for the duration of the participation of such 
beneficiaries under the Program; 
‘‘(B) eligible participating providers may 
form an ESRD Fee-For-Service Integrated 
Care Organization (in this section referred to as 
an ‘Organization’); and 
‘‘(C) an Organization shall integrate care 
under the original Medicare Fee-For-Service 
program under parts A and B for Program-eli-
gible beneficiaries. 
‘‘(2) DEFINITIONS.—In this section: 
‘‘(A) 
ELIGIBLE
PARTICIPATING
PRO-
VIDER.—The term ‘eligible participating pro-
vider’ means any of the following: 
‘‘(i) A facility certified as a renal di-
alysis facility under this title. 
‘‘(ii) An entity that owns one or more 
of such facilities described in clause (i). 
‘‘(iii) A nephrologist (including a pedi-
atric nephrologist) or nephrology practice. 
‘‘(iv) Any other physician or physician 
group practice. 
‘‘(v) A nurse practitioner, physician 
assistant, or clinical nurse specialist (as 
such 
terms 
are 
defined 
in 
section 
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1861(aa)(5)) or a clinical social worker (as 
defined in section 1861(hh)(1)) working in 
conjunction with such a nurse practitioner, 
physician assistant, or clinical nurse spe-
cialist. 
‘‘(B) 
ELIGIBLE
PARTICIPATING
PART-
NER.—The term ‘eligible participating partner’ 
means, with respect to an Organization, any of 
the following: 
‘‘(i) A Medicare Advantage plan de-
scribed in section 1851(a)(2) or a Medi-
care Advantage organization offering such 
a plan. 
‘‘(ii) A Medicaid managed care orga-
nization (as defined in section 1903(m)). 
‘‘(iii) A hospital or an academic med-
ical center experienced in the care of pa-
tients receiving dialysis. 
‘‘(iv) Any other entity determined ap-
propriate by the Secretary. 
‘‘(C) PROGRAM-ELIGIBLE BENEFICIARY.— 
‘‘(i) IN
GENERAL.—The term ‘Pro-
gram-eligible beneficiary’ means, with re-
spect to an Organization offering an 
ESRD Fee-For-Service Integrated Care 
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Model, an individual entitled to benefits 
under part A and enrolled under part B 
(including such an individual entitled to 
medical assistance under a State plan 
under title XIX) who— 
‘‘(I) is identified by the Secretary 
as having end-stage renal disease and 
who is receiving renal dialysis services 
under the original Medicare Fee-For- 
Service program under parts A and B, 
and is not enrolled in a Medicare Ad-
vantage plan under part C or group 
health insurance coverage or indi-
vidual health insurance coverage (as 
defined in section 2791(b) of the Pub-
lic Health Service Act (42 U.S.C. 
300gg–91(b))) that is primary to cov-
erage under this title; 
‘‘(II) receives renal dialysis serv-
ices primarily from an eligible partici-
pating provider of such Organization, 
including such renal dialysis services 
received after being identified as a 
suitable candidate for transplantation; 
and 
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‘‘(III) has attained the age of 18 
years. 
‘‘(ii) AFFIRMATION OF PROGRAM ELI-
GIBILITY
UPON
HOSPICE
ELECTION
OR 
KIDNEY TRANSPLANT.—A Program-eligible 
beneficiary who was assigned to or elected 
an ESRD Fee-For-Service Integrated Care 
Model offered by an Organization and 
who— 
‘‘(I) elects to receive hospice ben-
efits under section 1852(d)(1); or 
‘‘(II) receives a kidney transplant 
as covered under this title and main-
tains entitlement to benefits under 
part A and enrollment in part B on 
the basis of end stage renal disease, 
shall continue to meet the definition of 
Program-eligible 
beneficiary 
established 
under this subparagraph. 
‘‘(b) ESRD FEE-FOR-SERVICE INTEGRATED CARE 
ORGANIZATION ELIGIBILITY REQUIREMENTS.— 
‘‘(1) ORGANIZATIONS.— 
‘‘(A) IN GENERAL.—One or more eligible 
participating providers may establish an Orga-
nization and may enter into, subject to sub-
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paragraph (B), one or more partnership, owner-
ship, or co-ownership agreements with one or 
more eligible participating partners to establish 
an Organization or to offer one or more ESRD 
Fee-For-Service Integrated Care Models in ac-
cordance with paragraph (2). 
‘‘(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 
for purposes of offering one or more ESRD 
Fee-For-Service Integrated Care Models under 
partnership, ownership, or co-ownership agree-
ments described in subparagraph (A). 
‘‘(C) MINIMUM PROGRAM ELIGIBLE BENE-
FICIARY PARTICIPATION REQUIREMENT.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the Secretary may not enter into or 
continue an agreement with an Organiza-
tion unless the Organization has at least 
350 Program-eligible beneficiaries, or at 
least 60 percent of Program-eligible bene-
ficiaries receiving care from the Organiza-
tion’s facilities, who are assigned to or 
elect an ESRD Fee-For-Service Integrated 
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Model offered by the Organization and who 
continue their assignment to or election of 
the Organization. 
‘‘(ii) ALLOWING
TRANSITION.—The 
Secretary may waive the requirement 
under clause (i) for an Organization dur-
ing the first agreement year with respect 
to the Organization. 
‘‘(D) 
FISCAL
SOUNDNESS
REQUIRE-
MENTS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall enter into appropriate agreements 
under this section only with Organizations 
that demonstrate sufficient capital re-
serves, measured as a percentage of 
monthly prospective payments described in 
subsection (e) and consistent with capital 
reserve requirements established by each 
State in which the Organization operates, 
subject to clause (ii). 
‘‘(ii) ALTERNATIVE
MECHANISM
TO 
DEMONSTRATE RISK-BEARING CAPACITY.— 
An Organization shall be considered to 
meet the requirement in clause (i) if the 
Organization includes at least one eligible 
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cial information consistent with such infor-
mation required to be reported by a Medi-
care Advantage organization under part C 
to demonstrate that the Organization has 
a fiscally sound operation. 
