I 
109TH CONGRESS 
2D SESSION 
H. R. 5321 
To establish a pilot project to demonstrate the impact of payment for more 
frequent hemodialysis treatment under the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 9, 2006 
Mr. BASS (for himself, Mr. MCDERMOTT, and Mr. SAM JOHNSON of Texas) 
introduced 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 pilot project to demonstrate the impact of 
payment for more frequent hemodialysis treatment under 
the Medicare Program. 
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 ‘‘Access to Better 
Choice in Dialysis Act of 2006’’. 
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SEC. 2. MEDICARE PILOT PROJECT FOR PAYMENT FOR 
MORE 
FREQUENT 
HEMODIALYSIS 
TREAT-
MENT. 
(a) IN GENERAL.—Not later than 6 months after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall implement a 5-year pilot project 
to measure the impact of increasing the payment amount 
otherwise provided under section 1881(b) of the Social Se-
curity Act (42 U.S.C. 1395rr(b)), based upon the provi-
sion of hemodialysis treatment more frequently than 3 
times per week. 
(b) INCREASED PAYMENT AMOUNT.— 
(1) IN GENERAL.—Under the pilot project, sub-
ject to paragraph (2), the increase in payment 
amount shall be, in the case of hemodialysis treat-
ment provided— 
(A) for a 4th session in a week, 70 percent 
of the full composite rate; 
(B) for a 5th session in a week, 40 percent 
of the full composite rate; 
(C) for a 6th session in a week, 30 percent 
of the full composite rate; 
(D) for a 7th session in a week, 20 percent 
of the full composite rate; and 
(E) for any subsequent session in a week, 
no additional payment amount. 
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(2) FUNDING LIMITATION.—The pilot program 
shall be structured in a manner so that the total ad-
ditional amounts paid under the program for hemo-
dialysis treatment during— 
(A) its first year of operation does not ex-
ceed $15,000,000; 
(B) its second year of operation does not 
exceed $30,000,000; 
(C) its third year of operation does not ex-
ceed $50,000,000; 
(D) its fourth year of operation does not 
exceed $75,000,000; and 
(E) its fifth year of operation does not ex-
ceed $90,000,000. 
No expenditures shall be made for hemodialysis 
treatment under the pilot program after its fifth 
year of operation. 
(3) FUNDING FROM SMI TRUST FUND.—Funds 
from the Federal Supplementary Medical Insurance 
Trust Fund under section 1841 of the Social Secu-
rity Act (42 U.S.C. 1395t) shall be available, in ad-
vance of appropriations, to meet obligations arising 
from the pilot program under this section. 
(c) DATA COLLECTION AND ANALYSIS.— 
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(1) DATA
COLLECTION.—The Secretary shall 
provide for the collection of data to measure the 
clinical and financial impact of higher frequency 
hemodialysis treatments, including its impact on— 
(A) health status and on the utilization of, 
and expenditures for, other health care services, 
including for separately-billable drugs, such as 
erythropoietin (also known as Epogen), iron, 
and hospitalizations; and 
(B) patients’ working status, resulting 
in— 
(i) a reduction in Social Security Dis-
ability Insurance payments; 
(ii) increased Federal and State in-
come and employment tax payments; and 
(iii) a reduction in Medicare payments 
due to increased coverage under employer 
group health plans. 
(2) REPORTS
TO
CONGRESS.—The Secretary 
shall periodically submit to Congress reports on the 
pilot program under this section. The Secretary shall 
submit a final report to Congress and to the Medi-
care Payment Advisory Commission no later than 6 
months after the completion of the program. Such 
final report shall include findings regarding the clin-
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ical and financial impact of more frequent hemo-
dialysis treatment. 
(3) MEDPAC
ANALYSIS.—The Medicare Pay-
ment Advisory Commission shall evaluate the Sec-
retary’s findings in the final report under paragraph 
(2) and shall submit to Congress, no later than 6 
months after the date of the Commission’s receipt of 
such final report, and shall include in the report its 
analysis of the desirability of expanded medicare 
payment for more frequent hemodialysis treatment. 
(d) DEFINITIONS.—In this section: 
(1) FULL COMPOSITE RATE.—The term ‘‘full 
composite rate’’ means the rate determined under 
section 1881(b)(7) of the Social Security Act (42 
U.S.C. 1395rr(b)(7)). 
(2) HEMODIALYSIS
TREATMENT.—The term 
‘‘hemodialysis treatment’’ includes equivalent ther-
apy requiring blood access, but does not include 
treatment administered on an emergency or acute 
basis. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
Æ 
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