I 
117TH CONGRESS 
1ST SESSION H. R. 3893 
To improve kidney disease research, prevention, surveillance, and treatment 
in minority populations and rural and underserved communities, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 15, 2021 
Ms. BLUNT ROCHESTER (for herself and Mr. WENSTRUP) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To improve kidney disease research, prevention, surveillance, 
and treatment in minority populations and rural and 
underserved communities, 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 ‘‘Coordination, Account-
ability, Research, and Equity for All Kidneys Act of 2021’’ 
or the ‘‘CARE for All Kidneys Act of 2021’’. 
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SEC. 2. KIDNEY DISEASE RESEARCH IN MINORITY POPU-
LATIONS AND RURAL AND UNDERSERVED 
COMMUNITIES. 
(a) IN GENERAL.—The Director of the National In-
stitutes of Health shall expand, intensify, and support on-
going research and other activities with respect to kidney 
disease in minority populations and rural and underserved 
communities. 
(b) CONSULTATION.—The Director of the National 
Institutes of Health shall carry out subsection (a) in con-
sultation with the Administrator of the Centers for Medi-
care & Medicaid Services, working with personnel of the 
Centers who are responsible for chronic care management 
activities and have expertise in kidney care. 
(c) RESEARCH.— 
(1) DESCRIPTION.—Research under subsection 
(a) shall include investigation into— 
(A) the causes of kidney disease, including 
socioeconomic, geographic, clinical, environ-
mental, genetic, racial, ethnic, and other factors 
that may contribute to increased rates of kidney 
disease in minority populations and rural and 
underserved communities; and 
(B) the causes of increased incidence of 
kidney disease complications in minority popu-
lations and rural and underserved communities, 
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and possible clinical and nonclinical (such as 
food security, housing, and access to coverage) 
interventions to decrease such incidence. 
(2) INCLUSION
OF
PARTICIPANTS.—In con-
ducting and supporting research described in sub-
section (a), the Director of the National Institutes of 
Health shall seek to include participants from mi-
nority populations and rural and underserved com-
munities as study subjects in clinical trials. 
(d) REPORT.— 
(1) IN
GENERAL.—Not later than 6 months 
after the date of enactment of this section, the Sec-
retary of Health and Human Services shall prepare 
and submit to the Congress a report on Federal re-
search and public health activities with respect to 
kidney disease in minority populations and rural and 
underserved communities. 
(2) CONTENTS.—The report under paragraph 
(1) shall at minimum address each of the following: 
(A) Research on kidney disease in minority 
populations and rural and underserved commu-
nities, including such research on— 
(i) socioeconomic, geographic, clinical, 
environmental, genetic, racial, ethnic, and 
other factors (such as food security, hous-
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ing, and access to coverage) that may con-
tribute to increased rates of kidney disease 
in minority populations and rural and un-
derserved communities; and 
(ii) 
prevention 
and 
complications 
among individuals within these populations 
and communities who have already devel-
oped kidney disease. 
(B) Surveillance and data collection on 
kidney disease in minority populations and 
rural and underserved communities, including 
with respect to— 
(i) efforts to better determine the 
prevalence of kidney disease among Black, 
Hispanic/Latino, and Asian-American and 
Pacific Islander subgroups; and 
(ii) efforts to coordinate data collec-
tion on the American Indian population. 
(C) Community-based interventions to ad-
dress kidney disease targeting minority popu-
lations and rural and underserved communities, 
including— 
(i) the evidence base for such inter-
ventions; 
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(ii) the cultural appropriateness of 
such interventions; and 
(iii) efforts to educate the public on 
the causes of kidney disease, the impor-
tance of maintaining kidney health, and 
actions individuals can take to avoid kid-
ney disease. 
(D) Education and training programs for 
health 
professionals 
(including 
community 
health workers) on the prevention and manage-
ment of kidney disease and its related complica-
tions that is supported by the Health Resources 
and Services Administration, including such 
programs supported by the Bureau of Health 
Workforce, the Bureau of Primary Health Care, 
and the Healthcare Systems Bureau. 
SEC. 3. KIDNEY DISEASE ACTION PLAN. 
(a) IN
GENERAL.—The Assistant Secretary for 
Health of the Department of Health and Human Services 
shall conduct, support, and expand public health strate-
gies, prevention, diagnosis, surveillance, and public and 
professional awareness activities regarding kidney disease. 