‘‘(E) 
GOVERNANCE
REQUIREMENTS.— 
Each Organization with an agreement under 
this section shall establish a governing body 
with oversight responsibility for the Organiza-
tion’s compliance with Program requirements 
that includes— 
‘‘(i) representation from each eligible 
participating provider of such Organiza-
tion; 
‘‘(ii) at least two nephrologists, one of 
which may be affiliated with an eligible 
participating provider; and 
‘‘(iii) at least one beneficiary advo-
cate. 
‘‘(2) ESRD 
FEE-FOR-SERVICE
INTEGRATED 
CARE MODEL.— 
‘‘(A) BENEFIT REQUIREMENTS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(iii), an Organization shall offer an ESRD 
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Fee-For-Service Integrated Care Model 
that shall— 
‘‘(I) cover all benefits under 
parts A and B (subject to payment 
rules regarding the treatment of and 
payment for kidney organ acquisitions 
and hospice described in subsections 
(e)(3) and (4)); and 
‘‘(II) include services for transi-
tion (particularly including education) 
into transplantation, palliative care, 
and hospice. 
‘‘(ii) DETERMINATION
AND
TREAT-
MENT OF SAVINGS.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall require any Organization 
offering an ESRD Fee-For-Service 
Integrated Care Model to provide for 
the return under subclause (VI) to a 
Program-eligible beneficiary assigned 
to or who elects an Organization sav-
ings equal to the amount, if any, by 
which the payment amount described 
in subclause (V) with respect to the 
Program-eligible beneficiary for a year 
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exceeds the average revenue amount 
described in subclause (IV) with re-
spect to the Program-eligible bene-
ficiary for the year. 
‘‘(II) SAVINGS
DETERMINATION 
PROCESS.—The Secretary shall deter-
mine the savings described in sub-
clause (I) in the same manner as the 
rebate calculation for individuals with 
end-stage renal disease enrolled in 
Medicare 
Advantage 
organizations 
under section 1859(b)(6)(B)(iii). 
‘‘(III) APPLICATION OF MEDICAL 
LOSS
RATIO
REQUIREMENTS.—Noth-
ing shall preclude the Secretary from 
applying medical loss ratio require-
ments described in section 1857(e)(4) 
under this section. 
‘‘(IV) 
AVERAGE
REVENUE 
AMOUNT
DESCRIBED.—The revenue 
amount described in this subclause, 
with respect to an Organization offer-
ing an ESRD Fee-For-Service Inte-
grated Care Model and a Program-eli-
gible beneficiary assigned to or who 
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elects such Organization, is the Orga-
nization’s estimated average revenue 
requirements, including administrative 
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. 
‘‘(V) PAYMENT
AMOUNT
DE-
SCRIBED.—The payment amount de-
scribed in this subclause, with respect 
to an Organization offering an ESRD 
Fee-For-Service 
Integrated 
Care 
Model and a Program-eligible bene-
ficiary assigned to or who elects such 
Organization, is the payment amount 
to the Organization under subsection 
(e)(1) (adjusted pursuant to sub-
section (e)(2) and subject to the treat-
ment of payments for kidney acquisi-
tions and hospice care described in 
paragraphs (3) and (4) of subsection 
(e), respectively) made with respect to 
the Program-eligible beneficiary for 
the year. 
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‘‘(VI) RETURNING
SAVINGS
TO 
PROGRAM-ELIGIBLE
BENE-
FICIARIES.—An Organization shall, in 
a manner specified by the Secretary 
and consistent with returning Medi-
care Advantage rebates to individuals 
under part C, return the amount 
under subclause (I) to a Program-eli-
gible beneficiary through offering ben-
efits not covered under the original 
Medicare 
Fee-For-Service 
program 
consistent with the types of benefits, 
including non-health related benefits, 
that Medicare Advantage organiza-
tions may offer. 
‘‘(iii) BENEFIT
REQUIREMENTS
FOR 
DUAL ELIGIBLES.—In the case of a Pro-
gram-eligible beneficiary who is entitled to 
medical assistance under a State plan 
under title XIX, an Organization, in ac-
cordance with a mutual agreement entered 
into between the State and Organization 
under subsection (e)(7)— 
‘‘(I) shall provide, or arrange for 
the provision of, all benefits (other 
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than long-term services and supports) 
for which the Program-eligible bene-
ficiary is entitled to under a State 
plan under title XIX; and 
‘‘(II) may elect to provide, or ar-
range for the provision of, long-term 
services and supports for which the 
Program-eligible beneficiary is entitled 
under a State plan under title XIX, 
including services related to the tran-
sition into palliative care or hospice. 
‘‘(iv) APPLICATION OF MEDICARE FFS 
PROVIDER CHOICE AND COST-SHARING RE-
QUIREMENTS.—Under an ESRD Fee-For- 
Service Integrated Care Model offered by 
an Organization, the Organization shall— 
‘‘(I) allow Program-eligible bene-
ficiaries to receive benefits as de-
scribed in subsection (b)(2)(A)(i)(I) 
from any provider of services or sup-
plier enrolled under this title and who 
otherwise meets all applicable require-
ments under this title; 
‘‘(II) not apply any cost-sharing 
requirements for benefits described in 
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subsection (b)(2)(A)(i)(I) in addition 
to premium and cost-sharing require-
ments, respectively, that would be ap-
plicable under part A or part B for 
such benefits. 
‘‘(v) PROMOTING
ACCESS
TO
HIGH- 
QUALITY
PROVIDERS.—An Organization 
offering an ESRD Fee-For-Service Inte-
grated Care Model shall develop and imple-
ment performance-based incentives, includ-
ing financial incentives funded through 
payments made to an Organization under 
subsection (e), for providers of services and 
suppliers to promote delivery of high qual-
ity and efficient care. Such incentives shall 
comply with section 1852(j)(4) and section 
422.208 of title 42, Code of Federal regu-
lations (as in effect on the date of enact-
ment of this section) and be based on clin-
ical measures or non-clinical measures, 
such as with respect to notification of pa-
tient discharge from a hospital, patient 
education (such as with respect to treat-
ment options, including disease mainte-
nance, and nutrition), rates of completion 
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of patient education categorized by race, 
rates of completion of transplant evalua-
tion for patients who are clinically eligible 
for transplant, rates of completion of 
transplant evaluation categorized by race, 
and the interoperability of electronic health 
records developed by an Organization ac-
cording to requirements and standards 
specified by the Secretary pursuant to sub-
paragraph (B). 
