I 
115TH CONGRESS 
1ST SESSION H. R. 2644 
To improve the understanding of, and promote access to treatment for, 
chronic kidney disease, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 24, 2017 
Mr. MARINO (for himself, Mr. LEWIS of Georgia, and Mr. ROSKAM) intro-
duced 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 subsequently 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. 
This Act may be cited as the ‘‘Chronic Kidney Dis-
ease Improvement in Research and Treatment Act of 
2017’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
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Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—IMPROVING PATIENT LIVES AND QUALITY OF CARE 
THROUGH RESEARCH AND INNOVATION 
Sec. 101. Improving patient lives and quality of care through research and in-
novation. 
Sec. 102. Enhancing care through new technologies. 
Sec. 103. Understanding current utilization of palliative care services. 
Sec. 104. Understanding the progression of kidney disease and treatment of 
kidney failure in minority populations. 
TITLE II—EMPOWER PATIENT DECISION MAKING AND CHOICE 
Sec. 201. Providing individuals with kidney failure access to managed care. 
Sec. 202. Medigap coverage for beneficiaries with end-stage renal disease. 
Sec. 203. Promoting access to home dialysis treatments. 
Sec. 204. Allowing individuals with kidney failure to retain access to private in-
surance. 
TITLE III—IMPROVING PATIENT CARE AND ENSURING QUALITY 
OUTCOMES 
Sec. 301. Maintain an economically stable dialysis infrastructure. 
Sec. 302. Improve patient decision making and transparency by consolidating 
and modernizing quality programs. 
Sec. 303. Increasing access to Medicare kidney disease education benefit. 
Sec. 304. Certification of new facilities. 
Sec. 305. Improving access in underserved areas. 
TITLE I—IMPROVING PATIENT 
LIVES AND QUALITY OF CARE 
THROUGH RESEARCH AND IN-
NOVATION 
SEC. 101. 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: 
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(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. 
(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. 
102. 
ENHANCING 
CARE 
THROUGH 
NEW 
TECH-
NOLOGIES. 
(a) AGREEMENT WITH NATIONAL ACADEMY
OF 
SCIENCES.—The Secretary of Health and Human Services 
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shall seek to enter into an agreement with the National 
Academy of Sciences within six months of the date of the 
enactment of this Act under which the National Academy 
of Sciences will conduct a study on the design of payments 
for renal dialysis services under the Medicare program 
under title XVIII of the Social Security Act, including an 
analysis of whether adjustments to such payments are 
needed to allow for the incorporation of new technologies 
and therapies. 
(b) CONTENTS.—In conducting the study under sub-
section (a), the National Academy of Sciences shall evalu-
ate the current payment system for renal dialysis services 
under the Medicare program, identify barriers to adopting 
innovative items, services, and therapies, and make rec-
ommendations as to how to eliminate such barriers. 
SEC. 103. UNDERSTANDING CURRENT UTILIZATION OF PAL-
LIATIVE CARE SERVICES. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States (in this section referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
utilization of palliative care in treating individuals 
with advanced kidney disease, from stage 4 through 
stage 5, including individuals with kidney failure on 
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dialysis through any progression of the disease. Such 
study shall include an analysis of— 
(A) how palliative care can be utilized to 
improve the quality of life of those with kidney 
disease and facilitate care tailored to their indi-
vidual goals and values; 
(B) the successful use of palliative care in 
the care of patients with other chronic diseases 
and serious illnesses; 
(C) the utilization of palliative care at any 
point in an illness, including when used at the 
same time as curative treatment; and 
(D) other areas determined appropriate by 
the Comptroller General. 
(2) DEFINITION OF PALLIATIVE CARE.—In this 
section, the term ‘‘palliative care’’ means patient 
and family centered care that optimizes quality of 
life by anticipating, preventing, and treating suf-
fering. Such term includes care that is furnished 
throughout the continuum of the illness that ad-
dresses physical, intellectual, emotional, social, and 
spiritual needs and that facilitates patient autonomy, 
access to information and choice. 
(b) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Comptroller General shall 
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submit to the Congress a report on the study conducted 
under subsection (a), together with such recommendations 
as the Comptroller General 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 
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. 
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TITLE II—EMPOWER PATIENT 
DECISION MAKING AND CHOICE 
SEC. 201. PROVIDING INDIVIDUALS WITH KIDNEY FAILURE 
ACCESS TO MANAGED CARE. 
(a) PERMANENT EXTENSION OF MEDICARE ADVAN-
TAGE ESRD SPECIAL NEEDS PLANS AUTHORITY.—Sec-
tion 1859(f)(1) of the Social Security Act (42 U.S.C. 
