320 
State law) of the State in which such services are per-
formed, provided such services are covered under this title, 
as would otherwise be covered if furnished by a physician 
or as incident to a physician’s professional service, but 
only if no facility or other provider charges or is paid any 
amounts with respect to the furnishing of such services. 
‘‘(2) The term ‘marriage and family therapist’ means 
an individual who— 
‘‘(A) possesses a master’s or doctoral degree 
which qualifies for licensure or certification as a 
marriage and family therapist pursuant to State 
law; 
‘‘(B) after obtaining such degree has performed 
at least 2 years of clinical supervised experience in 
marriage and family therapy; and 
‘‘(C) is licensed or certified as a marriage and 
family therapist in the State in which marriage and 
family therapist services are performed.’’. 
(3) PROVISION
FOR
PAYMENT
UNDER
PART 
B.—Section 1832(a)(2)(B) of the Social Security 
Act (42 U.S.C. 1395k(a)(2)(B)) is amended by add-
ing at the end the following new clause: 
‘‘(v) marriage and family therapist 
services;’’. 
(4) AMOUNT OF PAYMENT.— 
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(A) IN GENERAL.—Section 1833(a)(1) of 
the Social Security Act (42 U.S.C. 1395l(a)(1)) 
is amended— 
(i) by striking ‘‘and’’ before ‘‘(V)’’; 
and 
(ii) by inserting before the semicolon 
at the end the following: ‘‘, and (W) with 
respect to marriage and family therapist 
services under section 1861(s)(2)(BB), the 
amounts paid shall be 80 percent of the 
lesser of (i) the actual charge for the serv-
ices or (ii) 75 percent of the amount deter-
mined for payment of a psychologist under 
subparagraph (L)’’. 
(B) DEVELOPMENT OF CRITERIA WITH RE-
SPECT TO CONSULTATION WITH A PHYSICIAN.— 
The Secretary of Health and Human Services 
shall, taking into consideration concerns for pa-
tient confidentiality, develop criteria with re-
spect to payment for marriage and family ther-
apist services for which payment may be made 
directly to the marriage and family therapist 
under part B of title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395j et seq.) under which 
such a therapist must agree to consult with a 
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patient’s attending or primary care physician in 
accordance with such criteria. 
(5) EXCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPIST SERVICES FROM SKILLED NURSING FA-
CILITY
PROSPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) of the Social Security Act (42 
U.S.C. 1395yy(e)(2)(A)(ii)), is amended by inserting 
‘‘marriage and family therapist services (as defined 
in subsection (ccc)(1)),’’ after ‘‘qualified psychologist 
services,’’. 
(6) COVERAGE
OF
MARRIAGE
AND
FAMILY 
THERAPIST SERVICES PROVIDED IN RURAL HEALTH 
CLINICS AND FEDERALLY QUALIFIED HEALTH CEN-
TERS.—Section 1861(aa)(1)(B) of the Social Secu-
rity Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by 
striking ‘‘or by a clinical social worker (as defined 
in subsection (hh)(1)),’’ and inserting ‘‘, by a clinical 
social worker (as defined in subsection (hh)(1)), or 
by a marriage and family therapist (as defined in 
subsection (ccc)(2)),’’. 
(7) INCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPISTS
AS
PRACTITIONERS
FOR
ASSIGNMENT 
OF CLAIMS.—Section 1842(b)(18)(C) of the Social 
Security Act (42 U.S.C. 1395u(b)(18)(C)) is amend-
ed by adding at the end the following new clause: 
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‘‘(vii) A marriage and family therapist (as de-
fined in section 1861(ccc)(2)).’’. 
(b) COVERAGE OF MENTAL HEALTH COUNSELOR 
SERVICES.— 
(1) 
COVERAGE
OF
SERVICES.—Section 
1861(s)(2) of the Social Security Act (42 U.S.C. 