‘‘(B) QUALITY AND REPORTING REQUIRE-
MENTS.— 
‘‘(i) CLINICAL MEASURES.—Under the 
Program, the Secretary shall— 
‘‘(I) require each participating 
Organization to submit to the Sec-
retary data on clinical measures devel-
oped using, as a reference, measures 
submitted by organizations partici-
pating in the Comprehensive ESRD 
Care Initiative operated by the Center 
for Medicare and Medicaid Innovation 
to assess the quality of care provided; 
‘‘(II) establish requirements for 
participating Organizations to submit 
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to the Secretary, in a form and man-
ner specified by the Secretary, infor-
mation on such measures; and 
‘‘(III) establish standards for 
making information on quality under 
the Program established under this 
section as assessed using clinical 
measures described in subclause (I) 
available to the public. 
As part of the standards described in sub-
clause (III) the Secretary shall, in con-
sultation with relevant stakeholders, de-
velop standards that would establish a 
minimum threshold for the volume of indi-
vidual patients to be listed for transplant 
in an Organ Procurement and Transplant 
Network under contract with the Secretary 
and that would measure the number of in-
dividuals that an Organization moved on 
to, kept on, or removed from the trans-
plant list and the number of individuals 
that receive a transplant after partici-
pating in the Organization. The number of 
Program-eligible beneficiaries assigned to 
an Organization on the transplant list that 
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have not opted out at the time of the 
agreement between the Secretary and an 
Organization shall be noted as part of such 
agreement. Organizations shall submit 
such measures as a condition of payment 
and Program-eligible beneficiary assign-
ment under this subsection. 
‘‘(ii) 
REQUIREMENT
FOR
STAKE-
HOLDER INPUT.—In developing measures 
and requirements under subclauses (I) and 
(II) of clause (i), the Secretary shall re-
quest and consider input from a stake-
holder board that includes at least one 
nephrologist, 
a 
pediatric 
nephrologist, 
other suppliers and providers of services as 
determined appropriate by the Secretary, 
renal dialysis facilities, beneficiary advo-
cates, a health equity expert, a mental 
health provider, a transplant surgeon, and 
Medicare-approved transplant programs. 
Section 14 of the Federal Advisory Com-
mittee Act shall not apply to the stake-
holder board. 
‘‘(iii) ADDITIONAL ASSESSMENTS AND 
REPORTING
REQUIREMENTS.—The 
Sec-
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retary shall assess the extent to which an 
Organization offers integrated and patient- 
centered care through analysis of informa-
tion obtained from Program-eligible bene-
ficiaries assigned to or who elect the Orga-
nization through surveys, such as the In- 
Center Hemodialysis Consumer Assess-
ment of Healthcare Providers and Sys-
tems. 
‘‘(iv) NO EFFECT ON OTHER RENAL 
DIALYSIS
FACILITY
QUALITY
REQUIRE-
MENTS.—Nothing in this section shall be 
construed as affecting the requirements es-
tablished under section 1881(h). 
‘‘(v) PRIORITIZATION
OF
QUALITY 
MEASURE
REPORTING.—The 
Secretary 
shall give priority to the development and 
reporting of quality measures that allow 
the assessment of health outcomes of pa-
tients, care coordination, patient experi-
ence and satisfaction, medication reconcili-
ation, patient safety, and other evidence- 
based quality measures determined appro-
priate by the Secretary. 
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‘‘(C) REQUIREMENTS FOR ESRD FEE-FOR- 
SERVICE INTEGRATED CARE STRATEGY.— 
‘‘(i) IN
GENERAL.—An Organization 
seeking a contract under this section to 
offer one or more ESRD Fee-For-Service 
Integrated Care Models shall develop and 
submit for the Secretary’s approval as part 
of the application of the Organization to 
participate in the Program under this sec-
tion, subject to clauses (ii) and (iii), an 
ESRD Fee-For-Service Integrated Care 
Strategy. 
‘‘(ii) ESRD FEE-FOR-SERVICE INTE-
GRATED CARE STRATEGY.—In assessing an 
ESRD Fee-For-Service Integrated Care 
Strategy under clause (i), the Secretary 
shall consider the extent to which the 
Strategy includes elements such as the fol-
lowing: 
‘‘(I) Use of interdisciplinary care 
teams led by at least one nephrologist, 
and comprised of registered nurses, 
social workers, renal dialysis facility 
managers, and as appropriate other 
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representatives from alternative set-
tings described in subclause (VIII). 
‘‘(II) Use of a decision process 
for care plans and care management 
that includes the nephrologist, a mem-
ber of the transplant evaluation team, 
and other practitioners responsible for 
direct delivery of care to Program-eli-
gible beneficiaries assigned to or who 
elect the Organization involved. 
‘‘(III) Use of health risk and 
other assessments to determine the 
physical, psychosocial, nutrition, lan-
guage, cultural, and other needs of 
Program-eligible beneficiaries assigned 
to or who elect the Organization in-
volved. 
‘‘(IV) 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 Pro-
gram-eligible beneficiaries assigned to 
or who elect the Organization, includ-
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ing a discussion on reconsideration of 
the method and location of dialysis. 
‘‘(V) Coordination and furnishing 
of non-clinical coordination benefits, 
such as transportation, aimed at im-
proving the adherence of Program-eli-
gible beneficiaries assigned to or who 
elect the Organization with care rec-
ommendations. 
‘‘(VI) As appropriate, coordina-
tion services, such as transplant eval-
uation, palliative care, evaluation for 
hospice eligibility, and vascular access 
care. 
‘‘(VII) In the case of an indi-
vidual who, during an assignment to, 
or an election of an ESRD Fee-For- 
Service Integrated Care model offered 
by an Organization, receives confirma-
tion that a kidney transplant is immi-
nent, the provision of counseling serv-
ices by an interdisciplinary care team 
described in subclause (I) to such in-
dividual on preparation for and poten-
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tial benefits and risks associated with 
such transplant. 
‘‘(VIII) Delivery of benefits and 
services in settings alternative to tra-
ditional clinical settings, such as the 
home of the Program-eligible bene-
ficiary. 
‘‘(IX) Use of patient reminder 
systems. 
‘‘(X) Education programs for pa-
tients, families, and caregivers. 
‘‘(XI) Use of health care advice 
resources, such as nurse advice lines. 