1395w–28(f)(1)) is amended by inserting ‘‘, in the case 
of a specialized MA plan for special needs individuals who 
have not been determined to have end stage renal dis-
ease,’’ before ‘‘for periods before January 1, 2019’’. 
(b) ACCELERATED ACCESS TO MEDICARE ADVAN-
TAGE.—Section 17006(a)(3) of the 21st Century Cures 
Act (Public Law 114–255) is amended by striking ‘‘2021’’ 
and inserting ‘‘2020’’. 
(c) ACCELERATED MEDPAC RISK ADJUSTMENT RE-
PORT.—Section 17006(f)(2)(A)(i)(II) of the 21st Century 
Cures Act (Public Law 114–255) is amended by striking 
‘‘2020’’ and inserting ‘‘2019’’. 
SEC. 202. MEDIGAP COVERAGE FOR BENEFICIARIES WITH 
END-STAGE RENAL DISEASE. 
(a) GUARANTEED AVAILABILITY OF MEDIGAP POLI-
CIES TO ALL ESRD MEDICARE BENEFICIARIES.— 
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(b) ADDITIONAL ENROLLMENT PERIOD FOR CER-
TAIN INDIVIDUALS.— 
(1) ONE-TIME ENROLLMENT PERIOD.— 
(A) IN GENERAL.—In the case of an indi-
vidual described in subparagraph (B), the Sec-
retary of Health and Human Services shall es-
tablish a one-time enrollment period during 
which such an individual may enroll in any 
Medicare supplemental policy under section 
1882 of the Social Security Act (42 U.S.C. 
1395ss) of the individual’s choosing. 
(B) ENROLLMENT
PERIOD.—The enroll-
ment period established under subparagraph 
(A) shall begin on January 1, 2020, and shall 
end June 30, 2020. 
(2) INDIVIDUAL DESCRIBED.—An individual de-
scribed in this paragraph is an individual who— 
(A) is entitled to hospital insurance bene-
fits under part A of title XVIII of the Social 
Security Act under section 226A(b) of such Act 
(42 U.S.C. 426–1); 
(B) is enrolled for benefits under part B of 
such title XVIII; and 
(C) would not, but for the provisions of, 
and amendments made by, subsection (a) be eli-
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gible for the guaranteed issue of a Medicare 
supplemental policy under paragraph (2) or (3) 
of section 1882(s) of such Act (42 U.S.C. 
1395ss(s)). 
SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREAT-
MENTS. 
(a) IN GENERAL.—Section 1881(b)(3) of the Social 
Security Act (42 U.S.C. 1395rr(b)(3)) is amended— 
(1) by redesignating subparagraphs (A) and 
(B) as clauses (i) and (ii), respectively; 
(2) in clause (ii), as redesignated by subpara-
graph (A), strike ‘‘on a comprehensive’’ and insert 
‘‘subject to subparagraph (B), on a comprehensive’’; 
(3) by striking ‘‘With respect to’’ and inserting 
‘‘(A) With respect to’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(B) For purposes of subparagraph (A)(ii), an indi-
vidual determined to have end-stage renal disease receiv-
ing home dialysis may choose to receive the monthly end- 
stage renal disease-related visits furnished on or after 
January 1, 2018, via telehealth if the individual receives 
a face-to-face visit, without the use of telehealth, at least 
once every three consecutive months.’’. 
(b) ORIGINATING SITE REQUIREMENTS.— 
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(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, 2018, for purposes of section 
1881(b)(3)(B), at an originating site described in 
subclause 
(VI), 
(IX), 
or 
(X) 
of 
paragraph 
(4)(C)(ii).’’. 
(2) NO
FACILITY
FEE
IF
ORIGINATING
SITE 
FOR HOME DIALYSIS THERAPY IS THE HOME.—Sec-
tion 1834(m)(2)(B) of the Social Security Act (42 
U.S.C. 1395m(m)(2)(B)) is amended— 
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(A) by redesignating clauses (i) and (ii) as 
subclauses (I) and (II), and indenting appro-
priately; 
(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 
be paid under this subparagraph to an 
originating site described in paragraph 
(4)(C)(ii)(X).’’. 
(c) CONFORMING AMENDMENT.—Section 1881(b)(1) 
of the Social Security Act (42 U.S.C. 1395rr(b)(1)) is 
amended by striking ‘‘paragraph (3)(A)’’ and inserting 
‘‘paragraph (3)(A)(i)’’. 