1395x(s)(2)), as amended in subsection (a)(1), is 
further amended— 
(A) in subparagraph (AA), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (BB), by inserting 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(CC) mental health counselor services (as 
defined in subsection (ddd)(2));’’. 
(2) DEFINITION.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x), as amended by sub-
section (a)(2), is further amended by adding at the 
end the following new subsection: 
‘‘(ddd) MENTAL
HEALTH
COUNSELOR; MENTAL 
HEALTH COUNSELOR SERVICES.—(1) The term ‘mental 
health counselor’ means an individual who— 
‘‘(A) possesses a master’s or doctor’s degree 
which qualifies the individual for licensure or certifi-
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cation for the practice of mental health counseling in 
the State in which the services are performed; 
‘‘(B) after obtaining such a degree has per-
formed at least 2 years of supervised mental health 
counselor practice; and 
‘‘(C) is licensed or certified as a mental health 
counselor or professional counselor by the State in 
which the services are performed. 
‘‘(2) The term ‘mental health counselor services’ 
means services performed by a mental health counselor (as 
defined in paragraph (1)) for the diagnosis and treatment 
of mental illnesses which the mental health counselor is 
legally authorized to perform under State law (or the 
State regulatory mechanism provided by the State law) of 
the State in which such services are performed, provided 
such services are covered under this title, as would other-
wise be covered if furnished by a physician or as incident 
to a physician’s professional service, but only if no facility 
or other provider charges or is paid any amounts with re-
spect to the furnishing of such services.’’. 
(3) PROVISION
FOR
PAYMENT
UNDER
PART 
B.—Section 1832(a)(2)(B) of the Social Security 
Act (42 U.S.C. 1395k(a)(2)(B)), as amended by 
subsection (a)(3), is further amended by adding at 
the end the following new clause: 
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‘‘(vi) mental health counselor serv-
ices;’’. 
(4) AMOUNT OF PAYMENT.— 
(A) IN GENERAL.—Section 1833(a)(1) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395l(a)(1)), as amended by subsection (a)(4), 
is further amended— 
(i) by striking ‘‘and’’ before ‘‘(W)’’; 
and 
(ii) by inserting before the semicolon 
at the end the following: ‘‘, and (X) with 
respect to mental health counselor services 
under section 1861(s)(2)(CC), the amounts 
paid shall be 80 percent of the lesser of (i) 
the actual charge for the services or (ii) 75 
percent of the amount determined for pay-
ment of a psychologist under subparagraph 
(L)’’. 
(B) DEVELOPMENT OF CRITERIA WITH RE-
SPECT TO CONSULTATION WITH A PHYSICIAN.— 
The Secretary of Health and Human Services 
shall, taking into consideration concerns for pa-
tient confidentiality, develop criteria with re-
spect to payment for mental health counselor 
services for which payment may be made di-
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326 
rectly to the mental health counselor under part 
B of title XVIII of the Social Security Act (42 
U.S.C. 1395j et seq.) under which such a coun-
selor must agree to consult with a patient’s at-
tending or primary care physician in accordance 
with such criteria. 
(5) EXCLUSION
OF
MENTAL
HEALTH
COUN-
SELOR SERVICES FROM SKILLED NURSING FACILITY 
PROSPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) of the Social Security Act (42 
U.S.C. 1395yy(e)(2)(A)(ii)), as amended by sub-
section (a)(5), is amended by inserting ‘‘mental 
health counselor services (as defined in section 
1861(ddd)(2)),’’ after ‘‘marriage and family thera-
pist services (as defined in subsection (ccc)(1)),’’. 
(6) COVERAGE
OF
MENTAL
HEALTH
COUN-
SELOR
SERVICES
PROVIDED
IN
RURAL
HEALTH 
CLINICS AND FEDERALLY QUALIFIED HEALTH CEN-
TERS.—Section 1861(aa)(1)(B) of the Social Secu-
rity Act (42 U.S.C. 1395x(aa)(1)(B)), as amended 
by subsection (a)(6), is amended by striking ‘‘or by 
a marriage and family therapist (as defined in sub-
section (ccc)(2)),’’ and inserting ‘‘by a marriage and 
family therapist (as defined in subsection (ccc)(2)), 
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or a mental health counselor (as defined in sub-
section (ddd)(1)),’’. 
