I 
118TH CONGRESS 
1ST SESSION H. R. 5027 
To improve the understanding of, and promote access to treatment for, 
chronic kidney disease, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 27, 2023 
Mrs. MILLER of West Virginia (for herself and Ms. SEWELL) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
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; TABLE OF CONTENTS. 
This Act may be cited as the ‘‘Chronic Kidney Dis-
ease Improvement in Research and Treatment Act of 
2023’’. 
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TITLE I—PREVENTING KIDNEY 
DISEASE 
AND 
EXPANDING 
AWARENESS AND EDUCATION 
SEC. 101. EXPANDING MEDICARE ANNUAL WELLNESS BEN-
EFIT TO INCLUDE KIDNEY DISEASE SCREEN-
ING. 
(a) IN GENERAL.—Section 1861(ww)(2) of the Social 
Security Act (42 U.S.C. 1395x(ww)(2)) is amended— 
(1) by redesignating subparagraph (O) as sub-
paragraph (P); and 
(2) by inserting after subparagraph (N) the fol-
lowing new subparagraph: 
‘‘(O) Chronic kidney disease screening as 
defined by the Secretary.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section apply to items and services furnished on or 
after January 1, 2022. 
SEC. 102. INCREASING ACCESS TO MEDICARE KIDNEY DIS-
EASE EDUCATION BENEFIT. 
(a) IN GENERAL.—Section 1861(ggg) of the Social 
Security Act (42 U.S.C. 1395x(ggg)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A), by inserting ‘‘or 
stage V’’ after ‘‘stage IV’’; and 
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(B) in subparagraph (B), by inserting ‘‘or 
of a physician assistant, nurse practitioner, or 
clinical nurse specialist (as defined in section 
1861(aa)(5)) assisting in the treatment of the 
individual’s kidney condition’’ after ‘‘kidney 
condition’’; and 
(2) in paragraph (2)— 
(A) by striking subparagraph (B); and 
(B) in subparagraph (A)— 
(i) by striking ‘‘(A)’’ after ‘‘(2)’’; 
(ii) by striking ‘‘and’’ at the end of 
clause (i); 
(iii) by striking the period at the end 
of clause (ii) and inserting ‘‘; and’’; 
(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, 
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nurse practitioner, or clinical nurse spe-
cialist (as defined in subsection (aa)(5)).’’. 
(b) PAYMENT TO RENAL DIALYSIS FACILITIES.— 
Section 1881(b) of the Social Security Act (42 U.S.C. 
1395rr(b)) is amended by adding at the end the following 
new paragraph: 
‘‘(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.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section apply to kidney disease education services fur-
nished on or after January 1, 2022. 
TITLE II—INCENTIVIZING 
KIDNEY CARE INNOVATION 
SEC. 201. REFINING THE END-STAGE RENAL DISEASE PAY-
MENT SYSTEM TO IMPROVE ACCURACY IN 
PAYMENT AND SUPPORT THERAPIES. 
(a) IN GENERAL.—Section 1881(b)(14) of the Social 
Security Act (42 U.S.C. 1395ww(b)(14)) is amended by 
adding the following new subparagraph: 
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‘‘(J) PAYMENT FOR NEW AND INNOVATIVE 
DRUGS, BIOLOGICALS, AND DEVICES THAT ARE 
RENAL DIALYSIS SERVICES.— 
‘‘(i) IN
GENERAL.—For drugs or 
biologicals defined as within a functional 
category and furnished on or after Janu-
ary 1, 2024, the Secretary shall implement 
an add-on adjustment for claims that in-
clude such drugs or biologicals that, among 
other things, shall— 
‘‘(I) calculate a per-treatment 
cost using the most recent cost and 
utilization data collected during a 
transitional payment period of not less 
than 3 years by dividing the total 
spending for such drug or biological 
during such transitional period by the 
total number of treatments for which 
such drug or biological was listed on 
such claim during such period of time; 
‘‘(II) offset the amount of the 
add-on adjustment by an amount that 
corresponds with the reduction in ex-
penditures for other formerly sepa-
rately billed renal dialysis drugs that 
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were directly the result of the inclu-
sion of the new product; 
‘‘(III) update the add-on adjust-
ment annually to account for infla-
tionary changes; and 
‘‘(IV) be applied immediately 
upon the expiration of the TDAPA 
period for a product to avoid a gap 
between the TDAPA and availability 
of the post-TDAPA add-on adjust-
ment. 
