‘(A) Program-eligible beneficiaries shall be 
considered enrolled under the original Medicare 
fee-for-service program under parts A and B; 
‘‘(B) eligible participating providers (as de-
fined in such paragraph) may form an ESRD 
Integrated Care Organization (in this section 
referred to as an ‘Organization’); and 
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‘‘(C) an Organization shall integrate care 
and serve as the medical home under the origi-
nal medicare fee-for-service program under 
parts A and B for Program-eligible bene-
ficiaries. 
‘‘(2) DEFINITIONS.—In this section: 
‘‘(A) 
ELIGIBLE
PARTICIPATING
PRO-
VIDER.—The term ‘eligible participating pro-
vider’ means the following: 
‘‘(i) A facility certified as a renal di-
alysis facility under this title. 
‘‘(ii) A dialysis organization that owns 
one or more of such facilities described in 
clause (i). 
‘‘(iii) A nephrologist or nephrology 
practice. 
‘‘(iv) Any other physician group prac-
tice or a group of affiliated physicians or 
providers. 
‘‘(B) 
ELIGIBLE
PARTICIPATING
PART-
NER.—The term ‘eligible participating partner’ 
means, with respect to an Organization, the fol-
lowing: 
‘‘(i) A Medicare Advantage plan de-
scribed in section 1851(a)(2) or a Medi-
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care Advantage organization offering such 
a plan. 
‘‘(ii) A prescription drug plan (as de-
fined in section 1860D–41(a)(14)). 
‘‘(iii) A medicaid managed care orga-
nization (as defined in section 1903(m)). 
‘‘(iv) An entity that is able to bear 
risk as deemed by a State, including public 
medical educational institutions experi-
enced in the care of patients receiving di-
alysis, and that chooses to bear risk as a 
condition of partnership in such organiza-
tion. 
‘‘(v) A third-party administrator orga-
nization. 
‘‘(C) PROGRAM-ELIGIBLE BENEFICIARY.— 
The term ‘Program-eligible beneficiary’ means, 
with respect to an Organization offering an 
ESRD Integrated Care Model, an individual en-
titled to benefits under part A and enrolled 
under part B who— 
‘‘(i) is identified by the Secretary or 
the Organization as receiving renal dialysis 
services under the original medicare fee- 
for-service program under parts A and B; 
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‘‘(ii) resides in the service area of 
such Organization; 
‘‘(iii) receives renal dialysis services 
primarily from a facility that participates 
in such Organization; 
‘‘(iv) has not received a successful 
kidney transplant; and 
‘‘(v) has experienced a failed trans-
plant. 
‘‘(b) ESRD INTEGRATED CARE ORGANIZATION ELI-
GIBILITY REQUIREMENTS.— 
‘‘(1) ORGANIZATIONS.— 
‘‘(A) IN GENERAL.—One or more eligible 
participating providers may establish an Orga-
nization or may enter into, subject to subpara-
graph (B), one or more partnership, ownership, 
or co-ownership agreements with one or more 
eligible participating partners to establish an 
Organization. 
‘‘(B) LIMITATION ON NUMBER OF AGREE-
MENTS.—The Secretary may specify a limita-
tion on the number of Organizations in which 
an eligible participating partner may participate 
under agreements described in subparagraph 
(A). 
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‘‘(2) ESRD INTEGRATED CARE MODEL.— 
‘‘(A) BENEFITS REQUIREMENTS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(iii), an Organization shall offer at least 
one ESRD Integrated Care Model that is 
an open network model (as described in 
subparagraph (B)(i)) in each of its service 
areas and may offer one or more ESRD 
Integrated Care Models that is a preferred 
network model (as described in subpara-
graph (B)(ii)) in each of its service areas. 
For purposes of this section an ESRD In-
tegrated Care Model (in this section re-
ferred to as the ‘Model’), subject to sub-
section (f)(3)(B)— 
‘‘(I) shall cover all benefits under 
parts A and B (other than hospice 
care) and include benefits for transi-
tion (particularly including education) 
into transplantation, palliative care, or 
hospice; and 
‘‘(II) may, through a partnership 
or other agreement with an MA–PD 
plan under part C or prescription 
drug plan under part D, cover all pre-
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scription drug benefits under such 
part D. 
‘‘(ii) TREATMENT OF SAVINGS.— 
‘‘(I) IN GENERAL.—Any Organi-
zation offering an ESRD Integrated 
Care Model shall provide for the re-
turn under subclause (IV) to a Pro-
gram-eligible beneficiary enrolled in 
the Organization of the amount, if 
any, by which the payment amount 
described in subclause (III) with re-
spect to the Program-eligible bene-
ficiary for a year exceeds the revenue 
amount described in subclause (II) 
with respect to the Program-eligible 
beneficiary for the year. 
‘‘(II) REVENUE
AMOUNT
DE-
SCRIBED.—The revenue amount de-
scribed in this subclause, with respect 
to an Organization offering an ESRD 
Integrated Care Model and a Pro-
gram-eligible beneficiary enrolled in 
such Organization, is the Organiza-
tion’s estimated average revenue re-
quirements, including administrative 
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costs and return on investment, for 
the Organization to provide the bene-
fits described in clause (i) under the 
Model for the Program-eligible bene-
ficiary for the year. 
‘‘(III) PAYMENT
AMOUNT
DE-
SCRIBED.—The payment amount de-
scribed in this subclause, with respect 
to an Organization offering an ESRD 
Integrated Care Model and a Pro-
gram-eligible beneficiary enrolled in 
such Organization, is the payment 
amount to the Organization under 
subsection (f)(1) made with respect to 
the Program-eligible beneficiary for 
the year. 
‘‘(IV) MEANS
OF
RETURNING 
SAVINGS
TO
PROGRAM-ELIGIBLE 
BENEFICIARIES ENROLLED IN ORGA-
NIZATIONS.—An Organization shall 
return the amount under subclause (I) 
to a Program-eligible beneficiary en-
rolled in the Organization in a man-
ner specified by the Organization, 
which may include, as applicable, cost- 
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