(7) INCLUSION
OF
MENTAL
HEALTH
COUN-
SELORS
AS
PRACTITIONERS
FOR
ASSIGNMENT
OF 
CLAIMS.—Section 1842(b)(18)(C) of the Social Se-
curity Act (42 U.S.C. 1395u(b)(18)(C)), as amended 
by subsection (a)(7), is amended by adding at the 
end the following new clause: 
‘‘(viii) A mental health counselor (as defined in 
section 1861(fff)(1)).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2008. 
SEC. 608. RENTAL AND PURCHASE OF POWER-DRIVEN 
WHEELCHAIRS. 
(a) IN GENERAL.—Section 1834(a)(7) of the Social 
Security Act (42 U.S.C. 1395m(a)(7)) is amended— 
(1) in subparagraph (A)— 
(A) clause (i)(I), by striking ‘‘Except as 
provided in clause (iii), payment’’ and inserting 
‘‘Payment’’; 
(B) by striking clause (iii); and 
(C) in clause (iv)— 
(i) by redesignating such clause as 
clause (iii); and 
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(ii) by striking ‘‘or in the case of a 
power-driven wheelchair for which a pur-
chase agreement has been entered into 
under clause (iii)’’; and 
(2) in subparagraph (C)(ii)(II), by striking ‘‘or 
(A)(iii)’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (1), 
the amendments made by subsection (a) shall take 
effect on January 1, 2008, and shall apply to power- 
driven wheelchairs furnished on or after such date. 
(2) APPLICATION
TO
COMPETITIVE
ACQUISI-
TION.—The amendments made by subsection (a) 
shall not apply to contracts entered into under sec-
tion 1847 of the Social Security Act (42 U.S.C. 
1395w–3) pursuant to a bid submitted under such 
section before July 21, 2007. 
SEC. 609. RENTAL AND PURCHASE OF OXYGEN EQUIPMENT. 
(a) IN GENERAL.—Section 1834(a)(5)(F) of the So-
cial Security Act (42 U.S.C. 1395m(a)(5)(F)) is amend-
ed— 
(1) in clause (i)— 
(A) by striking ‘‘Payment’’ and inserting 
‘‘Subject to clause (iii), payment’’; and 
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329 
(B) by striking ‘‘36 months’’ and inserting 
‘‘13 months’’; 
(2) in clause (ii)(I), by striking ‘‘36th contin-
uous month’’ and inserting ‘‘13th continuous 
month’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) SPECIAL
RULE
FOR
OXYGEN 
GENERATING
PORTABLE
EQUIPMENT.—In 
the case of oxygen generating portable 
equipment referred to in the final rule pub-
lished in the Federal Register on Novem-
ber 9, 2006 (71 Fed. Reg. 65897–65899), 
in applying clauses (i) and (ii)(I) each ref-
erence to ‘13 months’ is deemed a ref-
erence to ‘36 months’.’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (3), 
the amendments made by subsection (a) shall apply 
to oxygen equipment furnished on or after January 
1, 2008. 
(2) TRANSITION.—In the case of an individual 
receiving oxygen equipment on December 31, 2007, 
for which payment is made under section 1834(a) of 
the Social Security Act (42 U.S.C. 1395m(a)), the 
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13-month period described in paragraph (5)(F)(i) of 
such section, as amended by subsection (a), shall 
begin on January 1, 2008, but in no case shall the 
rental period for such equipment exceed 36 months. 
(3) APPLICATION
TO
COMPETITIVE
ACQUISI-
TION.—The amendments made by subsection (a) 
shall not apply to contracts entered into under sec-
tion 1847 of the Social Security Act (42 U.S.C. 