‘‘(XII) Use of team-based health 
care delivery models that provide com-
prehensive and continuous medical 
care, such as medical homes. 
‘‘(XIII) Co-location of providers 
and services. 
‘‘(XIV) Use of a demonstrated 
capacity to share electronic health 
record information across sites of 
care. 
‘‘(XV) Use of programs to pro-
mote 
better 
adherence 
to 
rec-
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ommended treatment regimens, in-
cluding prescription drug, by individ-
uals, including by addressing barriers 
to access to care by such individuals, 
including strategies to coordinate any 
prescription drug benefits under any 
prescription drug plan under part D 
in which a Program-eligible bene-
ficiary is enrolled. 
‘‘(XVI) Use of defined protocols, 
developed in conjunction with the pe-
diatric nephrology community, to fa-
cilitate the transition of pediatric indi-
viduals into adult end-stage renal dis-
ease care. 
‘‘(XVII) Use of health equity ex-
perts to implement programs and pro-
tocols which seek to decrease gender, 
racial, ethnic, and language inequities. 
‘‘(XVIII) Other services, strate-
gies, and approaches identified by the 
Organization to improve care coordi-
nation and delivery. 
‘‘(3) BENEFICIARY PROTECTIONS.— 
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‘‘(A) SEAMLESS
ACCESS
TO
CARE.—The 
Secretary shall ensure that the Organization es-
tablishes processes and takes steps necessary, 
including educating relevant providers of serv-
ices and suppliers about the Program, to ensure 
that Program-eligible beneficiaries assigned to 
or who elected an ESRD Fee-For-Service Inte-
grated Care Model offered by an Organization 
do not experience any disruption in access to 
providers of services and suppliers furnishing 
benefits under this title due to such assignment 
or election. Assignment to or an election of an 
ESRD Fee-For-Service Integrated Care Model 
offered by an Organization shall not be con-
strued as affecting a Program-eligible bene-
ficiary’s ability to receive benefits described in 
subsection (b)(2)(A)(i)(I) from any provider of 
services or suppliers enrolled and who otherwise 
meets requirements under this title, as de-
scribed in subsection (b)(2)(A)(iv). 
‘‘(B) ANTI-DISCRIMINATION.—Each agree-
ment between the Secretary and an Organiza-
tion under this section shall— 
‘‘(i) provide that each eligible partici-
pating provider of such Organization may 
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not deny, limit, or condition the furnishing 
of services, or affect the quality of services 
furnished, under this title to Program-eli-
gible beneficiaries on whether or not such 
a beneficiary is assigned to or elects the 
Organization; and 
‘‘(ii) prohibit the Organization from 
engaging in any activity that could reason-
ably be expected to have the effect of deny-
ing or discouraging assignment to or an 
election of an ESRD Fee-For-Service Inte-
grated Care Model offered by an Organiza-
tion by a Program-eligible beneficiary 
whose medical condition or history indi-
cates a need for substantial future medical 
services. 
‘‘(C) QUALITY ASSURANCE; PATIENT SAFE-
GUARDS.—Each agreement between the Sec-
retary and an Organization under this section 
shall require that such Organization have in ef-
fect at a minimum— 
‘‘(i) a written plan of quality assur-
ance and improvement, and procedures im-
plementing such plan, in accordance with 
regulations; and 
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‘‘(ii) written safeguards of the rights 
of Program-eligible beneficiaries assigned 
to or who elect the Organization (including 
a patient bill of rights and procedures for 
grievances and appeals) in accordance with 
regulations and with other requirements of 
this title and applicable Federal and State 
laws designed to protect Program-eligible 
beneficiaries (including those who are enti-
tled to medical assistance under a State 
plan under title XIX). 
‘‘(D) OVERSIGHT.—The Secretary shall 
develop and implement an oversight program to 
monitor an Organization’s compliance with Pro-
gram requirements under an agreement under 
this section. 
‘‘(4) TREATMENT AS ALTERNATIVE PAYMENT 
MODEL AND ELIGIBLE ALTERNATIVE PAYMENT EN-
TITY.— 
‘‘(A) TREATMENT
OF
PROGRAM.—The 
ESRD Fee-For-Service Integrated Care Dem-
onstration Program established under this sec-
tion shall meet the definition of an alternative 
payment 
model 
described 
in 
section 
1833(z)(3)(C)(iv). 
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‘‘(B) TREATMENT OF ORGANIZATION.—An 
Organization offering one or more ESRD Fee- 
For-Service Integrated Care Models shall be 
treated under this section as an eligible alter-
native payment entity as described in clauses (i) 
and (ii)(I) of section 1833(z)(3)(D). 
‘‘(c) PROGRAM OPERATION AND SCOPE.— 
‘‘(1) IN GENERAL.—The Secretary shall develop 
a process such that an Organization can apply to 
offer one or more ESRD Fee-For-Service Integrated 
Care Models. Such application shall include informa-
tion on at least the following: 
‘‘(A) 
The 
estimated 
average 
revenue 
amount described in subsection (b)(2)(A)(ii)(II) 
for the Organization to cover benefits described 
in subsection (b)(2)(A)(i)(I). 
‘‘(B) Any benefits offered by the Organiza-
tion beyond those described in such subsection. 
‘‘(C) A description of the Organization’s 
ESRD Fee-For-Service Integrated Care strat-
egy specified in subsection (b)(2)(D), including 
a detailed explanation of the Organization’s ap-
proach to fulfill the requirement to coordinate 
the delivery of multidisciplinary health and so-
cial services that, pursuant to a mutual agree-
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ment between a State and Organization, inte-
grates acute and long-term care services and 
supports. 
‘‘(2) PROGRAM
INITIATION.—The Secretary 
shall initiate the Program such that Organizations 
begin serving Program-eligible beneficiaries not later 
than January 1, 2024. 
‘‘(3) INITIAL AGREEMENT PERIOD.—The Sec-
retary shall enter into agreements for an initial pe-
riod of not less than 5 years with all Organizations 
that meet all Program requirements established 
under this section, as determined by the Secretary 
through the application process described in para-
graph (1). 