(b) NATIONAL ACTION PLAN.— 
(1) DEVELOPMENT.—Not later than 2 years 
after the date of the enactment of this Act, the As-
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sistant Secretary for Health of the Department of 
Health and Human Services shall develop a national 
action plan to address kidney disease in the United 
States with participation from patients, caregivers, 
health professionals, patient advocacy organizations, 
researchers, providers, public health professionals, 
and other stakeholders. 
(2) CONTENTS.—At a minimum, such plan 
shall include recommendations for— 
(A) public health interventions for the pur-
pose of implementation of the national plan; 
(B) biomedical, health services, and public 
health research on kidney disease; and 
(C) inclusion of kidney disease in the 
health data collections of all Federal agencies. 
(c) KIDNEY DISEASE PREVENTION PROGRAMS.—At 
the conclusion of the development of the national action 
plan under subsection (b), the Director of the National 
Institute of Diabetes and Digestive and Kidney Disease 
shall conduct public education and awareness activities 
with patient and professional organizations to stimulate 
earlier diagnosis and improve patient outcomes from treat-
ment of kidney disease. To the extent known and relevant, 
such public education and awareness activities shall reflect 
differences in kidney disease by cause (such as hyper-
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tension, diabetes, and polycystic kidney disease) and in-
clude a focus on outreach to undiagnosed and, as appro-
priate, minority populations and rural and underserved 
communities. 
(d) GRANTS FOR REDUCING BURDEN OF KIDNEY 
DISEASE.—Beginning not later than 2 years after the 
date of enactment of this Act, the Director of the Centers 
for Disease Control and Prevention shall supplement and 
expand upon the activities of the National Institute of Di-
abetes and Digestive and Kidney Disease by making 
grants to nonprofit organizations, State and local jurisdic-
tions, and Indian Tribes for the purpose of reducing the 
burden of kidney disease, especially in disproportionately 
impacted communities, through public health interventions 
and related activities. 
(e) DEVELOPMENT OF BEST PRACTICES FOR DIAG-
NOSIS AND MANAGEMENT OF KIDNEY DISEASE.—Begin-
ning not later than 2 years after the date of enactment 
of this Act, the Assistant Secretary for Health of the De-
partment of Health and Human Services shall— 
(1) in coordination with the Centers for Disease 
Control and Prevention, the Indian Health Service, 
the Health Resources and Services Administration, 
the Department of Veterans Affairs, dialysis pro-
viders, nephrologists, medical societies, and nursing 
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groups, develop pilot programs to demonstrate best 
practices for the diagnosis and management of kid-
ney disease; and 
(2) design such pilot programs and best prac-
tices for use by— 
(A) general practitioners, family physi-
cians, internal medicine practitioners, nurse 
practitioners, and physician assistants in pri-
vate practice; and 
(B) Federally qualified health centers, In-
dian reservations, prisons, community health 
centers, and other primary care settings. 
(f) DATA COLLECTION.—Not later than 180 days 
after the date of enactment of this Act, the Director of 
the National Institute of Diabetes and Digestive and Kid-
ney Disease and the Director of the Centers for Disease 
Control and Prevention, acting jointly, shall assess the 
depth and quality of information on kidney disease that 
is collected in surveys and population studies conducted 
by the Centers for Disease Control and Prevention, includ-
ing whether there are additional opportunities for informa-
tion to be collected in the National Health and Nutrition 
Examination Survey, the National Health Interview Sur-
vey, and the Behavioral Risk Factors Surveillance System 
surveys. The Director of the National Institute of Diabetes 
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and Digestive and Kidney Disease shall include the results 
of such assessment in the national action plan under sub-
section (b). 
(g) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
(1) $1,000,000 for fiscal year 2022; 
(2) $1,000,000 for fiscal year 2023; 
(3) $1,000,000 for fiscal year 2024; 
(4) $1,000,000 for fiscal year 2025; and 
(5) $1,000,000 for fiscal year 2026. 
SEC. 4. REPORT ON END-STAGE RENAL DISEASE (ESRD) 
TREATMENT CHOICES (ETC) MODEL. 
The Assistant Secretary for Health of the Depart-
ment of Health and Human Services shall— 
(1) annually provide to the Congress a report 
on how the end-stage renal disease treatment choices 
model has affected minority populations and rural 
and underserved communities; and 
(2) in each such report, include the number and 
percentage of people in home dialysis categorized by 
race, ethnicity, gender, geographic location, and age. 
