I 
114TH CONGRESS 
1ST SESSION H. R. 1130 
To improve the understanding of, and promote access to treatment for, 
chronic kidney disease, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 26, 2015 
Mr. MARINO (for himself, Mr. LEWIS, and Mr. ROSKAM) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee 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 
2015’’. 
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 UNDERSTANDING OF CHRONIC KIDNEY 
DISEASE THROUGH EXPANDED RESEARCH AND COORDINATION 
Sec. 101. Identifying gaps in chronic kidney disease research. 
Sec. 102. Coordinating research on chronic kidney disease. 
Sec. 103. Understanding the progression of kidney disease and treatment of 
kidney failure in minority populations. 
TITLE II—PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE 
TREATMENTS 
Sec. 201. Increasing access to Medicare kidney disease education benefit. 
Sec. 202. Improving access to chronic kidney disease treatment in underserved 
rural and urban areas. 
Sec. 203. Promoting access to home dialysis treatments. 
Sec. 204. Expand access for patients with acute kidney injury. 
TITLE III—CREATING ECONOMIC STABILITY FOR PROVIDERS 
CARING FOR INDIVIDUALS WITH CHRONIC KIDNEY DISEASE 
Sec. 301. Stabilizing Medicare payments for services provided to beneficiaries 
with stage V chronic kidney disease receiving dialysis services. 
Sec. 302. Allowing individuals with kidney failure to retain access to private in-
surance. 
Sec. 303. Providing individuals with kidney failure access to managed care and 
coordinated care programs. 
TITLE 
I—IMPROVING 
UNDER-
STANDING OF CHRONIC KID-
NEY DISEASE THROUGH EX-
PANDED RESEARCH AND CO-
ORDINATION 
SEC. 101. IDENTIFYING GAPS IN CHRONIC KIDNEY DISEASE 
RESEARCH. 
(a) REPORT.—Not later than one year after the date 
of enactment of this Act, the Comptroller General of the 
United States shall develop and submit to the Congress 
a comprehensive report assessing the adequacy of Federal 
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expenditures in chronic kidney disease research relative to 
Federal expenditures for chronic kidney disease care. 
(b) CONTENTS.—The report required by this section 
shall— 
(1) analyze the current chronic kidney disease 
research projects being funded by Federal agencies; 
(2) identify, including by surveying the kidney 
care community, areas of chronic kidney disease 
knowledge gaps that are not part of current Federal 
research efforts; 
(3) report on the level of Federal expenditures 
on kidney research as compared to the amount of 
Federal expenditures on treating individuals with 
chronic kidney disease; and 
(4) identify areas of kidney failure knowledge 
gaps in research to assess treatment patterns associ-
ated with providing care to minority populations 
that are disproportionately affected by kidney fail-
ure. 
SEC. 102. COORDINATING RESEARCH ON CHRONIC KIDNEY 
DISEASE. 
(a) INTERAGENCY COMMITTEE.—The Secretary of 
Health and Human Services shall establish and maintain 
an interagency committee for the purpose of improving the 
coordination of chronic kidney disease research. 
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(b) REPORTS.—For the purpose described in sub-
section (a), the interagency committee established under 
such subsection shall issue public reports that— 
(1) include a strategic plan, including rec-
ommendations for— 
(A) improving communication and coordi-
nation among Federal agencies; 
(B) procedures for monitoring Federal 
chronic kidney disease research activities; and 
(C) ways to maximize the efficiency of the 
Federal chronic kidney disease research invest-
ment and minimize the potential for unneces-
sary duplication; 
(2) include a portfolio analysis that provides in-
formation on chronic kidney disease research 
projects, organized by the strategic plan objectives; 
and 
(3) address such other topics as the interagency 
committee determines appropriate. 
(c) MEETINGS.—The interagency committee estab-
lished under subsection (a) shall meet not less than semi- 
annually. 
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SEC. 103. UNDERSTANDING THE PROGRESSION OF KIDNEY 
DISEASE AND TREATMENT OF KIDNEY FAIL-
URE IN MINORITY POPULATIONS. 
Not later than one year after the date of enactment 
of this Act, the Secretary of Health and Human Services 
shall— 
(1) complete a study on— 
(A) the social, behavioral, and biological 
factors leading to kidney disease; 
(B) efforts to slow the progression of kid-
ney disease in minority populations that are 
disproportionately affected by such disease; and 
(C) treatment patterns associated with 
providing care, under the Medicare program 
under title XVIII of the Social Security Act, the 
Medicaid program under title XIX of such Act, 
and through private health insurance, to minor-
ity populations that are disproportionately af-
fected by kidney failure; and 
(2) submit a report to the Congress on the re-
sults of such study. 