‘‘(4) ALLOWANCE FOR SERVICE AREA EXPAN-
SIONS.—During each year of the Program’s oper-
ation, the Secretary shall allow an Organization with 
an agreement under this section to expand its serv-
ice area during the initial agreement period upon the 
Secretary’s determination, through the application 
process described in paragraph (1), that the Organi-
zation meets all Program requirements established 
under this section. 
‘‘(5) CONTRACT
SUSPENSION
AND
TERMI-
NATION PROCESS.— 
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‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B)(ii), the Secretary may suspend as-
signment to or an election of an ESRD Fee- 
For-Service Integrated Care Model offered by 
an Organization if the Organization fails to 
comply with any Program requirements speci-
fied in an agreement under this section. An Or-
ganization also shall be considered not in com-
pliance if, for any calendar month during an 
agreement year, more than 50 percent of the 
total number of Program-eligible beneficiaries 
assigned to or who elect an ESRD Fee-For- 
Service Integrated Care Model offered by the 
Organization opt out of the Program. 
‘‘(B) OPPORTUNITY FOR CORRECTIVE AC-
TION PLAN AND APPEAL.— 
‘‘(i) IN
GENERAL.—Prior to sus-
pending assignment to or an election of an 
ESRD Fee-For-Service Integrated Care 
Model offered by an Organization or termi-
nating an agreement under this section, 
the Secretary shall afford an Organization 
sufficient opportunity to remedy any defi-
ciencies in complying with any Program re-
quirements under this section by imple-
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menting a corrective action plan. Any cor-
rective action plan implemented under this 
subparagraph shall specify a date by which 
the Organization shall resolve such defi-
ciencies and shall remain in effect until 
such time that the Secretary confirms that 
the Organization has achieved compliance. 
‘‘(ii) IMPOSITION OF AGREEMENT SUS-
PENSION OR TERMINATION.—In the case 
of an Organization that fails to achieve 
compliance by the date specified in correc-
tive action plan, subject to clause (iii) and 
depending on the severity of a compliance 
deficiency, the Secretary in a manner con-
sistent with processes established under 
part C of this title may— 
‘‘(I) 
suspend 
Program-eligible 
beneficiaries’ assignments to or an 
election of an ESRD Fee-For-Service 
Integrated Care Model offered by an 
Organization; or 
‘‘(II) terminate an agreement 
with an Organization under this sec-
tion. 
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‘‘(iii) IMMEDIATE AGREEMENT TERMI-
NATION FOR VIOLATING THE PROHIBITION 
ON
DISCRIMINATION.—Notwithstanding 
the corrective action plan process estab-
lished under clause (i), the Secretary may, 
in addition to the circumstances under 
which a contract under part C may be im-
mediately terminated, immediately termi-
nate an agreement under this section with 
an Organization if the Secretary— 
‘‘(I) notifies the Organization of 
the intent to investigate allegations of 
systematic activities with the intent of 
violating the prohibition on discrimi-
nation established under subsection 
(b)(3)(B)(ii); 
‘‘(II) 
determines, 
after 
con-
ducting a rigorous analysis of all 
available data based on a sufficient 
sample size, that the Organization en-
gaged in systematic activities with the 
intent of violating the prohibition on 
discrimination established in sub-
section (b)(3)(B)(ii); and 
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‘‘(III) discloses credible evidence 
to the Organization regarding a deter-
mination made under subclause (II). 
‘‘(iv) RECOVERY
OF
MONTHLY
PRO-
SPECTIVE PAYMENTS.—The Secretary may 
recover the prorated share of any monthly 
prospective payments described in sub-
section (e) covering the period of the 
month following an agreement termination 
if such agreement termination is effective 
in the middle of a calendar month. 
‘‘(v) NOTIFICATION OF PROGRAM-ELI-
GIBLE
BENEFICIARY
UPON
AGREEMENT 
TERMINATION.—Each 
agreement 
under 
this section between the Secretary and an 
Organization shall require the Organiza-
tion to provide and pay for written notice 
in advance of an agreement’s termination, 
as well as a description of alternatives for 
obtaining benefits under this title, in a 
manner consistent with beneficiary notifi-
cation requirements in the event of a con-
tract termination under part C. 
‘‘(6) PROGRAM
EVALUATION.—The Secretary 
shall conduct an evaluation of the Program under 
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this section to inform a determination regarding a 
Program expansion under paragraph (7). Such eval-
uation shall include an analysis of— 
‘‘(A) the quality of care furnished under 
the Program, including the measurement of pa-
tient-level outcomes and patient experience and 
patient-reported outcome measures determined 
appropriate by the Secretary; and 
‘‘(B) the changes in spending under parts 
A and B by reason of the Program. 
‘‘(7) PROGRAM EXPANSION.— 
‘‘(A) IN
GENERAL.—The Secretary may, 
through rulemaking, expand the duration and 
scope of the Program under this section, 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 
patient care; or 
‘‘(II) improve the quality of pa-
tient care without increasing spending 
under this title; 
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‘‘(ii) the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies 
that such expansion would reduce (or 
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. 
‘‘(B) ENSURING PROGRAM CONTINUITY.— 
The Secretary shall implement any Program ex-
pansion made in accordance with this para-
graph in a manner that ensures that Program- 
eligible beneficiaries and Organizations with an 
agreement under this section do not experience 
any disruptions in the Program. 
‘‘(8) PART D DATA SHARING ARRANGEMENT.— 
The Secretary on a monthly basis shall, in accord-
ance with the regulations promulgated under section 
264(c) of the Health Insurance Portability and Ac-
countability Act of 1996, provide access to Organiza-
tions to part D data claims that include part D data 
on Program-eligible beneficiaries assigned to or an 
election of an ESRD Fee-For-Service Integrated 
Care Model offered by an Organization unless a Pro-
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gram-eligible beneficiary opts out of such data shar-
ing. 
‘‘(9) FUNDING.—The Secretary shall allocate 
funds made available under section 1115A(f)(1) to 
implement and evaluate the demonstration program 
established under this section. 
‘‘(d) IDENTIFICATION
AND ASSIGNMENT
OF PRO-
GRAM-ELIGIBLE BENEFICIARIES.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a process for the initial and ongoing identifica-
tion of Program-eligible beneficiaries. 