‘‘(ii) IMPLEMENTATION.—This policy 
shall not be implemented in a budget neu-
tral manner.’’. 
(b) NEW DEVICES AND OTHER TECHNOLOGIES.—As 
part of the promulgation of the annual rule for the Medi-
care end-stage renal disease prospective payment system 
under section 1881(b)(14) of the Social Security Act (42 
U.S.C. 1395rr(b)(14)) for calendar year 2022, and in con-
sultation with stakeholders, the Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall ensure that the single payment amount is 
adequate to cover the cost of the new innovative device 
or other technology with substantial clinical improvement 
and increase the single payment amount if the Secretary 
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determines such payment amount is not adequate to cover 
such cost. In carrying out the preceding sentence, the Sec-
retary shall use the cost and utilization data collected dur-
ing a 3-year transitional payment period, as otherwise de-
scribed in the final regulation published on November 9, 
2020 (85 Fed. Reg. 71398 et seq.). 
SEC. 202. ENSURING MEDICARE ADVANTAGE SUPPORTS 
KIDNEY CARE INNOVATIVE THERAPIES. 
Section 1853(c) of the Social Security Act (42 U.S.C. 
1395ww–23(c)) is amended by adding the following new 
paragraph: 
‘‘(8) ADJUSTMENT FOR INNOVATIVE PRODUCTS 
FOR
ENROLLES
WITH
END
STAGE
RENAL
DIS-
EASE.—If the Secretary makes a determination with 
respect to the application of the End Stage Renal 
Disease Transitional Drug Add-On Payment Adjust-
ment or the Transitional Add-on Payment Adjust-
ment for New and Innovative Equipment and Sup-
plies to a product under this title that will result in 
an increase in the costs to Medicare+Choice of pro-
viding benefits under contracts under this part for 
the period of the Transitional Drug Add-On Pay-
ment Adjustment or the Transitional Add-on Pay-
ment Adjustment for New and Innovative Equip-
ment and Supplies, the Secretary shall directly make 
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the payments adjustments to providers of services or 
independent dialysis facilities consistent with the ap-
plication of such adjustments under the ESRD pro-
spective 
payment 
system 
outlined 
in 
section 
1881(b)(14) of this title for the complete duration 
that the adjustment applies under such section. 
After the duration of such adjustment, the Secretary 
shall adjust appropriately the payments to such or-
ganizations under this part. 
‘‘(9) POST-TDAPA PAYMENT ADD-ON ADJUST-
MENT.—The Secretary shall require providers of 
services or independent dialysis facilities to apply the 
adjustment required under subparagraph (J) of sec-
tion 1881(b)(14) to payments made under this 
part.’’. 
SEC. 203. IMPROVING PATIENT LIVES AND QUALITY OF 
CARE THROUGH RESEARCH AND INNOVA-
TION. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
shall conduct a study on increasing kidney transplantation 
rates. Such study shall include an analysis of each of the 
following: 
(1) Any disincentives in the payment systems 
under the Medicare program under title XVIII of 
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the Social Security Act (42 U.S.C. 1395 et seq.) 
that create barriers to kidney transplants and post- 
transplant care for beneficiaries with end-stage renal 
disease. 
(2) The practices used by States with higher 
than average donation rates and whether those prac-
tices and policies could be successfully utilized in 
other States. 
(3) Practices and policies that could increase 
deceased donation rates of minority populations. 
(4) Whether cultural and policy barriers exist to 
increasing living donation rates, including an exam-
ination of how to better facilitate chained donations. 
(5) Other areas determined appropriate by the 
Secretary. 
(b) REPORT.—Not later than 18 months after the 
date of the enactment of this Act, the Secretary shall sub-
mit to Congress a report on the study conducted under 
subsection (a), together with such recommendations as the 
Secretary determines to be appropriate. 
