unless under such Strategy the Organiza-
tion— 
‘‘(I) provides services to Pro-
gram-eligible beneficiaries enrolled in 
the Organization through a com-
prehensive, multidisciplinary health 
and social services delivery system 
which integrates acute and long-term 
care services pursuant to regulations; 
‘‘(II) specifies the covered items 
and services that will not be provided 
directly by the Organization, and to 
arrange for delivery of those items 
and services through contracts meet-
ing the requirements of regulations; 
and 
‘‘(III) establishes a governing 
body that— 
‘‘(aa) consists of representa-
tion from each eligible partici-
pating provider of such Organiza-
tion; 
‘‘(bb) includes at least one 
nephrologist who may be affili-
ated with a participating provider 
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in the preferred network, at least 
one nephrologist in the open net-
work, and at least one beneficiary 
advocate; and 
‘‘(cc) has responsibility for 
the oversight of the activities of 
the Organization. 
‘‘(3) REQUIREMENT FOR CAPITAL RESERVES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
enter into contracts under this section only with 
Organizations that demonstrate sufficient cap-
ital reserves, measured as a percentage of 
capitated payments and consistent with require-
ments established by the State in which the Or-
ganization operates. 
‘‘(B) ALTERNATIVE MECHANISM TO DEM-
ONSTRATE CAPACITY TO BEAR RISK.—An Orga-
nization shall be considered to meet the require-
ment in subparagraph (A) if the Organization 
includes at least one eligible participating pro-
vider or eligible participating partner that— 
‘‘(i) is licensed as a risk-bearing entity 
or deemed by a State as able to bear risk; 
and 
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‘‘(ii) chooses to bear risk as a condi-
tion of partnership in such Organization. 
‘‘(4) BENEFICIARY PROTECTIONS.— 
‘‘(A) SEAMLESS
ACCESS
TO
CARE.—The 
Secretary shall establish processes and take 
steps as necessary, including educating Medi-
care-certified providers and suppliers about the 
Program, to ensure that Program-eligible bene-
ficiaries assigned into an open network model 
or who elect into a preferred network model of-
fered by an Organization experience no disrup-
tion of access to Medicare-certified providers or 
suppliers furnishing items or services to such 
beneficiary immediately before such assignment 
or election and for purposes of receipt of such 
items or services. Assignment into an open net-
work model or election into a preferred network 
model under the Program shall in no way be 
construed as affecting a Program-eligible bene-
ficiary’s ability to receive covered benefits from 
any Medicare-certified provider or supplier as 
described in subsection (b)(2)(A). 
‘‘(B) CONTINUITY OF CARE.—To provide 
for continuity of care, each contract entered 
into with an Organization under this section 
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shall provide for a transition period during 
which a Program-eligible beneficiary who is 
first enrolled in the Organization or who elects 
to opt out of the Program or otherwise disenroll 
from the Organization maintains access to eligi-
ble participating providers furnishing items or 
services to such beneficiary immediately before 
such enrollment or election for purposes of re-
ceipt of such items or services. Payment for 
such items or services covered under this title 
furnished to such Program-eligible beneficiary 
during such transition period shall be made in 
accordance with this title and in such amounts 
as would otherwise be determined for such 
items and services provided to such a bene-
ficiary not enrolled under the Program. 
‘‘(C) 
ANTIDISCRIMINATION.—Each 
con-
tract entered into with an Organization under 
this section shall provide that each eligible par-
ticipating provider of such Organization may 
not deny, limit, or condition the furnishing of 
services, or affect the quality of services fur-
nished, under this title to Program-eligible 
beneficiaries on whether or not such a bene-
ficiary is enrolled with the Organization. 