‘‘(2) 
ASSIGNMENT
OF
PROGRAM-ELIGIBLE 
BENEFICIARIES TO AN ORGANIZATION’S ESRD FEE- 
FOR-SERVICE INTEGRATED CARE MODEL.— 
‘‘(A) IN GENERAL.—Under the Program, 
the Secretary shall assign all Program-eligible 
beneficiaries to an ESRD Fee-For-Service Inte-
grated Care Model offered by an Organization 
that includes the dialysis facility at which the 
Program-eligible beneficiary primarily receives 
renal dialysis services. 
‘‘(B) OPT-OUT
PERIOD
AND
CHANGES 
UPON
INITIAL
ASSIGNMENT
OR
ELECTION.— 
The Secretary shall provide for a 90-day period 
beginning on the date on which the assignment 
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of or election made by a Program-eligible bene-
ficiary into an ESRD Fee-For-Service Inte-
grated Care Model offered by an Organization 
becomes effective during which a Program-eligi-
ble beneficiary may— 
‘‘(i) opt out of the Program; or 
‘‘(ii) make a one-time change of as-
signment or election into an ESRD Fee- 
For-Service Integrated Care Model offered 
by a different Organization. 
‘‘(C) DEEMED
RE-ASSIGNMENT
AND
RE- 
ELECTION.—The Secretary shall establish a 
process through which a Program-eligible bene-
ficiary assigned to or who elects an ESRD Fee- 
For-Service Integrated Care Model offered by 
an Organization with respect to a year is 
deemed, unless the Program-eligible beneficiary 
otherwise changes such assignment or election 
under this paragraph, to have elected to con-
tinue such assignment or election with respect 
to the subsequent year. 
‘‘(D) ANNUAL OPPORTUNITY TO OPT OUT 
OR
ELECT
AN
ESRD
FEE-FOR-SERVICE
INTE-
GRATED
CARE
MODEL
OFFERED
BY
A
DIF-
FERENT ORGANIZATION.— 
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‘‘(i) IN GENERAL.—Annually, a Pro-
gram-eligible beneficiary shall be given a 
90-day period to— 
‘‘(I) opt out of the Program; or 
‘‘(II) make a one-time change of 
assignment or election into an ESRD 
Fee-For-Service 
Integrated 
Care 
Model offered by a different Organiza-
tion. 
‘‘(ii) ALIGNMENT WITH MEDICARE AD-
VANTAGE
OPEN
ENROLLMENT
PERIOD.— 
To the extent practicable, the Secretary 
shall align the annual 90-day period de-
scribed in clause (i) with the Medicare Ad-
vantage open enrollment period. 
‘‘(E) OPT OUT FOR CHANGE IN PRINCIPAL 
DIAGNOSIS
OR
ENTERING
HOME
DIALYSIS 
TREATMENT.—In addition to any other period 
during which a Program-eligible beneficiary 
may, pursuant to this paragraph, opt out of the 
Program, in the case of a Program-eligible ben-
eficiary who, after assignment under this para-
graph, is diagnosed with a principal diagnosis 
(as defined by the Secretary) other than end- 
stage renal disease or enters into home dialysis 
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treatment, such individual shall be given the op-
portunity to opt out of the Program during 
such period as specified by the Secretary. 
‘‘(3) PROGRAM-ELIGIBLE BENEFICIARY NOTIFI-
CATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
ensure that an Organization notifies Program- 
eligible beneficiaries about the Program under 
this section and provides them with materials 
explaining the Program, including— 
‘‘(i) information about receiving bene-
fits under this title through such Organiza-
tion; and 
‘‘(ii) an explanation that they retain 
the right to receive care from any Medicare 
provider. 
‘‘(B) TIMING OF NOTIFICATION.—Upon as-
signment to or election of an ESRD Fee-For- 
Service Integrated Care Model offered by an 
Organization, the Secretary shall provide the 
Organization written notification confirming the 
beneficiary’s assignment or election and not 
later than 15 business days after the date of re-
ceipt of such notification, the Organization shall 
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provide written notice to the Program-eligible 
beneficiary of such assignment or election. 
‘‘(C) CONTENT
OF
WRITTEN
NOTICE.— 
Subject to subparagraph (D), such notification 
shall— 
‘‘(i) inform Program-eligible bene-
ficiaries about the Program using an infor-
mation guide developed by the Organiza-
tion and approved by the Secretary; 
‘‘(ii) include the distribution of other 
Program materials developed by the Orga-
nization and approved by the Secretary; 
‘‘(iii) inform Program-eligible bene-
ficiaries about the importance of transplan-
tation as the best outcome, as well as min-
imum requirements for transplant eligi-
bility before and during dialysis treatment; 
and 
‘‘(iv) provide contact information for 
representatives of the Organization to re-
spond to Program-eligible beneficiaries’ 
questions. 
‘‘(D) LIMITATION ON UNSOLICITED NOTI-
FICATION.— 
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‘‘(i) IN
GENERAL.—Under the Pro-
gram, no person or entity (other than the 
Secretary, an employee of the Secretary, or 
an employee or volunteer of a federally au-
thorized State Health Insurance Assistance 
Program (SHIP)), subject to clause (ii), 
may provide any information about the 
Program, including information, materials, 
and assistance described in subparagraph 
(B), to a Program-eligible beneficiary un-
less such Program-eligible beneficiary re-
quests such information, materials, or as-
sistance. 
‘‘(ii) EXCEPTION
FOR
PROVIDERS 
TREATING
BENEFICIARIES.—An 
eligible 
participating provider that is part of an 
Organization may provide information, ma-
terials, and assistance described in sub-
paragraph (B) to a Program-eligible bene-
ficiary, without prior request of such bene-
ficiary, if such beneficiary is receiving 
renal dialysis services from a facility that 
participates in such Organization. 
‘‘(iii) PARITY
IN
NOTIFICATION.—In 
the case that an eligible participating pro-
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vider that is part of an Organization par-
ticipates 
in 
notifying 
Program-eligible 
beneficiaries about the Program under this 
subparagraph, such notification shall be 
provided in the same manner to all Pro-
gram-eligible beneficiaries to which, pursu-
ant to clause (ii), such eligible partici-
pating provider may provide information, 
materials, and assistance described in such 
clause. 
‘‘(E) 
PROGRAM-ELIGIBLE
BENEFICIARY 
GRIEVANCE AND APPEAL RIGHTS.—Program-el-
igible beneficiaries participating in the Program 
under this section shall have grievance and ap-
peal rights and procedures consistent with those 
rights and procedures established under sub-
sections (f) and (g) of section 1852. 
