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‘‘(B) if the date of enactment of such Act 
is after September 30, 2017, for the period be-
ginning on the date of enactment of such Act 
and ending on December 31, 2020’ ’’’; and 
(2) in paragraph (2), by adding at the end the 
following new sentences: ‘‘Subject to the preceding 
sentence, a Medicare beneficiary enrolled in the dem-
onstration project on September 30, 2017, shall be 
automatically enrolled during the period beginning 
on the date of the enactment of the Medicare Part 
B Improvement Act of 2017 and ending on Decem-
ber 31, 2020, without submission of another applica-
tion. Chapter 35 of title 44, United States Code, 
shall not apply to any application form used for a 
Medicare beneficiary who enrolls in the demonstra-
tion project on or after such date of enactment.’’. 
SEC. 103. ORTHOTIST’S AND PROSTHETIST’S CLINICAL 
NOTES AS PART OF THE PATIENT’S MEDICAL 
RECORD. 
Section 1834(h) of the Social Security Act (42 U.S.C. 
1395m(h)) is amended by adding at the end the following 
new paragraph: 
‘‘(5) 
DOCUMENTATION
CREATED
BY 
ORTHOTISTS AND PROSTHETISTS.—For purposes of 
determining the reasonableness and medical neces-
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sity of orthotics and prosthetics, documentation cre-
ated by an orthotist or prosthetist shall be consid-
ered part of the individual’s medical record to sup-
port documentation created by eligible professionals 
described in section 1848(k)(3)(B).’’. 
TITLE II—IMPROVEMENTS IN 
DIALYSIS SERVICES 
SEC. 201. INDEPENDENT ACCREDITATION FOR DIALYSIS 
FACILITIES AND ASSURANCE OF HIGH QUAL-
ITY SURVEYS. 
(a) ACCREDITATION AND SURVEYS.— 
(1) IN GENERAL.—Section 1865 of the Social 
Security Act (42 U.S.C. 1395bb) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), in the matter 
preceding subparagraph (A), by striking 
‘‘or the conditions and requirements under 
section 1881(b)’’; and 
(ii) in paragraph (4), by inserting 
‘‘(including a renal dialysis facility)’’ after 
‘‘facility’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(e) With respect to an accreditation body that has 
received approval from the Secretary under subsection 
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(a)(3)(A) for accreditation of provider entities that are re-
quired to meet the conditions and requirements under sec-
tion 1881(b), in addition to review and oversight authori-
ties otherwise applicable under this title, the Secretary 
shall (as the Secretary determines appropriate) conduct, 
with respect to such accreditation body and provider enti-
ties, any or all of the following as frequently as is other-
wise required to be conducted under this title with respect 
to other accreditation bodies or other provider entities: 
‘‘(1) Validation surveys referred to in sub-
section (d). 
‘‘(2) Accreditation program reviews (as defined 
in section 488.8(c) of title 42 of the Code of Federal 
Regulations, or a successor regulation). 
‘‘(3) Performance reviews (as defined in section 
488.8(a) of title 42 of the Code of Federal Regula-
tions, or a successor regulation).’’. 
(2) TIMING
FOR
ACCEPTANCE
OF
REQUESTS 
FROM ACCREDITATION ORGANIZATIONS.—Not later 
than 90 days after the date of enactment of this 
Act, the Secretary of Health and Human Services 
shall begin accepting requests from national accredi-
tation bodies for a finding described in section 
1865(a)(3)(A) of the Social Security Act (42 U.S.C. 
1395bb(a)(3)(A)) for purposes of accrediting pro-
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vider entities that are required to meet the condi-
tions and requirements under section 1881(b) of 
such Act (42 U.S.C. 1395rr(b)). 
(b) REQUIREMENT
FOR TIMING
OF SURVEYS
OF 
NEW DIALYSIS FACILITIES.—Section 1881(b)(1) of the 
Social Security Act (42 U.S.C. 1395rr(b)(1)) is amended 
by adding at the end the following new sentence: ‘‘Begin-
ning 180 days after the date of the enactment of this sen-
tence, an initial survey of a provider of services or a renal 
dialysis facility to determine if the conditions and require-
ments under this paragraph are met shall be initiated not 
later than 90 days after such date on which both the pro-
vider enrollment form (without regard to whether such 
form is submitted prior to or after such date of enactment) 
has been determined by the Secretary to be complete and 
the provider’s enrollment status indicates approval is 
pending the results of such survey.’’. 
SEC. 202. EXPANDING ACCESS TO HOME DIALYSIS THER-
APY. 
