IB 
Union Calendar No. 583 
114TH CONGRESS 
2D SESSION 
H. R. 5659 
[Report No. 114–751, Part I] 
To amend title XVIII of the Social Security Act with respect to expanding 
Medicare Advantage coverage for individuals with end-stage renal disease 
(ESRD). 
IN THE HOUSE OF REPRESENTATIVES 
JULY 7, 2016 
Mr. SMITH of Missouri (for himself, Mr. LEWIS, Mr. BILIRAKIS, Mr. SCHRA-
DER, and Mr. MARINO) 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 consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
SEPTEMBER 19, 2016 
Additional sponsors: Mr. HARPER, Mr. ROSKAM, Mr. YOUNG of Indiana, Ms. 
SINEMA, Mr. BARTON, Ms. JENKINS of Kansas, and Ms. LINDA T. 
SA´NCHEZ of California 
SEPTEMBER 19, 2016 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
SEPTEMBER 19, 2016 
The Committee on Energy and Commerce discharged; committed to the Com-
mittee of the Whole House on the State of the Union and ordered to be 
printed 
[For text of introduced bill, see copy of bill as introduced on July 7, 2016] 
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A BILL 
To amend title XVIII of the Social Security Act with respect 
to expanding Medicare Advantage coverage for individ-
uals with end-stage renal disease (ESRD). 
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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 ‘‘Expanding Seniors Re-
ceiving Dialysis Choice Act of 2016’’ or as the ‘‘ESRD 
Choice Act of 2016’’. 
SEC. 2. EXPANDING MEDICARE ADVANTAGE COVERAGE FOR 
INDIVIDUALS WITH END-STAGE RENAL DIS-
EASE (ESRD). 
(a) EXPANDED MA ELIGIBILITY.— 
(1) IN GENERAL.—Section 1851(a)(3) of the So-
cial Security Act (42 U.S.C. 1395w–21(a)(3)) is 
amended— 
(A) by striking subparagraph (B); and 
(B) by striking ‘‘ELIGIBLE
INDIVIDUAL’’ 
and all that follows through ‘‘In this title, subject 
to subparagraph (B),’’ and inserting ‘‘ELIGIBLE 
INDIVIDUAL.—In this title,’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1852(b)(1) of the Social Secu-
rity Act (42 U.S.C. 1395w–22(b)(1)) is amend-
ed— 
(i) by striking subparagraph (B); and 
(ii) by striking ‘‘BENEFICIARIES’’ and 
all 
that 
follows 
through 
‘‘A 
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Medicare+Choice organization’’ and insert-
ing ‘‘BENEFICIARIES.—A Medicare Advan-
tage organization’’. 
(B) Section 1859(b)(6) of the Social Secu-
rity Act (42 U.S.C. 1395w–28(b)(6)) is amended 
by striking ‘‘may waive’’ and all that follows 
through ‘‘subparagraph and’’. 
(b) EXCLUDING COSTS
FOR KIDNEY ACQUISITIONS 
FROM MA BENCHMARK.—Section 1853 of the Social Secu-
rity Act (42 U.S.C. 1395w–23) is amended— 
(1) in subsection (k)— 
(A) in paragraph (1)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘paragraphs (2) and 
(4)’’ and inserting ‘‘paragraphs (2), (4), 
and (5)’’; and 
(ii) in subparagraph (B)(i), by strik-
ing ‘‘paragraphs (2) and (4)’’ and inserting 
‘‘paragraphs (2), (4), and (5)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) EXCLUSION OF COSTS FOR KIDNEY ACQUISI-
TIONS FROM CAPITATION RATES.—After determining 
the applicable amount for an area for a year under 
paragraph (1) (beginning with 2019), the Secretary 
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shall adjust such applicable amount to exclude from 
such applicable amount the Secretary’s estimate of the 
standardized costs for payments for organ acquisi-
tions for kidney transplants covered under this title 
(including expenses covered under section 1881(d)) in 
the area for the year.’’; and 
(2) in subsection (n)(2)— 
(A) in subparagraph (A)(i), by inserting 
‘‘and, for 2019 and subsequent years, the exclu-
sion of payments for organ acquisitions for kid-
ney transplants from the capitation rate as de-
scribed in subsection (k)(5)’’ before the semicolon 
at the end; 
(B) in subparagraph (E), in the matter 
preceding clause (i), by striking ‘‘subparagraph 
(F)’’ and inserting ‘‘subparagraphs (F) and 
(G)’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(G) APPLICATION
OF
KIDNEY
ACQUISI-
TIONS ADJUSTMENT.—The base payment amount 
specified in subparagraph (E) for a year (begin-
ning with 2019) shall be adjusted in the same 
manner under paragraph (5) of subsection (k) as 
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the applicable amount is adjusted under such 
subsection.’’. 
