‘‘(VI) RETURNING
SAVINGS
TO 
PROGRAM-ELIGIBLE
BENE-
FICIARIES.—An Organization shall, in 
a manner specified by the Secretary 
and consistent with returning Medi-
care Advantage rebates to individuals 
under part C, return the amount 
under subclause (I) to a Program-eli-
gible beneficiary through offering ben-
efits not covered under the original 
Medicare 
Fee-For-Service 
program 
consistent with the types of benefits, 
including non-health related benefits, 
that Medicare Advantage organiza-
tions may offer. 
‘‘(iii) BENEFIT
REQUIREMENTS
FOR 
DUAL ELIGIBLES.—In the case of a Pro-
gram-eligible beneficiary who is entitled to 
medical assistance under a State plan 
under title XIX, an Organization, in ac-
cordance with a mutual agreement entered 
into between the State and Organization 
under subsection (e)(7)— 
‘‘(I) shall provide, or arrange for 
the provision of, all benefits (other 
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than long-term services and supports) 
for which the Program-eligible bene-
ficiary is entitled to under a State 
plan under title XIX; and 
‘‘(II) may elect to provide, or ar-
range for the provision of, long-term 
services and supports for which the 
Program-eligible beneficiary is entitled 
under a State plan under title XIX, 
including services related to the tran-
sition into palliative care or hospice. 
‘‘(iv) APPLICATION OF MEDICARE FFS 
PROVIDER CHOICE AND COST-SHARING RE-
QUIREMENTS.—Under an ESRD Fee-For- 
Service Integrated Care Model offered by 
an Organization, the Organization shall— 
‘‘(I) allow Program-eligible bene-
ficiaries to receive benefits as de-
scribed in subsection (b)(2)(A)(i)(I) 
from any provider of services or sup-
plier enrolled under this title and who 
otherwise meets all applicable require-
ments under this title; 
‘‘(II) not apply any cost-sharing 
requirements for benefits described in 
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subsection (b)(2)(A)(i)(I) in addition 
to premium and cost-sharing require-
ments, respectively, that would be ap-
plicable under part A or part B for 
such benefits. 
‘‘(v) PROMOTING
ACCESS
TO
HIGH- 
QUALITY
PROVIDERS.—An Organization 
offering an ESRD Fee-For-Service Inte-
grated Care Model shall develop and imple-
ment performance-based incentives, includ-
ing financial incentives funded through 
payments made to an Organization under 
subsection (e), for providers of services and 
suppliers to promote delivery of high qual-
ity and efficient care. Such incentives shall 
comply with section 1852(j)(4) and section 
422.208 of title 42, Code of Federal regu-
lations (as in effect on the date of enact-
ment of this section) and be based on clin-
ical measures or non-clinical measures, 
such as with respect to notification of pa-
tient discharge from a hospital, patient 
education (such as with respect to treat-
ment options, including disease mainte-
nance, and nutrition), rates of completion 
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of patient education categorized by race, 
rates of completion of transplant evalua-
tion for patients who are clinically eligible 
for transplant, rates of completion of 
transplant evaluation categorized by race, 
and the interoperability of electronic health 
records developed by an Organization ac-
cording to requirements and standards 
specified by the Secretary pursuant to sub-
paragraph (B). 
‘‘(B) QUALITY AND REPORTING REQUIRE-
MENTS.— 
‘‘(i) CLINICAL MEASURES.—Under the 
Program, the Secretary shall— 
‘‘(I) require each participating 
Organization to submit to the Sec-
retary data on clinical measures devel-
oped using, as a reference, measures 
submitted by organizations partici-
pating in the Comprehensive ESRD 
Care Initiative operated by the Center 
for Medicare and Medicaid Innovation 
to assess the quality of care provided; 
‘‘(II) establish requirements for 
participating Organizations to submit 
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to the Secretary, in a form and man-
ner specified by the Secretary, infor-
mation on such measures; and 
‘‘(III) establish standards for 
making information on quality under 
the Program established under this 
section as assessed using clinical 
measures described in subclause (I) 
available to the public. 