1395w–3) pursuant to a bid submitted under such 
section before July 21, 2007. 
(c) STUDY AND REPORT.— 
(1) STUDY.—The Secretary of Health and 
Human Services shall conduct a study to examine 
the service component and the equipment component 
of the provision of oxygen to Medicare beneficiaries. 
The study shall assess— 
(A) the type of services provided and vari-
ation across suppliers in providing such serv-
ices; 
(B) whether the services are medically nec-
essary or affect patient outcomes; 
(C) whether the Medicare program pays 
appropriately for equipment in connection with 
the provision of oxygen; 
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(D) whether such program pays appro-
priately for necessary services; 
(E) whether such payment in connection 
with the provision of oxygen should be divided 
between equipment and services, and if so, how; 
and 
(F) how such payment rate compares to a 
competitively bid rate. 
(2) REPORT.—Not later than 18 months after 
the date of the enactment of this Act, the Secretary 
of Health and Human Services shall submit to Con-
gress a report on the study conducted under para-
graph (1). 
SEC. 610. ADJUSTMENT FOR MEDICARE MENTAL HEALTH 
SERVICES. 
(a) IN GENERAL.—For purposes of payment for serv-
ices furnished under the physician fee schedule under sec-
tion 1848 of the Social Security Act (42 U.S.C. 1395w– 
4) during the applicable period, the Secretary of Health 
and Human Services shall increase the amount otherwise 
payable for applicable services by 5 percent. 
(b) DEFINITIONS.—For purposes of subsection (a): 
(1) APPLICABLE PERIOD.—The term ‘‘applica-
ble period’’ means the period beginning on January 
1, 2008, and ending on December 31 of the year be-
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fore the effective date of the first review after Janu-
ary 1, 2008, of work relative value units conducted 
under section 1848(c)(2)(B)(i) of the Social Security 
Act. 
(2) APPLICABLE SERVICES.—The term ‘‘appli-
cable services’’ means procedure codes for services— 
(A) in the categories of psychiatric thera-
peutic procedures furnished in office or other 
outpatient facility settings, or inpatient hos-
pital, partial hospital or residential care facility 
settings; and 
(B) which cover insight oriented, behavior 
modifying, or supportive psychotherapy and 
interactive 
psychotherapy 
services 
in 
the 
Healthcare Common Procedure Coding System 
established by the Secretary of Health and 
Human Services under section 1848(c)(5) of 
such Act. 
(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement this section by program instruc-
tion or otherwise. 
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333 
SEC. 611. EXTENSION OF BRACHYTHERAPY SPECIAL RULE. 
Section 1833(t)(16)(C) of the Social Security Act (42 
U.S.C. 1395l(t)(16)(C)) is amended by striking ‘‘2008’’ 
and inserting ‘‘2009’’. 
SEC. 612. PAYMENT FOR PART B DRUGS. 
(a) 
APPLICATION
OF
CONSISTENT
VOLUME 
WEIGHTING IN COMPUTATION OF ASP.—In order to as-
sure that payments for drugs and biologicals under section 
1847A of the Social Security Act (42 U.S.C. 1395w–3a) 
are correct and consistent with law, the Secretary of 
Health and Human Services shall, for payment for drugs 
and biologicals furnished on or after July 1, 2008, com-
pute the volume-weighted average sales price using equa-
tion #2 (specified in appendix A of the report of the In-
spector General of the Department of Health and Human 
Services on ‘‘Calculation of Volume-Weighted Average 
Sales Price for Medicare Part B Prescription Drugs’’ 
(February 2006; OEI–03–05–00310)) used by the Office 
of Inspector General to calculate a volume-weighted ASP. 