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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 such Act (42 U.S.C. 1395rr(b)) is 
amended by adding at the end the following new para-
graph: 
‘‘(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, 2016. 
SEC. 202. IMPROVING ACCESS TO CHRONIC KIDNEY DIS-
EASE TREATMENT IN UNDERSERVED RURAL 
AND URBAN 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 nephrologists and non-physician practi-
tioners providing renal dialysis services’’ 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 nephrologists and non-physician 
practitioners providing renal dialysis services’’ before the 
period at the end. 
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SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREAT-
MENTS. 
Section 1834(m)(4)(C)(ii) of the Social Security Act 
(42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at 
the end the following new subclause: 
‘‘(IX) A renal dialysis facility (as 
defined in section 1881).’’. 
SEC. 204. EXPAND ACCESS FOR PATIENTS WITH ACUTE KID-
NEY INJURY. 
Section 1881(b) of the Social Security Act (42 U.S.C. 
1395rr(b)) is amended— 
(1) in paragraph (1), by inserting ‘‘or acute 
kidney injury’’ after ‘‘individuals who have been de-
termined to have end stage renal disease’’; 
(2) in paragraph (2)(A), by inserting ‘‘or acute 
kidney injury’’ after ‘‘end stage renal disease’’; 
(3) in paragraph (2)(B), by inserting ‘‘or acute 
kidney injury’’ after ‘‘end stage renal disease’’; 
(4) in paragraph (3), in the matter preceding 
subparagraph (A), by inserting ‘‘or acute kidney in-
jury’’ after ‘‘end stage renal disease’’; 
(5) in paragraph (11)(A), by inserting ‘‘or 
acute kidney injury’’ after ‘‘end stage renal disease’’; 
(6) in paragraph (11)(B), by inserting ‘‘or 
acute kidney injury’’ after ‘‘end stage renal disease’’; 
(7) in paragraph (14)(B)— 
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(A) in clause (ii), by inserting ‘‘or acute 
kidney injury’’ after ‘‘end stage renal disease’’; 
(B) in clause (iii), by inserting ‘‘or acute 
kidney injury’’ after ‘‘end stage renal disease’’; 
and 
(C) in clause (iv), by inserting ‘‘or acute 
kidney injury’’ after ‘‘end stage renal disease’’; 
and 
(8) in paragraph (14)(H)(i), by inserting ‘‘or 
acute kidney injury’’ after ‘‘end stage renal disease’’. 
TITLE III—CREATING ECONOMIC 
STABILITY FOR PROVIDERS 
CARING 
FOR 
INDIVIDUALS 
WITH CHRONIC KIDNEY DIS-
EASE 
SEC. 301. STABILIZING MEDICARE PAYMENTS FOR SERV-
ICES PROVIDED TO BENEFICIARIES WITH 
STAGE V CHRONIC KIDNEY DISEASE RECEIV-
ING DIALYSIS SERVICES. 
Section 1881(b)(14) of the Social Security Act (42 
U.S.C. 1395rr(b)(14)) is amended— 
(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 
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(2) by adding at the end the following new sub-
paragraph: 
‘‘(J)(i) For payment for renal dialysis services fur-
nished on or after January 1, 2016, under the system 
under this paragraph— 
‘‘(I) the payment adjustment described in 
clause (i) of subparagraph (D) shall not take into 
account comorbidities; 
‘‘(II) the payment adjustment described in 
clause (ii) of such subparagraph shall not be in-
cluded; 
‘‘(III) the standardization factor described 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 utilization of drugs and any modifica-
tion in adjustors applied under this paragraph; and 
‘‘(IV) the Secretary shall take into account rea-
sonable costs consistent with paragraph (2)(B) when 
calculating such payments. 
‘‘(ii) Not later than January 1, 2016, the Secretary 
shall amend the ESRD facility cost report to— 
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‘‘(I) include the per treatment network fee (as 
described in paragraph (7)) as an allowable cost; 
and 
‘‘(II) eliminate the limitation for reporting med-
ical director fees on such reports in order to take 
into account the wages of a board-certified 
nephrologist.’’. 
SEC. 302. 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, 2016’’ after ‘‘prior to such date’’; 
and 
(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2016 (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 
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