I 
117TH CONGRESS 
1ST SESSION H. R. 4065 
To improve the understanding of, and promote access to treatment for, 
chronic kidney disease, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 22, 2021 
Ms. SEWELL (for herself and Mr. BUCHANAN) 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 subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To improve the understanding of, and promote access to 
treatment for, chronic kidney disease, 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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Chronic Kidney Disease Improvement in Research and 
Treatment Act of 2021’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
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TITLE I—INCREASING AWARENESS, EXPANDING PREVENTIVE 
SERVICES, AND IMPROVING CARE COORDINATION 
Sec. 101. Expanding Medicare annual wellness benefit to include kidney disease 
screening. 
Sec. 102. Increasing access to Medicare kidney disease education benefit. 
Sec. 103. Improving patient lives and quality of care through research and in-
novation. 
Sec. 104. Understanding the progression of kidney disease and treatment of 
kidney failure in minority populations. 
TITLE II—CREATING AN ECONOMICALLY STABLE DIALYSIS 
INFRASTRUCTURE AND INCENTIVIZING INNOVATION 
Sec. 201. Refining the end-stage renal disease payment system to improve accu-
racy in payment and support therapies. 
TITLE III—INCREASING PATIENT ACCESS TO QUALITY PERFORM-
ANCE BY IMPROVING THE ACCURACY AND TRANSPARENCY OF 
END-STAGE RENAL DISEASE QUALITY PROGRAMS 
Sec. 301. Improving patient decision making and transparency by consolidating 
and modernizing quality programs. 
TITLE IV—EMPOWERING PATIENTS 
Sec. 401. Medigap coverage for beneficiaries with end-stage renal disease. 
Sec. 402. Network adequacy requirements for dialysis services. 
Sec. 403. Allowing individuals with kidney failure to retain access to private in-
surance. 
TITLE 
I—INCREASING 
AWARE-
NESS, EXPANDING PREVEN-
TIVE SERVICES, AND IMPROV-
ING CARE COORDINATION 
SEC. 101. EXPANDING MEDICARE ANNUAL WELLNESS BEN-
EFIT TO INCLUDE KIDNEY DISEASE SCREEN-
ING. 
(a) IN GENERAL.—Section 1861(ww)(2) of the Social 
Security Act (42 U.S.C. 1395x(ww)(2)) is amended— 
(1) by redesignating subparagraph (O) as sub-
paragraph (P); and 
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(2) by inserting after subparagraph (N) the fol-
lowing new subparagraph: 
‘‘(O) Chronic kidney disease screening as 
defined by the Secretary.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section apply to items and services furnished on or 
after January 1, 2022. 
SEC. 102. INCREASING ACCESS TO MEDICARE KIDNEY DIS-
EASE EDUCATION BENEFIT. 
(a) IN GENERAL.—Section 1861(ggg) of the Social 
Security Act (42 U.S.C. 1395x(ggg)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A), by inserting ‘‘or 
stage V’’ after ‘‘stage IV’’; and 
(B) in subparagraph (B), by inserting ‘‘or 
of a physician assistant, nurse practitioner, or 
clinical nurse specialist (as defined in section 
1861(aa)(5)) assisting in the treatment of the 
individual’s kidney condition’’ after ‘‘kidney 
condition’’; and 
(2) in paragraph (2)— 
(A) by striking subparagraph (B); and 
(B) in subparagraph (A)— 
(i) by striking ‘‘(A)’’ after ‘‘(2)’’; 
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(ii) by striking ‘‘and’’ at the end of 
clause (i); 
(iii) by striking the period at the end 
of clause (ii) and inserting ‘‘; and’’; 
(iv) by redesignating clauses (i) and 
(ii) as subparagraphs (A) and (B), respec-
tively; and 
(v) by adding at the end the following: 
‘‘(C) a renal dialysis facility subject to the 
requirements of section 1881(b)(1) with per-
sonnel who— 
‘‘(i) provide the services described in 
paragraph (1); and 
‘‘(ii) is a physician (as defined in sub-
section (r)(1)) or a physician assistant, 
nurse practitioner, or clinical nurse spe-
cialist (as defined in subsection (aa)(5)).’’. 
