I 
117TH CONGRESS 
1ST SESSION H. R. 4942 
To establish a demonstration program to provide integrated care for Medicare 
beneficiaries with end-stage renal disease, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 6, 2021 
Mr. BLUMENAUER (for himself, Mr. CA´RDENAS, and Mr. BUTTERFIELD) in-
troduced the following bill; which was referred to the Committee on En-
ergy 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 jurisdic-
tion of the committee concerned 
A BILL 
To establish a demonstration program to provide integrated 
care for Medicare beneficiaries with end-stage renal dis-
ease, 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 ‘‘Bringing Enhanced 
Treatments and Therapies to ESRD Recipients Kidney 
Care Act’’ or the ‘‘BETTER Kidney Care Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Although the relative rate of end-stage renal 
disease (referred to in this section as ‘‘ESRD’’) 
among the Nation’s minority populations has de-
clined, significant disparities remain. Compared to 
Whites, Black Americans are 2.6 times more likely 
to have kidney failure, while Native Americans and 
Alaska Natives are 1.2 times more likely. Hispanics 
are 1.3 times more likely to have kidney failure com-
pared to non-Hispanics. 
(2) Disparities also exist with respect to treat-
ment modalities. Specifically, although home dialysis 
can offer advantages, Black, Hispanic, and Native 
American and Alaska Native ESRD patients are less 
likely to initiate home treatment than White ESRD 
patients. 
(3) Numerous studies show that individuals 
with low incomes and in low-income communities are 
at greater risk for ESRD. 
(4) In addition to their kidney disease, ESRD 
patients across all races and ethnicities often suffer 
from one or more comorbidities. Eighty-eight per-
cent of ESRD patients have a history of hyper-
tension, 42 percent have diabetes, and nearly 30 
percent have congestive heart failure. 
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(5) Each month, ESRD patients see multiple 
providers and take several medications to manage 
their kidney disease and comorbid conditions. Of all 
patients, those with ESRD stand to benefit greatly 
from better coordinated care. 
(6) The Executive order on Advancing Amer-
ican Kidney Health recognizes the need to develop 
and implement new ESRD care delivery models to 
improve quality and value for ESRD patients and 
the Medicare program. 
(7) In alignment with that goal, it is imperative 
that Medicare test new models that have at their 
core an interdisciplinary care team, among other 
structural requirements, to— 
(A) help ESRD patients better navigate 
the health care system; 
(B) empower such patients to manage 
their plan of care and medication regimen; 
(C) support such patients in receiving the 
treatment modality, including a kidney trans-
plant, as prescribed by their nephrologist; 
(D) access services to meet the nonclinical 
needs of such patients that can affect care out-
comes; and 
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(E) receive additional services, such as 
transplant evaluation, palliative care, evaluation 
for hospice eligibility, and vascular access care. 
SEC. 3. DEMONSTRATION PROGRAM TO PROVIDE INTE-
GRATED 
CARE 
FOR 
MEDICARE 
BENE-
FICIARIES WITH END-STAGE RENAL DISEASE. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act is amended by inserting after section 1866F the fol-
lowing new section: 
‘‘DEMONSTRATION
PROGRAM
TO
PROVIDE
INTEGRATED 
CARE
FOR
MEDICARE
BENEFICIARIES
WITH
END- 
STAGE RENAL DISEASE 
‘‘SEC. 1866G. (a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—The Secretary shall con-
duct under this section the ESRD Fee-For-Service 
Integrated Care Demonstration Program (in this 
section referred to as the ‘Program’), which is vol-
untary for Program-eligible beneficiaries and eligible 
participating providers, to assess the effects of alter-
native care delivery models and payment methodolo-
gies on patient care improvements under this title 
for such beneficiaries. Under the Program— 
‘‘(A) Program-eligible beneficiaries shall be 
considered original Medicare Fee-For-Service 
beneficiaries (as defined in section 1899(h)(3)) 
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