sharing lower than otherwise applica-
ble, benefits not covered under the 
original medicare fee-for-service pro-
gram (including preventive services re-
lated to chronic kidney disease and 
education surrounding the importance 
of transplantation), or financial incen-
tives (such as reduced cost sharing) 
for Program-eligible beneficiaries en-
rolled in the Organization to promote 
the delivery of high-value and efficient 
care and services. 
‘‘(iii) BENEFIT
REQUIREMENTS
FOR 
DUAL ELIGIBLES.—In the case of a Pro-
gram-eligible beneficiary who is eligible for 
benefits under this title and title XIX, an 
Organization, in accordance with an agree-
ment 
entered 
into 
under 
subsection 
(f)(4)— 
‘‘(I) may be responsible for pro-
viding, or arranging for the provision 
of, all benefits (other than long-term 
services and supports) for which the 
Program-eligible beneficiary is eligible 
for under the State Medicaid program 
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under title XIX in which the Pro-
gram-eligible beneficiary is enrolled; 
and 
‘‘(II) may elect to provide, or ar-
range for the provision of, long-term 
services and supports available to the 
Program-eligible beneficiary under the 
State Medicaid program, including 
services related to the transition into 
palliative care or hospice. 
‘‘(B) REQUIREMENTS FOR OPEN NETWORK 
AND PREFERRED NETWORK MODELS.— 
‘‘(i) OPEN NETWORK MODEL.—Under 
an ESRD Integrated Care Model offered 
by an Organization that is an open net-
work model, the Organization shall— 
‘‘(I) allow Program-eligible bene-
ficiaries to receive such covered bene-
fits from any provider of services or 
supplier regardless of whether such 
provider is within the network assem-
bled under clause (ii)(I); 
‘‘(II) pay any Medicare-certified 
provider or supplier that is not within 
the network assembled under sub-
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clause (I) for such covered benefits an 
amount equal to the amount the pro-
vider or supplier would otherwise re-
ceive under this title; and 
‘‘(III) not apply any additional 
premium or cost sharing requirements 
for such covered benefits in addition 
to premium or cost sharing require-
ments, respectively, that would be ap-
plicable under part A or part B for 
such benefits. 
‘‘(ii) 
PREFERRED
NETWORK 
MODEL.—Under 
an 
ESRD 
Integrated 
Care Model offered by an Organization 
that is a preferred network model, the Or-
ganization— 
‘‘(I) shall assemble a network of 
providers of services and suppliers 
identified by the Organization and 
confirmed by the Secretary as includ-
ing providers of services and suppliers 
with significant expertise in caring for 
individuals with end-stage renal dis-
ease through which Program-eligible 
beneficiaries shall receive covered ben-
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efits as described in subparagraph (A) 
that are required to be covered under 
the Model; 
‘‘(II) shall provide for payment 
for items and services furnished by 
providers of services and suppliers 
within such network to Program-eligi-
ble beneficiaries enrolled in such Or-
ganization in accordance with pay-
ment rates determined pursuant to an 
agreement entered into between the 
Organization and such providers of 
services and suppliers and shall pro-
vide for payment for items and serv-
ices furnished by providers of services 
and suppliers not within such network 
to such beneficiaries so enrolled in ac-
cordance that would be determined 
under section 1853(a)(1)(H); 
‘‘(III) may apply premium and 
cost-sharing requirements, in addition 
to premium or cost-sharing require-
ments, respectively, that would be ap-
plicable under part B, for benefits in 
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addition to those required to be cov-
ered under the Model; and 
‘‘(IV) shall apply network stand-
ards as defined by the Secretary. 
‘‘(iii) PROMOTING ACCESS TO HIGH- 
QUALITY
PROVIDERS.—An Organization 
offering an ESRD Integrated Care Model 
may develop and implement performance- 
based incentives for providers of services 
and suppliers to promote delivery of high 
quality and efficient care. Such incentives 
shall be based on clinical measures and 
non-clinical measures, such as with respect 
to notification of patient discharge from a 
hospital, patient education (such as with 
respect to treatment options, including 
chronic kidney disease maintenance, and 
nutrition), and the interoperability of elec-
tronic health records developed by an Or-
ganization according to requirements and 
standards specified by the Secretary pursu-
ant to subparagraph (C). 
‘‘(iv) APPLICATION OF MEDICARE AD-
VANTAGE
REQUIREMENT
WITH
RESPECT 
TO
MEDICARE
SERVICES
FURNISHED
BY 
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OUT-OF-NETWORK
PROVIDERS
AND
SUP-
PLIERS.— 
‘‘(I) 
IN
GENERAL.—Section 
1852(k)(1) (relating to limitations on 
balance billing against MA organiza-
tions for noncontract physicians and 
other entities with respect to services 
covered under this title) shall apply to 
Organizations, Program-eligible bene-
ficiaries enrolled in such Organiza-
tions, and physicians and other enti-
ties that do not have a contract or 
other agreement with the Organiza-
tion establishing payment amounts for 
services furnished to such a bene-
ficiary in the same manner as such 
section applies to MA organizations, 
individuals enrolled with such organi-
zations, and physicians and other en-
tities referred to in such section. 
‘‘(II) REFERENCE
FOR
ADDI-
TIONAL
PROVISION.—For the provi-
sion relating to limitations on balance 
billing against Organizations for serv-
ices covered under this title furnished 
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