(b) IMPROVEMENTS IN THE COMPETITIVE ACQUISI-
TION PROGRAM (CAP).— 
(1) CONTINUOUS
OPEN
ENROLLMENT; AUTO-
MATIC
REENROLLMENT
WITHOUT
NEED
FOR
RE-
APPLICATION.—Subsection 
(a)(1)(A) 
of 
section 
1847B of the Social Security Act (42 U.S.C. 
1395w–3b) is amended— 
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(A) in clause (ii), by striking ‘‘annually’’ 
and inserting ‘‘on an ongoing basis’’; 
(B) in clause (iii), by striking ‘‘an annual 
selection’’ and inserting ‘‘a selection (which 
may be changed on an annual basis)’’ ; and 
(C) by adding at the end the following: 
‘‘An election and selection described in clauses 
(ii) and (iii) shall continue to be effective with-
out the need for any periodic reelection or re-
application or selection.’’. 
(2) PERMITTING VENDER TO DELIVER DRUGS 
TO SITE OF ADMINISTRATION.—Subsection (b)(4)(E) 
of such section is amended— 
(A) by striking ‘‘or’’ at the end of clause 
(I); 
(B) by striking the period at the end of 
clause (ii) and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iii) prevent a contractor from deliv-
ering drugs and biologicals to the site in 
which the drugs or biologicals will be ad-
ministered.’’. 
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335 
(3) PHYSICIAN OUTREACH AND EDUCATION.— 
Subsection (a)(1) of such section is amended by add-
ing at the end the following new subparagraph: 
‘‘(E) PHYSICIAN
OUTREACH
AND
EDU-
CATION.—The Secretary shall conduct a pro-
gram of outreach to education physicians con-
cerning the program and the ongoing oppor-
tunity of physicians to elect to obtain drugs and 
biologicals under the program.’’. 
(4) REBIDDING OF CONTRACTS.—The Secretary 
of Health and Human Services shall provide for the 
rebidding of contracts under section 1847B(c) of the 
Social Security Act (42 U.S.C. 1395w–3b(c)) only 
for periods on or after the expiration of the contract 
in effect under such section as of the date of the en-
actment of this Act. 
(c) TREATMENT
OF
CERTAIN
DRUGS.—Section 
1847A(b) of the Social Security Act (42 U.S.C. 1395w– 
3a(b)) is amended— 
(1) in paragraph (1), by inserting ‘‘paragraph 
(6) and’’ after ‘‘Subject to’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(6) SPECIAL RULE.—.In applying subsection 
(c)(6)(C)(ii), beginning with January 1, 2008, the 
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average sales price for drugs or biologicals described 
in section 1842(o)(1)(G) is the lower of the average 
sales price calculated including drugs or biologicals 
to which such subsection applies and the average 
sales price that would have been calculated if such 
subsection were not applied.’’. 
(d) EFFECTIVE DATE.—Except as otherwise pro-
vided, the amendments made by this section shall apply 
to drugs furnished on or after January 1, 2008. 
Subtitle B—Extension of Medicare 
Rural Access Protections 
SEC. 621. 2-YEAR EXTENSION OF FLOOR ON MEDICARE 
WORK GEOGRAPHIC ADJUSTMENT. 
Section 1848(e)(1)(E) of such Act (42 U.S.C. 
1395w–4(e)(1)(E)) is amended by striking ‘‘2008’’ and in-
serting ‘‘2010’’. 
SEC. 622. 2-YEAR EXTENSION OF SPECIAL TREATMENT OF 
CERTAIN PHYSICIAN PATHOLOGY SERVICES 
UNDER MEDICARE. 
Section 542(c) of the Medicare, Medicaid, and 
SCHIP Benefits Improvement and Protection Act of 
2000, as amended by section 732 of the Medicare Pre-
scription Drug, Improvement, and Modernization Act of 
2003, and section 104 of the Medicare Improvements and 
Extension Act of 2006 (division B of Public Law 109– 
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432), is amended by striking ‘‘and 2007’’ and inserting 
‘‘2007, 2008, and 2009’’. 