(b) PAYMENT TO RENAL DIALYSIS FACILITIES.— 
Section 1881(b) of the Social Security Act (42 U.S.C. 
1395rr(b)) is amended by adding at the end the following 
new paragraph: 
‘‘(15) For purposes of paragraph (14), the sin-
gle payment for renal dialysis services under such 
paragraph shall not take into account the amount of 
payment for kidney disease education services (as 
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defined in section 1861(ggg)). Instead, payment for 
such services shall be made to the renal dialysis fa-
cility on an assignment-related basis under section 
1848.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section apply to kidney disease education services fur-
nished on or after January 1, 2022. 
SEC. 103. IMPROVING PATIENT LIVES AND QUALITY OF 
CARE THROUGH RESEARCH AND INNOVA-
TION. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
shall conduct a study on increasing kidney transplantation 
rates. Such study shall include an analysis of each of the 
following: 
(1) Any disincentives in the payment systems 
under the Medicare program under title XVIII of 
the Social Security Act that create barriers to kid-
ney transplants and post-transplant care for bene-
ficiaries with end-stage renal disease. 
(2) The practices used by States with higher 
than average donation rates and whether those prac-
tices and policies could be successfully utilized in 
other States. 
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(3) Practices and policies that could increase 
deceased donation rates of minority populations. 
(4) Whether cultural and policy barriers exist to 
increasing living donation rates, including an exam-
ination of how to better facilitate chained donations. 
(5) Other areas determined appropriate by the 
Secretary. 
(b) REPORT.—Not later than 18 months after the 
date of the enactment of this Act, the Secretary shall sub-
mit to Congress a report on the study conducted under 
subsection (a), together with such recommendations as the 
Secretary determines to be appropriate. 
SEC. 104. UNDERSTANDING THE PROGRESSION OF KIDNEY 
DISEASE AND TREATMENT OF KIDNEY FAIL-
URE IN MINORITY POPULATIONS. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
shall conduct a study on— 
(1) the social, behavioral, and biological factors 
leading to kidney disease; 
(2) efforts to slow the progression of kidney dis-
ease in minority populations that are disproportion-
ately affected by such disease; and 
(3) treatment patterns associated with pro-
viding care, under the Medicare program under title 
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XVIII of the Social Security Act, the Medicaid pro-
gram under title XIX of such Act, and through pri-
vate health insurance, to minority populations that 
are disproportionately affected by kidney failure. 
(b) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on the study conducted under sub-
section (a), together with such recommendations as the 
Secretary determines to be appropriate. 
TITLE II—CREATING AN ECO-
NOMICALLY STABLE DIALY-
SIS 
INFRASTRUCTURE 
AND 
INCENTIVIZING INNOVATION 
SEC. 201. REFINING THE END-STAGE RENAL DISEASE PAY-
MENT SYSTEM TO IMPROVE ACCURACY IN 
PAYMENT AND SUPPORT THERAPIES. 
(a) IN GENERAL.—Section 1881(b)(14) of the Social 
Security Act (42 U.S.C. 1395rr(b)(14)) is amended— 
(1) in subparagraph (D), in the matter pre-
ceding clause (i), by striking ‘‘Such system’’ and in-
serting ‘‘Subject to subparagraph (J), such system’’; 
and 
(2) by adding at the end the following new sub-
paragraph: 
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‘‘(J) For payment for renal dialysis serv-
ices furnished on or after January 1, 2024, 
under the system under this paragraph— 
‘‘(i) the payment adjustment de-
scribed in clause (i) of subparagraph (D)— 
‘‘(I) shall not take into account 
comorbidities; and 
‘‘(II) shall take into account age 
for purposes of distinguishing between 
individuals who are under 18 years of 
age and those who are 18 years of age 
and older but shall not include any 
other adjustment for age for patients 
18 years of age and older; 
‘‘(ii) the Secretary shall reassess any 
adjustments related to patient weight 
under such clause; 
‘‘(iii) the payment adjustment de-
scribed in clause (ii) of such subparagraph 
shall not be included; and 
‘‘(iv) take into account reasonable 
costs for determining the payment rate 
consistent with paragraph (2)(B).’’. 
(b) INCLUSION OF NETWORK FEE AS AN ALLOW-
ABLE COST.—Section 1881(b)(14) of the Social Security 
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