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‘‘(D) 
QUALITY
ASSURANCE; 
PATIENT 
SAFEGUARDS.—Each contract entered into with 
an Organization under this section shall require 
that such Organization have in effect at a min-
imum— 
‘‘(i) a written plan of quality assur-
ance and improvement, and procedures im-
plementing such plan, in accordance with 
regulations; and 
‘‘(ii) written safeguards of the rights 
of Program-eligible beneficiaries enrolled in 
the Organization (including a patient bill 
of rights and procedures for grievances 
and appeals) in accordance with regula-
tions and with other requirements of this 
title and Federal and State law that are 
designed for the protection of patients. 
‘‘(E) OVERSIGHT.—The Secretary shall 
oversee the marketing and assignment practices 
of each Organization entering into a contract 
under this section as part of the approval and 
renewal processes of Organizations under this 
section. 
‘‘(5) NON-APPLICATION
OF
CERTAIN
PROVI-
SIONS OF LAW.—For purposes of sections 162(m)(6) 
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and 414(m) of the Internal Revenue Code of 1986 
and section 9010 of the Patient Protection and Af-
fordable Care Act (26 U.S.C. 4001 note prec.), in 
the case of an eligible participating provider that es-
tablishes an Organization or that enters into a part-
nership, ownership, or co-ownership agreement to es-
tablish an Organization, or an Organization with a 
contract under this section, risk-based payments in 
exchange for providing medical care shall not be con-
sidered premiums for health insurance coverage. 
‘‘(6) TREATMENT AS MEDICARE ADVANCED AL-
TERNATIVE PAYMENT MODEL.—Alternative care de-
livery models under the Program shall be treated 
under this title as an advanced alternative payment 
model. 
‘‘(c) PROGRAM OPERATION AND SCOPE.— 
‘‘(1) IN GENERAL.—Not later than one year 
after the date of enactment of this section, the Sec-
retary shall establish a process through which an 
Organization can apply to offer one or more ESRD 
Integrated Care Models. Such application shall in-
clude information on at least the following: 
‘‘(A) 
The 
estimated 
average 
revenue 
amount described in subsection (b)(2)(A)(ii)(II) 
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for the Organization to deliver benefits de-
scribed in subsection (b)(2)(A). 
‘‘(B) Any benefits offered by the Organiza-
tion beyond those described in such subsection. 
‘‘(C) A listing of network providers of serv-
ices and supplier. 
‘‘(D) Information on the expertise of net-
work providers of services and suppliers in serv-
ing ESRD patients. 
‘‘(E) A description of the ESRD Inte-
grated Care Strategy of the Organization de-
scribed in subsection (b)(2)(D). 
‘‘(2) PROGRAM
INITIATION.—The Secretary 
shall initiate the Program such that Organizations 
begin serving Program-eligible beneficiaries not later 
than January 1, 2018. 
‘‘(3) CONTRACT
AWARD
AND
PERIOD.—The 
Secretary shall enter into contracts for an initial pe-
riod of not less than 5 years with all Organizations 
that meet Program requirements. 
‘‘(4) ALLOWANCE FOR LARGER SERVICE AREAS 
AND EXPANSION OF SERVICE AREAS.—Organizations 
shall demonstrate in their application that the pro-
posed service area has the capacity to serve Pro-
gram-eligible beneficiaries through an adequate pro-
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vider network and is reflective of the communities in 
which beneficiaries live, work, and obtain health care 
services. 
‘‘(5) CONTRACT
TERMINATION
AND
SUSPEN-
SION.— 
‘‘(A) IN
GENERAL.—The Secretary may 
terminate a contract with an Organization 
under this section if the Secretary determines 
that an Organization has failed to meet quality 
requirements described in subsection (b) or 
(e)(2)(C)(iii) or violates other terms of the con-
tract. 
‘‘(B) INSUFFICIENT BENEFICIARY PARTICI-
PATION.—The Secretary shall, in the case of an 
Organization with a contract under this section 
with respect to which, for any period of at least 
30 consecutive days during a year for which 
such contract applies, fewer than 50 percent of 
the total number of Program-eligible bene-
ficiaries served by the Organization receive ben-
efits through the Organization under this sec-
tion— 
‘‘(i) suspend such contract for the re-
mainder of such year; and 
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‘‘(ii) provide for the Organization to 
return any prospective payments made to 
the Organization under this section for 
items and services not provided pursuant 
to clause (i). 