‘‘(e) ESRD FEE-FOR-SERVICE INTEGRATED CARE 
PROGRAM MONTHLY PAYMENT AND CLAIMS PROCESSING 
MECHANISM.— 
‘‘(1) IN GENERAL.—For each Program-eligible 
beneficiary receiving care through an Organization, 
the Secretary shall make a monthly prospective pay-
ment in accordance with payment rates that would 
be determined under section 1853(a)(1)(H). 
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‘‘(2) APPLICATION
OF
HEALTH
STATUS
RISK 
ADJUSTMENT METHODOLOGY.—The Secretary shall 
adjust the monthly prospective payment to an Orga-
nization under this subsection in the same manner 
in which the payment amount to a Medicare Advan-
tage plan is adjusted under section 1853(a)(1)(C). 
‘‘(3) TREATMENT OF AND PAYMENT FOR KID-
NEY ACQUISITION COSTS.— 
‘‘(A) EXCLUDING COSTS FOR KIDNEY AC-
QUISITIONS FROM MA BENCHMARK.—The Sec-
retary shall adjust the payment amount to an 
Organization to exclude from such payment 
amount the Secretary’s estimate of the stand-
ardized costs for payments for organ acquisi-
tions for kidney transplants in the area involved 
for the year. 
‘‘(B) FFS TREATMENT OF AND PAYMENT 
FOR KIDNEY ACQUISITIONS.—An Organization 
shall provide all benefits described in subsection 
(b)(2)(A)(i), except for kidney acquisition costs. 
Payment for kidney acquisition costs covered 
under this title furnished to a Program-eligible 
beneficiary shall be made in accordance with 
this title and in such amounts as would other-
wise be made and determined for such items 
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and services provided to such a beneficiary not 
participating in the Program under this section. 
‘‘(4) TREATMENT OF AND PAYMENT FOR HOS-
PICE CARE.— 
‘‘(A) IN GENERAL.—An agreement under 
this section shall require an Organization to in-
form each Program-eligible beneficiary who is 
assigned to or elects an ESRD Fee-For-Service 
Integrated Care Model offered by the Organiza-
tion about the availability of hospice care if— 
‘‘(i) a hospice program participating 
under this title is located within the Orga-
nization’s service area; or 
‘‘(ii) it is common practice to refer pa-
tients to hospice programs outside such 
service area. 
‘‘(B) PAYMENT.—If a Program-eligible 
beneficiary who is assigned to or elects an 
ESRD Fee-For-Service Integrated Care Model 
offered by an Organization with an agreement 
under this section makes an election under sec-
tion 1812(d)(1) to receive hospice care from a 
particular hospice program— 
‘‘(i) payment for the care furnished to 
the Program-eligible beneficiary shall be 
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made by the Secretary to the hospice pro-
gram elected by the Program-eligible bene-
ficiary; 
‘‘(ii) payment for other services for 
which the Program-eligible beneficiary in-
dividual is eligible notwithstanding the 
Program-eligible beneficiary’s election of 
hospice care under section 1812(d)(1), in-
cluding services not related to the Pro-
gram-eligible beneficiary’s terminal illness, 
shall be made by the Secretary to the Or-
ganization or the provider or supplier of 
the service instead of the monthly prospec-
tive payment determined under subsection 
(f); and 
‘‘(iii) the Secretary shall continue to 
make monthly payments to the Organiza-
tion in an amount equal to the value of 
benefits and services determined under 
subsection (b)(2)(A)(ii)(IV). 
‘‘(5) APPLICATION OF CMI CLAIMS PROCESSING 
FRAMEWORK.— 
‘‘(A) IN GENERAL.—Under the Program, 
the Secretary shall apply a claims processing 
framework based on those that the Center for 
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Medicare and Medicaid Innovation applies 
under various direct contracting models under 
section 1115A such that— 
‘‘(i) providers of services and suppliers 
serving Program-eligible beneficiaries con-
tinue to submit claims to a medicare ad-
ministrative contractor; 
‘‘(ii) the Secretary forwards claims to 
the Organization for payment; and 
‘‘(iii) the Organization pays providers 
of services and suppliers an amount equal 
to the amount that they would otherwise 
receive under the original Medicare Fee- 
For-Service program plus any additional 
amount to which the provider may be eligi-
ble under subsection (b)(2)(A)(v) of this 
section. 
‘‘(B) APPLICATION OF BALANCE BILLING 
LIMITATIONS.—Section 1852(a)(2)(A) (relating 
to payments made by an MA organization to a 
non-contract provider of services), section 
1852(k)(1) (relating to limitations on balance 
billing), and section 1866(a)(1)(o) (relating to 
payments made by an MA organization to a 
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non-contract supplier) shall apply to the Pro-
gram. 
‘‘(C) PAYMENTS FOR GRADUATE MEDICAL 
EDUCATION.—Section 1886(d)(11) and section 
1886(h)(3)(D) (relating to payments for grad-
uate medical education) shall apply to Organi-
zations and providers of services under the Pro-
gram. 
‘‘(6) NO EFFECT ON MA ESRD RATE SETTING 
OR RISK ADJUSTMENT MODEL.—To ensure the in-
tegrity of the Medicare Advantage end stage renal 
disease rate setting process and risk adjustment fac-
tors applied to Medicare Advantage end stage renal 
disease rates, claims paid on behalf of Program-eligi-
ble beneficiaries shall not be included in neither the 
determination of such rates nor the development of 
such risk adjustment factors. 
‘‘(7) AGREEMENT BETWEEN A STATE AND OR-
GANIZATION FOR MEDICAID BENEFITS.—In the case 
that a State and Organization enter into a mutual 
agreement under which the Organization coordinates 
benefits under title XIX for Program-eligible bene-
ficiaries eligible for benefits under this title and title 
XIX such mutual agreement shall specify the pay-
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ment from the State for providing or arranging for 
the provision of such benefits. 