(a) ALLOWING USE OF TELEHEALTH FOR MONTHLY 
END STAGE RENAL DISEASE-RELATED VISITS.— 
(1) IN
GENERAL.—Paragraph (3) of section 
1881(b) of the Social Security Act (42 U.S.C. 
1395rr(b)) is amended— 
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(A) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively; 
(B) in clause (i), as redesignated by sub-
paragraph (A), by striking ‘‘under this subpara-
graph’’ and inserting ‘‘under this clause’’; 
(C) in clause (ii), as redesignated by sub-
paragraph (A), by inserting ‘‘subject to sub-
paragraph (B),’’ before ‘‘on a comprehensive’’; 
(D) by striking ‘‘With respect to’’ and in-
serting ‘‘(A) With respect to’’; and 
(E) by adding at the end the following new 
subparagraph: 
‘‘(B)(i) Subject to clause (ii), an individual who is 
determined to have end stage renal disease and who is re-
ceiving home dialysis may choose to receive monthly end 
stage renal disease-related visits, furnished on or after 
January 1, 2019, via telehealth. 
‘‘(ii) Clause (i) shall apply to an individual only if 
the individual receives a face-to-face visit, without the use 
of telehealth— 
‘‘(I) in the case of the initial 3 months of home 
dialysis of such individual, at least monthly; and 
‘‘(II) after such initial 3 months, at least once 
every 3 consecutive months.’’. 
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(2) CONFORMING AMENDMENT.—Paragraph (1) 
of such section is amended by striking ‘‘paragraph 
(3)(A)’’ and inserting ‘‘paragraph (3)(A)(i)’’. 
(b) EXPANDING ORIGINATING SITES
FOR TELE-
HEALTH TO INCLUDE RENAL DIALYSIS FACILITIES AND 
THE HOME FOR PURPOSES OF MONTHLY END STAGE 
RENAL DISEASE-RELATED VISITS.— 
(1) IN GENERAL.—Section 1834(m) of the So-
cial Security Act (42 U.S.C. 1395m(m)) is amend-
ed— 
(A) in paragraph (4)(C)(ii), by adding at 
the end the following new subclauses: 
‘‘(IX) A renal dialysis facility, 
but only for purposes of section 
1881(b)(3)(B). 
‘‘(X) The home of an individual, 
but only for purposes of section 
1881(b)(3)(B).’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY 
ESRD-RELATED
VISIT.—The geographic require-
ments described in paragraph (4)(C)(i) shall not 
apply with respect to telehealth services furnished on 
or after January 1, 2019, for purposes of section 
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1881(b)(3)(B), at an originating site described in 
subclause 
(VI), 
(IX), 
or 
(X) 
of 
paragraph 
(4)(C)(ii)), subject to applicable State law require-
ments, including State licensure requirements.’’. 
(2) NO
FACILITY
FEE
IF
ORIGINATING
SITE 
FOR HOME DIALYSIS THERAPY IS THE HOME.—Sec-
tion 1834(m)(2)(B) of the Social Security (42 
U.S.C. 1395m(m)(2)(B)) is amended— 
(A) by redesignating clauses (i) and (ii) as 
subclauses (I) and (II), respectively, and by in-
denting each of such subclauses 2 ems to the 
right; 
(B) in subclause (II), as redesignated by 
subparagraph (A), by striking ‘‘clause (i) or 
this clause’’ and inserting ‘‘subclause (I) or this 
subclause’’; 
(C) by striking ‘‘SITE.—With respect to’’ 
and inserting ‘‘SITE.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), with respect to’’; and 
(D) by adding at the end the following new 
clause: 
‘‘(ii) NO
FACILITY
FEE
IF
ORIGI-
NATING SITE FOR HOME DIALYSIS THER-
APY IS THE HOME.—No facility fee shall 
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be paid under this subparagraph to an 
originating site described in subclause (X) 
of paragraph (4)(C)(ii).’’. 
(c) CLARIFICATION REGARDING TELEHEALTH PRO-
VIDED TO BENEFICIARIES.—Section 1128A(i)(6) of the 
Social Security Act (42 U.S.C. 1320a–7a(i)(6)) is amend-
ed— 
(1) in subparagraph (H), by striking ‘‘; or’’ and 
inserting a semicolon; 
(2) in subparagraph (I), by striking the period 
at the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(J) the provision of telehealth tech-
nologies on or after January 1, 2019, to indi-
viduals with end stage renal disease under title 
XVIII by a health care provider for the purpose 
of furnishing of telehealth.’’. 