As part of the standards described in sub-
clause (III) the Secretary shall, in con-
sultation with relevant stakeholders, de-
velop standards that would establish a 
minimum threshold for the volume of indi-
vidual patients to be listed for transplant 
in an Organ Procurement and Transplant 
Network under contract with the Secretary 
and that would measure the number of in-
dividuals that an Organization moved on 
to, kept on, or removed from the trans-
plant list and the number of individuals 
that receive a transplant after partici-
pating in the Organization. The number of 
Program-eligible beneficiaries assigned to 
an Organization on the transplant list that 
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have not opted out at the time of the 
agreement between the Secretary and an 
Organization shall be noted as part of such 
agreement. Organizations shall submit 
such measures as a condition of payment 
and Program-eligible beneficiary assign-
ment under this subsection. 
‘‘(ii) 
REQUIREMENT
FOR
STAKE-
HOLDER INPUT.—In developing measures 
and requirements under subclauses (I) and 
(II) of clause (i), the Secretary shall re-
quest and consider input from a stake-
holder board that includes at least one 
nephrologist, 
a 
pediatric 
nephrologist, 
other suppliers and providers of services as 
determined appropriate by the Secretary, 
renal dialysis facilities, beneficiary advo-
cates, a health equity expert, a mental 
health provider, a transplant surgeon, and 
Medicare-approved transplant programs. 
Section 14 of the Federal Advisory Com-
mittee Act shall not apply to the stake-
holder board. 
‘‘(iii) ADDITIONAL ASSESSMENTS AND 
REPORTING
REQUIREMENTS.—The 
Sec-
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retary shall assess the extent to which an 
Organization offers integrated and patient- 
centered care through analysis of informa-
tion obtained from Program-eligible bene-
ficiaries assigned to or who elect the Orga-
nization through surveys, such as the In- 
Center Hemodialysis Consumer Assess-
ment of Healthcare Providers and Sys-
tems. 
‘‘(iv) NO EFFECT ON OTHER RENAL 
DIALYSIS
FACILITY
QUALITY
REQUIRE-
MENTS.—Nothing in this section shall be 
construed as affecting the requirements es-
tablished under section 1881(h). 
‘‘(C) REQUIREMENTS FOR ESRD FEE-FOR- 
SERVICE INTEGRATED CARE STRATEGY.— 
‘‘(i) IN
GENERAL.—An Organization 
seeking a contract under this section to 
offer one or more ESRD Fee-For-Service 
Integrated Care Models shall develop and 
submit for the Secretary’s approval as part 
of the application of the Organization to 
participate in the Program under this sec-
tion, subject to clauses (ii) and (iii), an 
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ESRD Fee-For-Service Integrated Care 
Strategy. 
‘‘(ii) ESRD FEE-FOR-SERVICE INTE-
GRATED CARE STRATEGY.—In assessing an 
ESRD Fee-For-Service Integrated Care 
Strategy under clause (i), the Secretary 
shall consider the extent to which the 
Strategy includes elements such as the fol-
lowing: 
‘‘(I) Use of interdisciplinary care 
teams led by at least one nephrologist, 
and comprised of registered nurses, 
social workers, renal dialysis facility 
managers, and as appropriate other 
representatives from alternative set-
tings described in subclause (VIII). 
‘‘(II) Use of a decision process 
for care plans and care management 
that includes the nephrologist, a mem-
ber of the transplant evaluation team, 
and other practitioners responsible for 
direct delivery of care to Program-eli-
gible beneficiaries assigned to or who 
elect the Organization involved. 
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‘‘(III) Use of health risk and 
other assessments to determine the 
physical, psychosocial, nutrition, lan-
guage, cultural, and other needs of 
Program-eligible beneficiaries assigned 
to or who elect the Organization in-
volved. 
‘‘(IV) Development and at least 
annual updating of individualized care 
plans that incorporate at least the 
medical, social, and functional needs, 
preferences, and care goals of Pro-
gram-eligible beneficiaries assigned to 
or who elect the Organization, includ-
ing a discussion on reconsideration of 
the method and location of dialysis. 