‘‘(8) AFFIRMATION OF STATE OBLIGATIONS TO 
PAY
PREMIUM
AND
COST-SHARING
AMOUNTS.—A 
State shall continue to make medical assistance 
under the State plan under title XIX available for 
the duration of the Program for Medicare cost-shar-
ing (as defined in section 1905(p)(3)) under this 
title for qualified Medicare beneficiaries described in 
section 1905(p)(1) and other individuals who are 
Program-eligible beneficiaries assigned to or who 
elect an Organization and entitled to medical assist-
ance for premiums and such cost-sharing under the 
State plan under title XIX in an amount equal to 
the amount of medical assistance that would be 
made available by such State if such Program-eligi-
ble beneficiaries were not participating in the Pro-
gram under this section. 
‘‘(f) WAIVER AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary shall waive 
those requirements waived under section 1899 deter-
mined by the Secretary to be relevant and necessary 
for the operation of the Program under this section 
and may waive, as necessary, such additional re-
quirements that have been or may be waived based 
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on authority established under section 1115A for 
purposes of models tested by the Centers for Medi-
care and Medicaid Innovation in order to carry out 
the Program under this section. 
‘‘(2) NOTICE OF WAIVERS.—Not later than 3 
months after the date of enactment of this section, 
the Secretary shall publish a notice of waivers that 
will apply in connection with the Program. The no-
tice shall include the specific conditions that an Or-
ganization must meet to qualify for each waiver, and 
commentary explaining the waiver requirements. 
‘‘(g) REPORT.—Not later than December 31, 2025, 
the Medicare Payment Advisory Commission shall submit 
to Congress an interim report on the Program.’’. 
(b) RULES OF CONSTRUCTION.— 
(1) USE OF MEDICARE SUPPLEMENTAL POLICY 
UNDER
AN
ESRD
FEE-FOR-SERVICE
INTEGRATED 
CARE
MODEL.—Nothing in the provisions of, or 
amendments made by, this Act shall be construed to 
prevent a Program-eligible beneficiary assigned to, 
or who elects, an ESRD Fee-For-Service Integrated 
Care Model offered by an Organization with an 
agreement under this section from enrolling in or 
continuing enrollment in a medicare supplemental 
policy available to such Program-eligible beneficiary 
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or receiving benefits under such medicare supple-
mental policy throughout the duration of the Pro-
gram-eligible beneficiary’s participation in an ESRD 
Fee-For-Service Integrated Care model offered by an 
Organizations with an agreement under this section. 
(2) APPLICATION OF STATE RULES REGARDING 
ISSUANCE OF MEDICARE SUPPLEMENTAL POLICIES 
TO INDIVIDUAL UNDER AGE 65.—Nothing in the pro-
visions of, or amendments made by, this Act shall be 
construed to establish a Federal requirement on an 
issuer of a medicare supplemental policy to offer 
such medicare supplemental policy to individuals 
under age 65. 
(3) CONTINUED
AVAILABILITY
OF
MEDICARE 
SUPPLEMENTAL POLICIES TO INDIVIDUALS UNDER 
AGE 65.—Nothing in the provisions of, or amend-
ments made by, this Act shall be construed to affect 
a State’s authority to require an issuer of a medi-
care supplemental policy to offer such medicare sup-
plemental policy to individual. 
(4) CONTINUED
APPLICATION
OF
EDUCATION 
REQUIREMENT.—Nothing in the provisions of, or the 
amendments made by, this Act shall be construed to 
exempt dialysis facilities participating in an Organi-
zation from complying with Medicare rules that re-
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quire such Organizations to educate their patients 
about all treatment modalities, including home dialy-
sis and transplantation. 
(5) PARTICIPATION
IN
ESRD
TREATMENT 
CHOICES DEMONSTRATION.—Nothing in the provi-
sions of, or the amendments made by, this Act shall 
be construed to exempt an Organization under the 
ESRD FFS Integrated Care demonstration from 
participating in the Centers for Medicare & Medicaid 
Innovation’s mandatory ESRD Treatment Choices 
demonstration. 
(c) GAO STUDY AND REPORT ON PAYMENT ADE-
QUACY FOR PEDIATRIC ESRD SERVICES.— 
(1) STUDY ON PAYMENT FOR PEDIATRIC ESRD 
SERVICES.—The Comptroller General of the United 
States shall conduct a study to examine the accuracy 
of pediatric data reported to the Centers for Medi-
care & Medicaid Services as part of the ESRD pro-
spective payment system. The study shall evaluate 
whether the organizations described in section 
1866G of the Social Security Act, as added by sub-
section (a), and the existing prospective payment 
system accurately capture and reimburse costs of pe-
diatric dialysis care and include an analysis of the 
following factors that influence such costs: 
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(A) Increased acuity of nursing care com-
pared to adult dialysis patients, especially for 
smaller and younger pediatric hemodialysis pa-
tients. 
(B) Need for developmental and behavioral 
specialists, including child life specialists. 
(C) Need for more frequent assessment by 
pediatric dieticians to adjust formulas and diet 
for the specialized growth and nutrition require-
ments of children treated with dialysis. 
(D) Need for social workers, school liai-
sons, and other trained individuals designated 
to help families navigate challenging psycho-
social situations and to coordinate with schools 
to ensure school attendance and optimize school 
performance among pediatric dialysis patients. 
(E) Need for a broader array of dialysis 
supplies, including different-sized dialyzers, tub-
ing, and peritoneal fluid bags to accommodate 
care provided infants through young adults. 
(2) REPORT.—Not later than 18 months after 
the date of the enactment of this Act, the Comp-
troller General shall submit to Congress a report 
containing the results of the study conducted under 
paragraph (1), together with recommendations for 
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such legislation and administrative action as the 
Comptroller General determines appropriate. 
(d) GAO STUDY AND REPORT ON THE IMPACT OF 
RACE-BASED CORRECTION OF eGFR ON REFERRAL OF 
ESRD PATIENTS FOR TRANSPLANT EVALUATION.— 
(1) STUDY ON IMPACT OF RACE-BASED COR-
RECTION
OF
EGFR
ON
REFERRAL
OF
ESRD
PA-
TIENTS
FOR
TRANSPLANT
EVALUATION.—The 
Comptroller General of the United States shall con-
duct a study to examine the impact of race-based 
correction of the estimated glomerular filtration rate 
(referred to in this subsection as ‘‘eGFR’’) on the 
referral of ESRD patients for transplant evaluation. 
(2) REPORT.—Not later than 18 months after 
the date of enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
Æ 
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