spectives of physicians, other health care profes-
sionals, hospitals, dialysis facilities, health plans, 
purchasers, and patients. 
(b) REPORT.—Not later than the date that is 18 
months after the date of enactment of this Act, the Insti-
tute shall submit to the Secretary and appropriate com-
mittees of Congress a report on the evaluation conducted 
under subsection (a)(1) describing the findings of such 
evaluation and recommendations for implementing incen-
tives to encourage patients to elect to receive home dialysis 
services under the medicare program. 
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary for purposes of conducting the evaluation and 
preparing the report required by this section. 
TITLE IV—SUSTAINABLE 
ECONOMICS 
SEC. 401. MODIFICATION OF PHYSICIAN SURGICAL REIM-
BURSEMENT FOR DIALYSIS ACCESS PROCE-
DURES TO ALIGN INCENTIVES FOR COST AND 
QUALITY. 
(a) FULL COVERAGE OF DIALYSIS ACCESS PROCE-
DURES IN THE AMBULATORY SURGICAL CENTER SET-
TING.—The Secretary of Health and Human Services 
shall include in the surgical procedures specified under
section 1833(i)(1) of the Social Security Act (42 U.S.C. 
1395l(i)(1)) the full range of dialysis access procedures 
when provided to individuals with end stage renal disease 
who are entitled to benefits under part A and enrolled 
under part B of title XVIII of the Social Security Act pur-
suant to section 226A of that Act (42 U.S.C. 426). For 
purposes of the preceding sentence, the full range of dialy-
sis services includes all reasonable and necessary interven-
tion procedures for the creation, repair, and maintenance 
of an individual’s dialysis access, such as the placement, 
insertion, and maintenance services related to fistulas, 
synthetic grafts, tunnel catheters, and peritoneal dialysis 
catheters. 
(b) REVISION OF RBRVS TO REFLECT THE DIF-
FICULTY OF VASCULAR ACCESS PROCEDURES.—The Sec-
retary of Health and Human Services shall structure the 
relative value units determined under section 1848(c)(2) 
of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) that 
are applicable with respect to physicians’ services for vas-
cular access procedures to encourage clinically appropriate 
placement of natural vascular access for dialysis patients. 
SEC. 402. DEMONSTRATION PROJECT FOR OUTCOMES- 
BASED ESRD REIMBURSEMENT SYSTEM. 
(a) ESTABLISHMENT.—Subject to the succeeding 
provisions of this section, the Secretary of Health and
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish demonstration projects (in this 
section referred to as ‘‘demonstration projects’’) under 
which the Secretary shall evaluate methods that improve 
the quality of care provided to medicare beneficiaries with 
end-stage renal disease. 
(b) OUTCOMES-BASED ESRD REIMBURSEMENT SYS-
TEM.— 
(1) IN
GENERAL.—Under the demonstration 
projects, the Secretary shall provide financial incen-
tives to providers of services and renal dialysis facili-
ties that demonstrate improved quality of care to 
such beneficiaries. 
(2) CONSIDERATION OF OUTCOMES AND CASE- 
MIX.—In determining whether a provider or facility 
has demonstrated an improved quality of care under 
paragraph (1), the Secretary shall take into account 
the outcomes of individuals receiving services from 
the provider or facility and the case-mix of the pro-
vider or facility. 
(3) INCENTIVES DESCRIBED.—The financial in-
centives provided under paragraph (1) shall— 
(A) reflect the interactions of payments 
under parts A and B of title XVIII of the So-
cial Security Act; and
(B) recognize improvements based on high 
quality outcomes during previous periods as 
well as recent changes in performance to re-
ward long-term improvements. 
(c) DURATION.—The Secretary shall conduct the 
demonstration program under this section for a period 
that is not longer than 5 years that begins on January 
1, 2006. 
(d) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall conduct 
an evaluation of the demonstration projects con-
ducted under this section. 
(2) REPORT.—Not later than 6 months after 
the date on which the demonstration projects are 
completed, the Secretary shall submit to Congress a 
report on the evaluation conducted under paragraph 
(1) together with recommendations for such legisla-
tion and administrative action as the Secretary de-
termines appropriate. 
(e) WAIVER AUTHORITY.—The Secretary shall waive 
compliance with the requirements of title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) to such extent 
and for such period as the Secretary determines is nec-
essary to conduct the demonstration projects. 
(f) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—Payments for the costs of 
carrying out the demonstration project under this 
section shall be made from the Federal Supple-
mentary Medical Insurance Trust Fund under sec-
tion 1841 of such Act (42 U.S.C. 1395t). 
(2) AMOUNT.—There are authorized to be ap-
propriated from such Trust Fund such sums as may 
be necessary to carry out this section. 
SEC. 403. GAO STUDY AND REPORT ON IMPACT OF G- 
CODES. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study on the impact of the tem-
porary codes for nephrologists’ services applicable under 
the fee schedule for physicians’ services under section 
1848 of the Social Security Act (commonly known as ‘‘G- 
codes’’). 
(b) REPORT.—Not later than the date that is 6 
months after the date of enactment of this Act, the Comp-
troller General shall submit to Congress a report on the 
study conducted under subsection (a) together with rec-
ommendations for such legislation and administrative ac-
tion as the Comptroller General determines appropriate. 
Æ