(c) FFS COVERAGE OF KIDNEY ACQUISITIONS.— 
(1) IN
GENERAL.—Section 1852(a)(1)(B)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395w– 
22(a)(1)(B)(i)) is amended by inserting ‘‘or coverage 
for organ acquisitions for kidney transplants, includ-
ing as covered under section 1881(d)’’ after ‘‘hospice 
care’’. 
(2) CONFORMING AMENDMENT.—Section 1851(i) 
of the Social Security Act (42 U.S.C. 1395w–21(i)) is 
amended by adding at the end the following new 
paragraph: 
‘‘(3) FFS PAYMENT FOR EXPENSES FOR KIDNEY 
ACQUISITIONS.—Paragraphs (1) and (2) do not apply 
with respect to expenses for organ acquisitions for 
kidney 
transplants 
described 
in 
section 
1852(a)(1)(B)(i).’’. 
(d) SENSE OF CONGRESS REGARDING APPLICATION OF 
APPROPRIATE MEDICARE ADVANTAGE RISK ADJUSTMENT 
FOR PAYMENT FOR INCREASED ESRD ENROLLEES.—It is 
the sense of Congress that in implementing the policies 
under this section, the Centers for Medicare & Medicaid 
Services should provide, in an accurate and transparent 
manner, for risk adjustment to payment under the Medicare 
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Advantage program to account for the increased enrollment 
in Medicare Advantage plans of individuals with end-stage 
renal disease. 
(e) 
EXPANDED
MA 
EDUCATION.—Section 
1851(d)(2)(A)(iii) of the Social Security Act (42 U.S.C. 
1395w–21(d)(2)(A)(iii)) is amended by inserting before the 
period at the end the following: ‘‘, including any additional 
information that individuals determined to have end-stage 
renal disease may need to make informed decisions with 
respect to such an election’’. 
(f) REPORT.—Not later than April 1, 2022, the Ad-
ministrator of the Centers for Medicare & Medicaid Services 
shall submit to Congress a report on the impact of the 
amendments made by this section on spending under the 
traditional Medicare fee-for-service program under parts A 
and B of title XVIII of the Social Security Act as well as 
on spending under parts C and D of such title. The report 
shall include an assessment of the risk adjustment payment 
methodologies under such parts C and D and their ade-
quacy with respect to individuals with end-stage renal dis-
ease and such recommendations as the Administrator deems 
appropriate. 
(g) EFFECTIVE DATE.—The amendments made by this 
section shall apply to plans years beginning on or after 
January 1, 2020. 
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Union Calendar No. 583 
114TH CONGRESS 
2D SESSION 
H. R. 5659 
[Report No. 114–751, Part I] 
A BILL 
To amend title XVIII of the Social Security Act 
with respect to expanding Medicare Advantage 
coverage for individuals with end-stage renal dis-
ease (ESRD). 
SEPTEMBER 19, 2016 
Reported from the Committee on Ways and Means with 
an amendment 
SEPTEMBER 19, 2016 
The Committee on Energy and Commerce discharged; 
committed to the Committee of the Whole House on 
the State of the Union and ordered to be printed 
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