SEC. 623. 2-YEAR EXTENSION OF MEDICARE REASONABLE 
COSTS PAYMENTS FOR CERTAIN CLINICAL 
DIAGNOSTIC 
LABORATORY 
TESTS 
FUR-
NISHED TO HOSPITAL PATIENTS IN CERTAIN 
RURAL AREAS. 
Section 416(b) of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2282; 42 U.S.C. 1395l–4(b)), as 
amended by section 105 of the Medicare Improvement and 
Extension Act of 2006 (division B of Public Law 109– 
432), is amended by striking ‘‘3-year’’ and inserting ‘‘5- 
year’’. 
SEC. 624. 2-YEAR EXTENSION OF MEDICARE INCENTIVE 
PAYMENT PROGRAM FOR PHYSICIAN SCAR-
CITY AREAS . 
(a) IN GENERAL.—Section 1833(u)(1) of the Social 
Security Act (42 U.S.C. 1395l(u)(1)) is amended by strik-
ing ‘‘2008’’ and inserting ‘‘2010’’. 
(b) TRANSITION.—With respect to physicians’ serv-
ices furnished during 2008 and 2009, for purposes of sub-
section (a), the Secretary of Health and Human Services 
shall use the primary care scarcity areas and the specialty 
care scarcity areas (as identified in section 1833(u)(4)) 
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338 
that the Secretary was using under such subsection with 
respect to physicians’ services furnished on December 31, 
2007. 
SEC. 625. 2-YEAR EXTENSION OF MEDICARE INCREASE PAY-
MENTS FOR GROUND AMBULANCE SERVICES 
IN RURAL AREAS. 
Section 1834(l)(13) of the Social Security Act (42 
U.S.C. 1395m(l)(13)) is amended— 
(1) in subparagraph (A)— 
(A) in the matter before clause (i), by 
striking ‘‘furnished on or after July 1, 2004, 
and before January 1, 2007,’’; 
(B) in clause (i), by inserting ‘‘for services 
furnished on or after July 1, 2004, and before 
January 1, 2007, and on or after January 1, 
2008, and before January 1, 2010,’’ after ‘‘in 
such paragraph,’’; and 
(C) in clause (ii), by inserting ‘‘for services 
furnished on or after July 1, 2004, and before 
January 1, 2007,’’ after ‘‘in clause (i),’’; and 
(2) in subparagraph (B)— 
(A) in the heading, by striking ‘‘AFTER 
2006’’ and inserting ‘‘FOR SUBSEQUENT PERI-
ODS’’; 
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339 
(B) by inserting ‘‘clauses (i) and (ii) of’’ 
before ‘‘subparagraph (A)’’; and 
(C) by striking ‘‘in such subparagraph’’ 
and inserting ‘‘in the respective clause’’. 
SEC. 626. EXTENDING HOLD HARMLESS FOR SMALL RURAL 
HOSPITALS UNDER THE HOPD PROSPECTIVE 
PAYMENT SYSTEM. 
Section 1833(t)(7)(D)(i)(II) of the Social Security 
Act (42 U.S.C. 1395l(t)(7)(D)(I)(II)) is amended— 
(1) by striking ‘‘January 1, 2009’’ and insert-
ing ‘‘January 1, 2010’’; 
(2) by striking ‘‘2007, or 2008,’’; and 
(3) by striking ‘‘90 percent, and 85 percent, re-
spectively,’’ and inserting ‘‘, and with respect to 
such services furnished after 2006 the applicable 
percentage shall be 90 percent.’’. 