‘‘(C) REMEDY AND APPEALS PROCESS.— 
Prior to the Secretary terminating or sus-
pending a contract with an Organization under 
this section, the Secretary shall afford such Or-
ganization sufficient opportunity to remedy any 
contract violations and appeal a contract termi-
nation. 
‘‘(D) 
PROGRAM-ELIGIBLE
BENEFICIARY 
NOTICE
AT
TIME
OF
CONTRACT
TERMI-
NATION.—Each contract under this section with 
an Organization shall require the Organization 
to provide (and pay for) written notice in ad-
vance of the contract’s termination or suspen-
sion, as well as a description of alternatives for 
obtaining benefits under this title, to each Pro-
gram-eligible beneficiary assigned to or who 
elected to receive benefits through the Organi-
zation under this section. 
‘‘(6) PROGRAM
EXPANSION.—The Secretary 
may, through rulemaking, expand the duration and 
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scope of the Program under this section, to the ex-
tent determined appropriate by the Secretary, if— 
‘‘(A) 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 patient 
care without increasing spending under 
this title; 
‘‘(B) the Chief Actuary of the Centers for 
Medicare & Medicaid Services certifies that 
such expansion would reduce (or would not re-
sult in any increase in) net program spending 
under this title; and 
‘‘(C) the Secretary determines that such 
expansion would not deny or limit the coverage 
or provision of benefits under this title for ap-
plicable individuals. 
‘‘(7) STUDY.—The Secretary shall conduct a 
study on an appropriate payment adjustor under the 
Program to ensure there are not disincentives in 
under the payment method under the Program from 
providing proper transplant evaluations. 
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‘‘(d) IDENTIFICATION OF PROGRAM-ELIGIBLE BENE-
FICIARIES.—The Secretary shall establish a process for 
the initial and ongoing identification of Program-eligible 
beneficiaries. 
‘‘(e) PROGRAM-ELIGIBLE BENEFICIARIES ASSIGNED 
INTO AN ESRD INTEGRATED CARE ORGANIZATION OPEN 
NETWORK MODEL.— 
‘‘(1) ASSIGNMENT.— 
‘‘(A) IN GENERAL.—Under the Program, 
subject to the succeeding provisions of this 
paragraph, the Secretary shall, upon the Sec-
retary identifying a beneficiary as a Program- 
eligible beneficiary, assign all such Program-eli-
gible beneficiary to an open network model of-
fered by an Organization that includes the di-
alysis facility at which the Program-eligible ben-
eficiary primarily receives renal dialysis serv-
ices. 
‘‘(B) 
PROGRAM-ELIGIBLE
BENEFICIARY 
NOTIFICATION OF ASSIGNMENT.— 
‘‘(i) IN GENERAL.—Upon assignment 
of a Program-eligible beneficiary to an Or-
ganization, the Secretary shall provide to 
the Organization written notification of 
such assignment of such Program-eligible 
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beneficiary and not later than 15 business 
days after the date of receipt of such noti-
fication, the Organization shall provide 
written notice to the Program-eligible ben-
eficiary— 
‘‘(I) of such assignment; and 
‘‘(II) including education regard-
ing the importance of transplantation 
as the best health outcome, as well as 
the minimum health requirements for 
transplant eligibility before and dur-
ing dialysis treatment. 
‘‘(ii) OPT-OUT PERIOD AND CHANGES 
UPON
INITIAL
ASSIGNMENT.—The Sec-
retary shall provide for a 75-day period be-
ginning on the date on which the assign-
ment of a Program-eligible beneficiary into 
an open network model offered by an Or-
ganization becomes effective during which 
a Program-eligible beneficiary may— 
‘‘(I) opt out of the Program; 
‘‘(II) make a one-time change of 
assignment into an open network 
model offered by a different Organiza-
tion; or 
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