‘‘(V) Coordination and furnishing 
of non-clinical coordination benefits, 
such as transportation, aimed at im-
proving the adherence of Program-eli-
gible beneficiaries assigned to or who 
elect the Organization with care rec-
ommendations. 
‘‘(VI) As appropriate, coordina-
tion services, such as transplant eval-
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uation, palliative care, evaluation for 
hospice eligibility, and vascular access 
care. 
‘‘(VII) In the case of an indi-
vidual who, during an assignment to, 
or an election of an ESRD Fee-For- 
Service Integrated Care model offered 
by an Organization, receives confirma-
tion that a kidney transplant is immi-
nent, the provision of counseling serv-
ices by an interdisciplinary care team 
described in subclause (I) to such in-
dividual on preparation for and poten-
tial benefits and risks associated with 
such transplant. 
‘‘(VIII) Delivery of benefits and 
services in settings alternative to tra-
ditional clinical settings, such as the 
home of the Program-eligible bene-
ficiary. 
‘‘(IX) Use of patient reminder 
systems. 
‘‘(X) Education programs for pa-
tients, families, and caregivers. 
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‘‘(XI) Use of health care advice 
resources, such as nurse advice lines. 
‘‘(XII) Use of team-based health 
care delivery models that provide com-
prehensive and continuous medical 
care, such as medical homes. 
‘‘(XIII) Co-location of providers 
and services. 
‘‘(XIV) Use of a demonstrated 
capacity to share electronic health 
record information across sites of 
care. 
‘‘(XV) Use of programs to pro-
mote 
better 
adherence 
to 
rec-
ommended treatment regimens, in-
cluding prescription drug, by individ-
uals, including by addressing barriers 
to access to care by such individuals, 
including strategies to coordinate any 
prescription drug benefits under any 
prescription drug plan under part D 
in which a Program-eligible bene-
ficiary is enrolled. 
‘‘(XVI) Use of defined protocols, 
developed in conjunction with the pe-
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diatric nephrology community, to fa-
cilitate the transition of pediatric indi-
viduals into adult end-stage renal dis-
ease care. 
‘‘(XVII) Use of health equity ex-
perts to implement programs and pro-
tocols which seek to decrease gender, 
racial, ethnic, and language inequities. 
‘‘(XVIII) Other services, strate-
gies, and approaches identified by the 
Organization to improve care coordi-
nation and delivery. 
‘‘(3) BENEFICIARY PROTECTIONS.— 
‘‘(A) SEAMLESS
ACCESS
TO
CARE.—The 
Secretary shall ensure that the Organization es-
tablishes processes and takes steps necessary, 
including educating relevant providers of serv-
ices and suppliers about the Program, to ensure 
that Program-eligible beneficiaries assigned to 
or who elected an ESRD Fee-For-Service Inte-
grated Care Model offered by an Organization 
do not experience any disruption in access to 
providers of services and suppliers furnishing 
benefits under this title due to such assignment 
or election. Assignment to or an election of an 
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ESRD Fee-For-Service Integrated Care Model 
offered by an Organization shall not be con-
strued as affecting a Program-eligible bene-
ficiary’s ability to receive benefits described in 
subsection (b)(2)(A)(i)(I) from any provider of 
services or suppliers enrolled and who otherwise 
meets requirements under this title, as de-
scribed in subsection (b)(2)(A)(iv). 
‘‘(B) ANTI-DISCRIMINATION.—Each agree-
ment between the Secretary and an Organiza-
tion under this section shall— 
‘‘(i) provide that each eligible partici-
pating provider of such Organization may 
not deny, limit, or condition the furnishing 
of services, or affect the quality of services 
furnished, under this title to Program-eli-
gible beneficiaries on whether or not such 
a beneficiary is assigned to or elects the 
Organization; and 
‘‘(ii) prohibit the Organization from 
engaging in any activity that could reason-
ably be expected to have the effect of deny-
ing or discouraging assignment to or an 
election of an ESRD Fee-For-Service Inte-
grated Care Model offered by an Organiza-
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tion by a Program-eligible beneficiary 
whose medical condition or history indi-
cates a need for substantial future medical 
services. 