Subtitle C—End Stage Renal 
Disease Program 
SEC. 631. CHRONIC KIDNEY DISEASE DEMONSTRATION 
PROJECTS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’), acting through the Director of the National In-
stitutes of Health, shall establish demonstration projects 
to— 
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(1) increase public and medical community 
awareness (particularly of those who treat patients 
with diabetes and hypertension) about the factors 
that lead to chronic kidney disease, how to prevent 
it, how to diagnose it, and how to treat it; 
(2) increase screening and use of prevention 
techniques for chronic kidney disease for Medicare 
beneficiaries and the general public (particularly 
among patients with diabetes and hypertension, 
where prevention techniques are well established and 
early detection makes prevention possible); and 
(3) enhance surveillance systems and expand re-
search to better assess the prevalence and incidence 
of chronic kidney disease, (building on work done by 
Centers for Disease Control and Prevention). 
(b) SCOPE AND DURATION.— 
(1) SCOPE.—The Secretary shall select at least 
3 States in which to conduct demonstration projects 
under this section. In selecting the States under this 
paragraph, the Secretary shall take into account the 
size of the population of individuals with end-stage 
renal disease who are enrolled in part B of title 
XVIII of the Social Security Act and ensure the par-
ticipation of individuals who reside in rural and 
urban areas. 
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(2) DURATION.—The demonstration projects 
under this section shall be conducted for a period 
that is not longer than 5 years and shall begin on 
January 1, 2009. 
(c) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall conduct 
an evaluation of the demonstration projects con-
ducted under this section. 
(2) REPORT.—Not later than 12 months after 
the date on which the demonstration projects under 
this section are completed, the Secretary shall sub-
mit to Congress a report on the evaluation con-
ducted under paragraph (1) together with rec-
ommendations for such legislation and administra-
tive action as the Secretary determines appropriate. 
SEC. 632. MEDICARE COVERAGE OF KIDNEY DISEASE PA-
TIENT EDUCATION SERVICES. 
(a) COVERAGE
OF KIDNEY DISEASE EDUCATION 
SERVICES.— 
(1) COVERAGE.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed— 
(A) in subparagraph (Z), by striking 
‘‘and’’ after the semicolon at the end; 
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342 
(B) in subparagraph (AA), by adding 
‘‘and’’ after the semicolon at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(BB) kidney disease education services 
(as defined in subsection (ccc));’’. 
(2) SERVICES
DESCRIBED.—Section 1861 of 
the Social Security Act (42 U.S.C. 1395x) is amend-
ed by adding at the end the following new sub-
section: 
‘‘Kidney Disease Education Services 
‘‘(ccc)(1) The term ‘kidney disease education serv-
ices’ means educational services that are— 
‘‘(A) furnished to an individual with stage IV 
chronic kidney disease who, according to accepted 
clinical guidelines identified by the Secretary, will re-
quire dialysis or a kidney transplant; 
‘‘(B) furnished, upon the referral of the physi-
cian managing the individual’s kidney condition, by 
a qualified person (as defined in paragraph (2)); and 
‘‘(C) designed— 
‘‘(i) to provide comprehensive information 
(consistent with the standards developed under 
paragraph (3)) regarding— 
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‘‘(I) the management of comorbidities, 
including for purposes of delaying the need 
for dialysis; 
‘‘(II) the prevention of uremic com-
plications; and 
‘‘(III) each option for renal replace-
ment therapy (including hemodialysis and 
peritoneal dialysis at home and in-center 
as well as vascular access options and 
transplantation); 
‘‘(ii) to ensure that the individual has the 
opportunity to actively participate in the choice 
of therapy; and 
‘‘(iii) to be tailored to meet the needs of 
the individual involved. 
‘‘(2) The term ‘qualified person’ means a physician, 
physician assistant, nurse practitioner, or clinical nurse 
specialist who furnishes services for which payment may 
be made under the fee schedule established under section 
1848. Such term does not include a renal dialysis facility. 
‘‘(3) The Secretary shall set standards for the con-
tent of such information to be provided under paragraph 
(1)(C)(i) after consulting with physicians, other health 
professionals, health educators, professional organizations, 
accrediting organizations, kidney patient organizations, di-
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344 
alysis facilities, transplant centers, network organizations 
described in section 1881(c)(2), and other knowledgeable 
persons. To the extent possible the Secretary shall consult 
with a person or entity described in the previous sentence, 
other than a dialysis facility, that has not received indus-
try funding from a drug or biological manufacturer or di-
alysis facility. 
