TITLE 
II—PROVIDING 
ACCESS 
TO PATIENTS IN NEED OF DI-
ALYSIS TREATMENT 
SEC. 201. SURVEY REQUIREMENTS FOR RENAL DIALYSIS 
FACILITIES. 
Section 1864 of the Social Security Act (42 U.S.C. 
1395aa) is amended— 
(1) by redesignating subsection (e) as sub-
section (f) and by inserting after subsection (d) the 
following new subsection: 
‘‘(e)(1) If the Secretary has entered into an agree-
ment with any State under this section under which the 
appropriate State or local agency that performs any sur-
vey related to determining the compliance of a renal dialy-
sis facility subject to the requirements of section 1881(b) 
and the State licensure survey requirements are consistent 
with or exceed such Federal requirements, the Secretary 
must accept the results of the State licensure survey for 
purposes of determining Federal certification of compli-
ance. In the case of such an initial survey of a renal dialy-
sis facility, the Secretary may allow any State to waive 
the reimbursement for conducting the survey under this 
subsection if it requests such a waiver. 
‘‘(2) In the case of a renal dialysis facility that has 
waited for more than 6 months to receive the results of 
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an initial survey under this section, the Secretary shall 
establish a specific timetable for completing and reporting 
the results of the survey.’’; 
(2) in subsection (f), as so redesignated— 
(A) by striking ‘‘Notwithstanding any 
other provision of law,’’ and inserting ‘‘(1) Not-
withstanding any other provision of law and ex-
cept as provided in paragraph (2)’’; and 
(B) by adding at the end the following: 
‘‘(2) The Secretary may assess and collect fees for 
the initial Medicare survey from a renal dialysis facility 
subject to the requirements of section 1881(b) in an 
amount not to exceed a reasonable fee necessary to cover 
the costs of initial surveys conducted for purposes of deter-
mining the compliance of a renal dialysis facility with the 
requirements of section 1881(b). Fees may be assessed 
and collected under this paragraph only in such manner 
as would result in an aggregate amount of fees collected 
during any fiscal year which equals the aggregate amount 
of costs for such fiscal year for initial surveys of such fa-
cilities under this section. A renal dialysis facility’s liabil-
ity for such fees shall be reasonably based on the propor-
tion of the survey costs which relate to such facility. Any 
funds collected under this paragraph shall be used only 
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to conduct the initial survey of the facilities providing the 
fees. 
‘‘(3) Fees authorized under paragraph (2) shall be 
collected by the Secretary and available only to the extent 
and in the amount provided in advance in appropriations 
Acts and upon request of the Secretary, subject to the 
amount and usage limitations of such paragraph. Such 
fees so collected are authorized to remain available until 
expended.’’. 
SEC. 202. GAO STUDY ON TRANSPORTATION BARRIERS TO 
ACCESSING KIDNEY CARE. 
(a) IN GENERAL.—The Comptroller General of the 
United States shall conduct an evaluation of the transpor-
tation barriers facing dialysis patients that result in less 
than 100 percent compliance with their plan of care under 
the Medicare program. 
(b) SPECIFIC MATTERS EVALUATED.—In conducting 
the evaluation under subsection (a), the Comptroller Gen-
eral shall examine— 
(1) the costs associated with providing dialysis 
services; 
(2) the number and characteristics of patients 
who miss at least 2 dialysis treatments during a 
month or have shortened treatments because of bar-
riers to transportation; and 
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(3) the potential sources of providing dialysis 
patients with such transportation services. 
(c) REPORT.—Not later than the date that is 6 
months after the date of the enactment of this Act, the 
Comptroller General shall submit to Congress a report on 
the study conducted under subsection (a) together with 
recommendations for such legislation and administrative 
action as the Comptroller General determines appropriate. 
SEC. 203. VASCULAR ACCESS CARE SERVICE SITES. 
Not later than 1 year after the date of the enactment 
of this Act, the Secretary of Health and Human Services 
shall report and provide recommendations to the Congress 
on the benefits of recognizing dialysis vascular and peri-
toneal dialysis access care service sites for purposes of re-
ceiving reimbursement under the Medicare program. 
TITLE III—ELIMINATING INEQUI-
TIES 
FOR 
PATIENTS 
WITH 
KIDNEY FAILURE 
SEC. 301. PATIENT CHOICE OF PRIMARY INSURER. 
(a) PROVIDING PATIENT CHOICE IN MEDICARE.— 
(1) IN GENERAL.—Section 1862(b)(1)(C) of the 
Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is 
amended— 
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(A) in the last sentence, by inserting ‘‘and 
before January 1, 2011’’ after ‘‘prior to such 
date)’’; and 
(B) by adding at the end the following new 
sentence: ‘‘Effective for items and services fur-
nished on or after January 1, 2011 (with re-
spect to periods beginning on or after the date 
that is 42 months prior to such date), clauses 
(i) and (ii) shall be applied by substituting ‘42- 
month’ for ‘12-month ’each place it appears in 
the first sentence.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on the date of en-
actment of this Act. For purposes of determining an 
individual’s status under section 1862(b)(1)(C) of 
the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), 
as amended by paragraph (1), an individual who is 
within the coordinating period as of the date of en-
actment of this Act shall have that period extended 
to the full 42 months described in the last sentence 
of such section, as added by the amendment made 
by paragraph (1)(B). 
(b) APPLICATION OF RULES TO QUALIFIED HEALTH 
PLANS
AND
INDIVIDUAL
HEALTH
INSURANCE
COV-
ERAGE.—Such section is further amended, in the matter 
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