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SEC. 5. INCREASING KIDNEY TRANSPLANTS IN MINORITY, 
RURAL, AND UNDERSERVED COMMUNITIES. 
(a) IN GENERAL.—The Director of the National In-
stitutes of Health shall expand, intensify, and support on-
going research and other activities with respect to kidney 
transplants in minority populations and rural and under-
served communities. 
(b) CONSULTATION.—The Director of the National 
Institutes of Health shall carry out this section in con-
sultation with the Administrator of the Centers for Medi-
care & Medicaid Services, working with personnel of the 
Centers who are responsible for chronic care management 
activities and have expertise in kidney care. 
(c) RESEARCH.—Research under subsection (a) shall 
include investigation into— 
(1) the causes of lower rates of kidney trans-
plants in minority, rural, and underserved commu-
nities, including socioeconomic, geographic, clinical, 
environmental, genetic, racial, ethnic, and other fac-
tors that may contribute to lower rates of kidney 
transplants in minority populations and rural and 
underserved communities; and 
(2) possible interventions to increase kidney 
transplants. 
(d) REPORT; COMPREHENSIVE PLAN.— 
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(1) IN GENERAL.—The Secretary of Health and 
Human Services shall— 
(A) prepare and submit to the Congress, 
not later than 6 months after the date of enact-
ment of this section, a report on Federal re-
search and public health activities with respect 
to kidney transplants as a treatment for end- 
stage renal disease in minority populations and 
rural and underserved communities; and 
(B) develop and submit to the Congress, 
not later than 1 year after the date of enact-
ment of this section, an effective and com-
prehensive Federal plan (including all appro-
priate Federal health programs) to increase the 
number of kidney transplants in minority popu-
lations and rural and underserved communities. 
(2) CONTENTS.—The report under paragraph 
(1)(A) shall at minimum address each of the fol-
lowing: 
(A) Research on kidney transplants in mi-
nority populations and rural and underserved 
communities, including such research on finan-
cial, insurance coverage, genetic, behavioral, 
and environmental factors. 
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(B) Surveillance and data collection on 
kidney transplants in minority populations and 
rural and underserved communities, including 
with respect to— 
(i) efforts to increase kidney trans-
plants 
among 
Black, 
Hispanic/Latino, 
Asian-American, and Pacific Islander sub-
groups with end-stage renal disease; and 
(ii) efforts to increase kidney trans-
plants in the American Indian population. 
(C) Community-based efforts to increase 
kidney transplants targeting minority popu-
lations and rural and underserved communities, 
including— 
(i) the evidence base for such in-
creases; 
(ii) the cultural appropriateness of 
such increases; and 
(iii) efforts to educate the public on 
the kidney transplants. 
(D) Education and training programs for 
health 
professionals 
(including 
community 
health workers) on kidney transplants that are 
supported by the Health Resources and Serv-
ices Administration, including such programs 
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supported by the Bureau of Health Workforce, 
the Bureau of Primary Health Care, and the 
Healthcare Systems Bureau. 
SEC. 6. ENVIRONMENTAL AND OCCUPATIONAL HEALTH 
PROGRAMS. 
The Director of the Centers for Disease Control and 
Prevention shall— 
(1) support research into the environmental and 
occupational causes and biological mechanisms that 
contribute to kidney disease; and 
(2) develop and disseminate public health inter-
ventions that will lessen the impact of environmental 
and occupational causes of kidney disease. 
SEC. 7. UNDERSTANDING THE TREATMENT PATTERNS AS-
SOCIATED 
WITH 
PROVIDING 
CARE 
AND 
TREATMENT OF KIDNEY FAILURE IN MINOR-
ITY POPULATIONS AND RURAL AND UNDER-
SERVED COMMUNITIES. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
shall conduct a study on treatment patterns associated 
with providing care, under the Medicare program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.), the Medicaid program under title XIX of such 
Act (42 U.S.C. 1396 et seq.), and through private health 
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insurance, to minority populations, and rural and under-
served communities, 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 the Congress a report on the study conducted under 
subsection (a), together with such recommendations as the 
Secretary determines to be appropriate. 
SEC. 8. 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 ‘‘renal di-
alysis,’’ after ‘‘dentistry,’’. 
(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 ‘‘, which may include 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 ‘‘, which may include nephrology health pro-
fessionals’’ before the period at the end. 
Æ 
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