‘‘(C) QUALITY ASSURANCE; PATIENT SAFE-
GUARDS.—Each agreement between the Sec-
retary and an Organization under this section 
shall require that such Organization have in ef-
fect at a minimum— 
‘‘(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 assigned 
to or who elect the Organization (including 
a patient bill of rights and procedures for 
grievances and appeals) in accordance with 
regulations and with other requirements of 
this title and applicable Federal and State 
laws designed to protect Program-eligible 
beneficiaries (including those who are enti-
tled to medical assistance under a State 
plan under title XIX). 
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‘‘(D) OVERSIGHT.—The Secretary shall 
develop and implement an oversight program to 
monitor an Organization’s compliance with Pro-
gram requirements under an agreement under 
this section. 
‘‘(4) TREATMENT AS ALTERNATIVE PAYMENT 
MODEL AND ELIGIBLE ALTERNATIVE PAYMENT EN-
TITY.— 
‘‘(A) TREATMENT
OF
PROGRAM.—The 
ESRD Fee-For-Service Integrated Care Dem-
onstration Program established under this sec-
tion shall meet the definition of an alternative 
payment 
model 
described 
in 
section 
1833(z)(3)(C)(iv). 
‘‘(B) TREATMENT OF ORGANIZATION.—An 
Organization offering one or more ESRD Fee- 
For-Service Integrated Care Models shall be 
treated under this section as an eligible alter-
native payment entity as described in clauses (i) 
and (ii)(I) of section 1833(z)(3)(D). 
‘‘(c) PROGRAM OPERATION AND SCOPE.— 
‘‘(1) IN GENERAL.—The Secretary shall develop 
a process such that an Organization can apply to 
offer one or more ESRD Fee-For-Service Integrated 
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Care Models. Such application shall include informa-
tion on at least the following: 
‘‘(A) 
The 
estimated 
average 
revenue 
amount described in subsection (b)(2)(A)(ii)(II) 
for the Organization to cover benefits described 
in subsection (b)(2)(A)(i)(I). 
‘‘(B) Any benefits offered by the Organiza-
tion beyond those described in such subsection. 
‘‘(C) A description of the Organization’s 
ESRD Fee-For-Service Integrated Care strat-
egy specified in subsection (b)(2)(D), including 
a detailed explanation of the Organization’s ap-
proach to fulfill the requirement to coordinate 
the delivery of multidisciplinary health and so-
cial services that, pursuant to a mutual agree-
ment between a State and Organization, inte-
grates acute and long-term care services and 
supports. 
‘‘(2) PROGRAM
INITIATION.—The Secretary 
shall initiate the Program such that Organizations 
begin serving Program-eligible beneficiaries not later 
than January 1, 2024. 
‘‘(3) INITIAL AGREEMENT PERIOD.—The Sec-
retary shall enter into agreements for an initial pe-
riod of not less than 5 years with all Organizations 
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that meet all Program requirements established 
under this section, as determined by the Secretary 
through the application process described in para-
graph (1). 
‘‘(4) ALLOWANCE FOR SERVICE AREA EXPAN-
SIONS.—During each year of the Program’s oper-
ation, the Secretary shall allow an Organization with 
an agreement under this section to expand its serv-
ice area during the initial agreement period upon the 
Secretary’s determination, through the application 
process described in paragraph (1), that the Organi-
zation meets all Program requirements established 
under this section. 
‘‘(5) CONTRACT
SUSPENSION
AND
TERMI-
NATION PROCESS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B)(ii), the Secretary may suspend as-
signment to or an election of an ESRD Fee- 
For-Service Integrated Care Model offered by 
an Organization if the Organization fails to 
comply with any Program requirements speci-
fied in an agreement under this section. An Or-
ganization also shall be considered not in com-
pliance if, for any calendar month during an 
agreement year, more than 50 percent of the 
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