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TITLE 
III—ADDRESSING 
THE 
KIDNEY 
CARE 
WORKFORCE 
CRISIS 
SEC. 301. ENSURING ACCURACY AND STABILITY IN KIDNEY 
CARE PAYMENT. 
Section 1881(b)(14) of the Social Security Act (42 
U.S.C. 1395ww(b)(14)) is amended by adding the fol-
lowing new subparagraph: 
‘‘(K) Beginning with calendar year 2024, 
the Secretary shall compute an adjustment to 
the annual update of the previous calendar 
year’s rate to account for forecast error. The 
initial adjustment (in calendar year 2024) to 
the update of the previous calendar year’s rate 
will take into account the cumulative forecast 
error between calendar years 2021 and 2022. 
Subsequent adjustments in succeeding fiscal 
years will take into account the forecast error 
from the most recently available calendar year 
for which there is final data. The forecast error 
adjustment shall apply whenever the difference 
between the forecasted and actual percentage 
change in the ESRD market basket index ex-
ceeds the threshold of 0.5 percentage points.’’. 
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SEC. 302. ENCOURAGING KIDNEY CARE WORKFORCE IN 
UNDER SERVED 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. 
TITLE IV—EXPANDING PATIENT 
CHOICE OF COVERAGE 
SEC. 401. MEDIGAP COVERAGE FOR BENEFICIARIES WITH 
END-STAGE RENAL DISEASE. 
(a) GUARANTEED AVAILABILITY OF MEDIGAP POLI-
CIES TO ALL ESRD MEDICARE BENEFICIARIES.— 
(1) IN GENERAL.—Section 1882(s) of the So-
cial Security Act (42 U.S.C. 1395ss(s)) is amend-
ed— 
(A) in paragraph (2)— 
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(i) in subparagraph (A), by striking 
‘‘is 65’’ and all that follows through the 
period and inserting the following: ‘‘is— 
‘‘(i) 65 years of age or older and is 
enrolled for benefits under part B; or 
‘‘(ii) 
entitled 
to 
benefits 
under 
226A(b) and is enrolled for benefits under 
part B.’’; and 
(ii) in subparagraph (D), in the mat-
ter preceding clause (i), by inserting ‘‘(or 
is entitled to benefits under 226A(b))’’ 
after ‘‘is 65 years of age or older’’; and 
(B) in paragraph (3)(B)— 
(i) in clause (ii), by inserting ‘‘(or is 
entitled to benefits under 226A(b))’’ after 
‘‘is 65 years of age or older’’; and 
(ii) in clause (vi), by inserting ‘‘(or 
under 226A(b))’’ after ‘‘at age 65’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to Medicare supple-
mental policies effective on or after January 1, 
2022. 
(b) ADDITIONAL ENROLLMENT PERIOD FOR CER-
TAIN INDIVIDUALS.— 
(1) ONE-TIME ENROLLMENT PERIOD.— 
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(A) IN GENERAL.—In the case of an indi-
vidual described in subparagraph (B), the Sec-
retary of Health and Human Services shall es-
tablish a one-time enrollment period during 
which such an individual may enroll in any 
Medicare supplemental policy under section 
1882 of the Social Security Act (42 U.S.C. 
1395ss) of the individual’s choosing. 
(B) ENROLLMENT
PERIOD.—The enroll-
ment period established under subparagraph 
(A) shall begin on January 1, 2023, and shall 
end June 30, 2023. 
(2) INDIVIDUAL DESCRIBED.—An individual de-
scribed in this paragraph is an individual who— 
(A) is entitled to hospital insurance bene-
fits under part A of title XVIII of the Social 
Security Act under section 226A(b) of such Act 
(42 U.S.C. 426–1); 
(B) is enrolled for benefits under part B of 
such title XVIII; and 
(C) would not, but for the provisions of, 
and amendments made by, subsection (a) be eli-
gible for the guaranteed issue of a Medicare 
supplemental policy under paragraph (2) or (3) 
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of section 1882(s) of such Act (42 U.S.C. 
1395ss(s)). 
Æ 
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