(d) EXCLUSION FROM REMUNERATION FOR PUR-
POSES OF APPLYING CIVIL MONETARY PENALTIES.— 
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(1) IN GENERAL.—Section 1128A(i)(6) of the 
Social Security Act (42 U.S.C. 1320a–7a(i)(6)) is 
amended— 
(A) in subparagraph (H)(iv), by striking ‘‘; 
or’’ at the end; 
(B) in subparagraph (I), by striking the 
period at the end and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(J) the provision of telehealth or remote 
patient monitoring technologies to individuals 
under title XVIII by a health care provider for 
the purpose of furnishing telehealth or remote 
patient monitoring services.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to services furnished 
on or after the date of the enactment of this Act. 
SEC. 204. ALLOWING INDIVIDUALS WITH KIDNEY FAILURE 
TO RETAIN ACCESS TO PRIVATE INSURANCE. 
(a) IN GENERAL.—Section 1862(b)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend-
ed— 
(1) in the last sentence, by inserting ‘‘and be-
fore January 1, 2018’’ after ‘‘prior to such date’’; 
and 
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(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2018 (with respect to periods 
beginning on or after the date that is 42 months 
prior to such date), clauses (i) and (ii) shall be ap-
plied by substituting ‘42-month’ for ‘12-month’ each 
place it appears.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this subsection shall take effect on the date of enactment 
of this Act. For purposes of determining an individual’s 
status under section 1862(b)(1)(C) of the Social Security 
Act (42 U.S.C. 1395y(b)(1)(C)), as amended by sub-
section (a), an individual who is within the coordinating 
period as of the date of enactment of this Act shall have 
that period extended to the full 42 months described in 
the last sentence of such section, as added by the amend-
ment made by subsection (a)(2). 
TITLE III—IMPROVING PATIENT 
CARE AND ENSURING QUAL-
ITY OUTCOMES 
SEC. 301. MAINTAIN AN ECONOMICALLY STABLE DIALYSIS 
INFRASTRUCTURE. 
(a) IN GENERAL.—Section 1881(b)(14) of the Social 
Security Act (42 U.S.C. 1395rr(b)(14)) is amended— 
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(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: 
‘‘(J) For payment for renal dialysis serv-
ices furnished on or after January 1, 2018, 
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 only take into account 
age for purposes of distinguishing be-
tween 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; 
‘‘(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; 
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‘‘(iv) the standardization factor de-
scribed in the final rule published in the 
Federal Register on November 8, 2012 (77 
Fed. Reg. 67470), shall be established 
using the most currently available data 
(and not historical data) and adjusted on 
an annual basis, based on such available 
data, to account for any change in utiliza-
tion of drugs and any modification in ad-
justors applied under this paragraph; and 
‘‘(v) 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 
Act (42 U.S.C. 1395rr(b)(14)), as amended by subsection 
(a), is amended by adding at the end the following new 
subparagraph: 
‘‘(K) Not later than January 1, 2018, the 
Secretary shall amend the ESRD facility cost 
report to include the per treatment network fee 
(as described in paragraph (7)) as an allowable 
cost or offset to revenue.’’. 
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SEC. 302. IMPROVE PATIENT DECISION MAKING AND 
TRANSPARENCY 
BY 
CONSOLIDATING 
AND 
MODERNIZING QUALITY PROGRAMS. 
(a) MEASURES.—Section 1881(h)(2) of the Social 
Security Act (42 U.S.C. 1395rr(h)(2)) is amended by add-
ing at the end the following new subparagraphs: 
‘‘(F) WEIGHTING LIMITATION.—No single 
measure specified by the Secretary or individual 
measure within a composite measure so speci-
fied may be weighted less than 10 percent of 
the total performance score. 
‘‘(G) STATISTICALLY
VALID
AND
RELI-
ABLE.—In specifying measures under subpara-
graph (A), the Secretary shall only specify 
measures that have been shown to be statis-
tically valid and reliable through testing.’’. 
(b) ENDORSEMENT.—Section 1881(h)(2)(B) of the 
Social Security Act (42 U.S.C. 1395rr(h)(2)(B)) is 
amended— 
(1) in clause (ii), by adding at the end the fol-
lowing new sentence: ‘‘The exception under the pre-
ceding sentence shall not apply to a measure that 
the entity with a contract under section 1890(a) (or 
a similar entity) considered but failed to endorse.’’; 
and 
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(2) by adding at the end the following new 
clause: 
‘‘(iii) 
COMPOSITE
MEASURES.— 
Clauses (i) and (ii) shall apply to com-
posite measures in the same manner as 
such clauses apply to individual meas-
ures.’’. 