(d) STUDY
AND REPORT
ON FURTHER EXPAN-
SION.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study to examine the 
feasibility, benefits, and drawbacks of expanding the 
use of telehealth and store-and-forward technologies 
under the Medicare program under title XVIII of 
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the Social Security Act for items and services in-
cluded in renal dialysis services, as such term is de-
fined in section 1881(b)(14)(B) of such Act (42 
U.S.C. 1395rr(b)(14)(B)). 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report on the re-
sults of the study conducted under paragraph (1). 
TITLE III—IMPROVEMENTS IN 
APPLICATION OF STARK RULE 
SEC. 301. MODERNIZING THE APPLICATION OF THE STARK 
RULE UNDER MEDICARE. 
(a) CLARIFICATION OF THE WRITING REQUIREMENT 
AND SIGNATURE REQUIREMENT
FOR ARRANGEMENTS 
PURSUANT TO THE STARK RULE.— 
(1) 
WRITING
REQUIREMENT.—Section 
1877(h)(1) of the Social Security Act (42 U.S.C. 
1395nn(h)(1)) is amended by adding at the end the 
following new subparagraph: 
‘‘(D) WRITTEN REQUIREMENT CLARIFIED.—In 
the case of any requirement pursuant to this section 
for a compensation arrangement to be in writing, 
such requirement shall be satisfied by such means as 
determined by the Secretary, including by a collec-
tion of documents, including contemporaneous docu-
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ments evidencing the course of conduct between the 
parties involved.’’. 
(2) 
SIGNATURE
REQUIREMENT.—Section 
1877(h)(1) of the Social Security Act (42 U.S.C. 
1395nn(h)(1)), as amended by paragraph (1), is fur-
ther amended by adding at the end the following 
new subparagraph: 
‘‘(E) SPECIAL RULE FOR SIGNATURE RE-
QUIREMENTS.—In the case of any requirement 
pursuant to this section for a compensation ar-
rangement to be in writing and signed by the 
parties, such signature requirement shall be 
met if— 
‘‘(i) not later than 90 consecutive cal-
endar days immediately following the date 
on which the compensation arrangement 
became noncompliant, the parties obtain 
the required signatures; and 
‘‘(ii) the compensation arrangement 
otherwise complies with all criteria of the 
applicable exception.’’. 
(b) INDEFINITE HOLDOVER FOR LEASE ARRANGE-
MENTS AND PERSONAL SERVICES ARRANGEMENTS PUR-
SUANT TO THE STARK RULE.—Section 1877(e) of the So-
cial Security Act (42 U.S.C. 1395nn(e)) is amended— 
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(1) in paragraph (1), by adding at the end the 
following new subparagraph: 
‘‘(C) 
HOLDOVER
LEASE
ARRANGE-
MENTS.—In the case of a holdover lease ar-
rangement for the lease of office space or equip-
ment, which immediately follows a lease ar-
rangement described in subparagraph (A) for 
the use of such office space or subparagraph 
(B) for the use of such equipment and that ex-
pired after a term of at least 1 year, payments 
made by the lessee to the lessor pursuant to 
such holdover lease arrangement, if— 
‘‘(i) the lease arrangement met the 
conditions of subparagraph (A) for the 
lease of office space or subparagraph (B) 
for the use of equipment when the ar-
rangement expired; 
‘‘(ii) the holdover lease arrangement is 
on the same terms and conditions as the 
immediately preceding arrangement; and 
‘‘(iii) the holdover arrangement con-
tinues to satisfy the conditions of subpara-
graph (A) for the lease of office space or 
subparagraph (B) for the use of equip-
ment.’’; and 
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(2) in paragraph (3), by adding at the end the 
following new subparagraph: 
‘‘(C) HOLDOVER PERSONAL SERVICE AR-
RANGEMENT.—In the case of a holdover per-
sonal service arrangement, which immediately 
follows an arrangement described in subpara-
graph (A) that expired after a term of at least 
1 year, remuneration from an entity pursuant 
to such holdover personal service arrangement, 
if— 
‘‘(i) the personal service arrangement 
met the conditions of subparagraph (A) 
when the arrangement expired; 
‘‘(ii) the holdover personal service ar-
rangement is on the same terms and condi-
tions as the immediately preceding ar-
rangement; and 
‘‘(iii) the holdover arrangement con-
tinues to satisfy the conditions of subpara-
graph (A).’’. 
SEC. 302. FUNDS FROM THE MEDICARE IMPROVEMENT 
FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 1395iii(b)(1)) is amended by striking ‘‘during and 
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after fiscal year 2021, $270,000,000’’ and inserting ‘‘dur-
ing and after fiscal year 2021, $245,000,000’’. 
Passed the House of Representatives July 25, 2017. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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