‘‘(4) In promulgating regulations to carry out this 
subsection, the Secretary shall ensure that each individual 
who is eligible for benefits for kidney disease education 
services under this title receives such services in a timely 
manner to maximize the benefit of those services. 
‘‘(5) The Secretary shall monitor the implementation 
of this subsection to ensure that individuals who are eligi-
ble for benefits for kidney disease education services re-
ceive such services in the manner described in paragraph 
(4). 
‘‘(6) No individual shall be eligible to be provided 
more than 6 sessions of kidney disease education services 
under this title.’’. 
(3) PAYMENT
UNDER
THE
PHYSICIAN
FEE 
SCHEDULE.—Section 1848(j)(3) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(j)(3)) is amended by 
inserting ‘‘(2)(BB),’’ after ‘‘(2)(AA),’’. 
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345 
(4) LIMITATION ON NUMBER OF SESSIONS.— 
Section 1862(a)(1) of the Social Security Act (42 
U.S.C. 1395y(a)(1)) is amended— 
(A) in subparagraph (M), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (N), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(O) in the case of kidney disease edu-
cation 
services 
(as 
defined 
in 
section 
1861(ccc)), which are furnished in excess of the 
number of sessions covered under such sec-
tion;’’. 
(5) GAO REPORT.—Not later than September 
1, 2010, the Comptroller General of the United 
States shall submit to Congress a report on the fol-
lowing: 
(A) The number of Medicare beneficiaries 
who are eligible to receive benefits for kidney 
disease education services (as defined in section 
1861(ccc) of the Social Security Act, as added 
by paragraph (2)) under title XVIII of such Act 
and who receive such services. 
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(B) The extent to which there is a suffi-
cient amount of physicians, physician assist-
ants, nurse practitioners, and clinical nurse spe-
cialists to furnish kidney disease education serv-
ices (as so defined) under such title and wheth-
er or not renal dialysis facilities (and appro-
priate employees of such facilities) should be in-
cluded as an entity eligible under such section 
to furnish such services. 
(C) Recommendations, if appropriate, for 
renal dialysis facilities (and appropriate employ-
ees of such facilities) to structure kidney dis-
ease education services (as so defined) in a 
manner that is objective and unbiased and that 
provides a range of options and alternative loca-
tions for renal replacement therapy and man-
agement of co-morbidities that may delay the 
need for dialysis. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2009. 
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347 
SEC. 633. REQUIRED TRAINING FOR PATIENT CARE DIALY-
SIS TECHNICIANS. 
Section 1881 of the Social Security Act (42 U.S.C. 
1395rr) is amended by adding the following new sub-
section: 
‘‘(h)(1) Except as provided in paragraph (2), a pro-
vider of services or a renal dialysis facility may not use, 
for more than 12 months during 2009, or for any period 
beginning on January 1, 2010, any individual as a patient 
care dialysis technician unless the individual— 
‘‘(A) has completed a training program in the 
care and treatment of an individual with chronic 
kidney failure who is undergoing dialysis treatment; 
and 
‘‘(B) has been certified by a nationally recog-
nized certification entity for dialysis technicians. 
‘‘(2)(A) A provider of services or a renal dialysis facil-
ity may permit an individual enrolled in a training pro-
gram described in paragraph (1)(A) to serve as a patient 
care dialysis technician while they are so enrolled. 
‘‘(B) The requirements described in subparagraphs 
(A), (B), and (C) of paragraph (1) do not apply to an 
individual who has performed dialysis-related services for 
at least 5 years. 
‘‘(3) For purposes of paragraph (1), if, since the most 
recent completion by an individual of a training program 
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