(c) REQUIREMENTS FOR DIALYSIS FACILITY COM-
PARE STAR RATING PROGRAM.—Section 1881(h)(6) of 
the Social Security Act (42 U.S.C. 1395rr(h)(6)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(E) REQUIREMENTS FOR ANY DIALYSIS 
FACILITY COMPARE STAR RATING PROGRAM.— 
To the extent that the Secretary maintains a 
dialysis facility compare star rating program, 
under such a program the Secretary— 
‘‘(i) shall assign stars using the same 
methodology and total performance score 
results from the quality incentive program 
under this subsection; 
‘‘(ii) shall determine the stars using 
the same methodology used under such 
quality incentive program; and 
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‘‘(iii) shall not use a forced bell curve 
when determining the stars or rebaselining 
the stars.’’. 
(d) HOSPITALS REQUIRED TO PROVIDE INFORMA-
TION.—Section 1881 of the Social Security Act (42 U.S.C. 
1395rr) is amended by adding at the end the following 
new subsection: 
‘‘(i) HOSPITALS REQUIRED TO PROVIDE INFORMA-
TION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a process under which a hospital or a critical ac-
cess hospital shall provide a renal dialysis facility 
with health and treatment information with respect 
to an individual who is discharged from the hospital 
or critical access hospital and who subsequently re-
ceives treatment at facility. 
‘‘(2) ELEMENTS.—Under the process estab-
lished under paragraph (1)— 
‘‘(A) the request for the health information 
may be initiated by the individual prior to dis-
charge or upon request by the renal dialysis fa-
cility after the patient is discharged; and 
‘‘(B) the information must be provided to 
the facility within 7 days of the request being 
made.’’. 
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(e) INCENTIVE PAYMENTS.—Section 1881(h)(1) of 
the Social Security Act (42 U.S.C. 1395rr(h)(1)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(D) INCENTIVE PAYMENTS.— 
‘‘(i) IN GENERAL.—In the case of a 
provider of services or a renal dialysis fa-
cility that the Secretary determines exceeds 
the attainment performance standards 
under paragraph (4) with respect to a 
year, the Secretary may make a bonus 
payment to the provider or facility (pursu-
ant to a process established by the Sec-
retary). 
‘‘(ii) FUNDING.—The total amount of 
bonus payments under clause (i) in a year 
shall be equal to the total amount of re-
duced payments in a year under subpara-
graph (A). 
‘‘(iii) NO
EFFECT
IN
SUBSEQUENT 
YEARS.—The provisions of subparagraph 
(C) shall apply to a bonus payment under 
this subparagraph in the same manner 
subparagraph (C) applies to a reduction 
under such subparagraph.’’. 
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(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2019. 
SEC. 303. 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)’’; 
(ii) by striking ‘‘and’’ at the end of 
clause (i); 
(iii) by striking the period at the end 
of clause (ii) and inserting ‘‘; and’’; 
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(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 
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.’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section apply to kidney disease education services fur-
nished on or after January 1, 2018. 
SEC. 304. CERTIFICATION OF NEW FACILITIES. 
(a) IN GENERAL.—Section 1865(a) of the Social Se-
curity Act (42 U.S.C. 1395bb(a)) is amended— 
(1) in paragraph (1), by striking ‘‘or the condi-
tions and requirements under section 1881(b)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) Not later than 6 months after the date of enact-
ment of the Chronic Kidney Disease Improvement in Re-
search and Treatment Act of 2017, the Secretary shall, 
for purposes of this subsection, accept a completed appli-
cation from any national accreditation body for purposes 
of accrediting provider entities required to meet the condi-
tions and requirements under section 1881(b). Any appli-
cation received under this paragraph shall be deemed ap-
proved unless the Secretary, not later than 90 days after 
the date of the submission of the application to the Sec-
retary, either denies such request in writing or informs 
the applicant in writing with respect to any additional in-
formation that is needed in order to make a final deter-
mination with respect to the applicant. After the date the 
Secretary receives such additional information, the Sec-
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retary, not later than 90 days after such date, shall ap-
prove or deny such request.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of enactment 
of this Act and apply to a finding made on or after such 
date. 
SEC. 305. IMPROVING ACCESS IN UNDERSERVED AREAS. 
(a) DEFINITION OF PRIMARY CARE SERVICES.—Sec-
tion 331(a)(3)(D) of the Public Health Service Act (42 
U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘and in-
cludes renal dialysis services’’ before the period at the end. 
(b) NATIONAL HEALTH SERVICE CORPS SCHOLAR-
SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 
Service Act (42 U.S.C. 254l(a)(2)) is amended by insert-
ing ‘‘, including nephrology health professionals’’ before 
the period at the end. 
(c) NATIONAL HEALTH SERVICE CORPS LOAN RE-
PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 
Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended 
by inserting ‘‘, including nephrology health professionals’’ 
before the period at the end. 
Æ 
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