I 
116TH CONGRESS 
1ST SESSION H. R. 3912 
To amend title XVIII of the Social Security Act to increase awareness, 
expand preventative services, and improve care for individuals with end- 
stage renal disease, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 23, 2019 
Mr. LEWIS (for himself and Mr. BUCHANAN) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to increase 
awareness, expand preventative services, and improve 
care for individuals with end-stage renal 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. 
This Act may be cited as the ‘‘Chronic Kidney Dis-
ease Improvement in Research and Treatment Act’’. 
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TITLE 
I—INCREASING 
AWARE-
NESS, EXPANDING PREVENT-
ATIVE 
SERVICES, 
AND 
IM-
PROVING 
CARE 
COORDINA-
TION 
SEC. 101. 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 
(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); 
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(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, 
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-
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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, 2020. 
SEC. 102. UNDERSTANDING CURRENT UTILIZATION OF PAL-
LIATIVE CARE SERVICES. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States (in this section referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
utilization of palliative care in treating individuals 
with advanced kidney disease, from stage 4 through 
stage 5, including individuals with kidney failure on 
dialysis through any progression of the disease. Such 
study shall include an analysis of— 
(A) how palliative care can be utilized to 
improve the quality of life of those with kidney 
disease and facilitate care tailored to their indi-
vidual goals and values; 
(B) the successful use of palliative care in 
the care of patients with other chronic diseases 
and serious illnesses; 
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(C) the utilization of palliative care at any 
point in an illness, including when used at the 
same time as curative treatment; and 
(D) other areas determined appropriate by 
the Comptroller General. 
(2) DEFINITION OF PALLIATIVE CARE.—In this 
section, the term ‘‘palliative care’’ means patient 
and family centered care that optimizes quality of 
life by anticipating, preventing, and treating suf-
fering. Such term includes care that is furnished 
throughout the continuum of the illness that ad-
dresses physical, intellectual, emotional, social, and 
spiritual needs and that facilitates patient autonomy, 
access to information and choice. 
(b) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Comptroller General shall 
submit to the Congress a report on the study conducted 
under subsection (a), together with such recommendations 
as the Comptroller General determines to be appropriate. 
SEC. 103. IMPROVING ACCESS IN UNDERSERVED 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 ‘‘and in-
cludes renal dialysis services’’ before the period at the end. 
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(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 ‘‘, including 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 ‘‘, including nephrology health professionals’’ 
before the period at the end. 
SEC. 104. IMPROVING CARE COORDINATION FOR DIALYSIS 
PATIENTS. 
(a) HOSPITALS REQUIRED TO PROVIDE INFORMA-
TION.—Section 1881 of the Social Security Act (42 U.S.C. 
1395rr) is amended by adding at the end the following 
new subsection: 
‘‘(i) HOSPITALS REQUIRED TO PROVIDE INFORMA-
TION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a process under which a hospital or a critical ac-
cess hospital shall provide a renal dialysis facility 
with health and treatment information with respect 
to an individual who is discharged from the hospital 
or critical access hospital and who subsequently re-
ceives treatment at facility. 
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‘‘(2) ELEMENTS.—Under the process estab-
lished under paragraph (1)— 
‘‘(A) the request for the health information 
may be initiated by the individual prior to dis-
charge or upon request by the renal dialysis fa-
cility after the patient is discharged; and 
‘‘(B) the information must be provided to 
the facility within 7 days of the request being 
made.’’. 
TITLE II—INCENTIVIZING INNO-
VATION FOR TRULY INNOVA-
TIVE 
NEW 
DRUGS, 
BIOLOGICALS, DEVICES, AND 
OTHER TECHNOLOGIES. 
SEC. 201. MAINTAIN AN ECONOMICALLY STABLE DIALYSIS 
INFRASTRUCTURE. 
(a) IN GENERAL.—Section 1881(b)(14) of the Social 
Security Act (42 U.S.C. 1395rr(b)(14)) is amended— 
(1) in subparagraph (D), in the matter pre-
ceding clause (i), by striking ‘‘Such system’’ and in-
serting ‘‘Subject to subparagraph (J), such system’’; 
and 
(2) by adding at the end the following new sub-
paragraph: 
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‘‘(J) For payment for renal dialysis services 
furnished on or after January 1, 2020, under the 
system under this paragraph— 
‘‘(i) the payment adjustment described in 
clause (i) of subparagraph (D)— 
‘‘(I) shall not take into account 
comorbidities; and 
‘‘(II) shall only take into account age 
for purposes of distinguishing between in-
dividuals who are under 18 years of age 
and those who are 18 years of age and 
older but shall not include any other ad-
justment for age; 
‘‘(ii) the Secretary shall reassess any ad-
justments related to patient weight under such 
clause; 
‘‘(iii) the payment adjustment described in 
clause (ii) of such subparagraph shall not be in-
cluded; 
‘‘(iv) the standardization factor described 
in the final rule published in the Federal Reg-
ister on November 8, 2012 (77 Fed. Reg. 
67470), shall be established using the most cur-
rently available data (and not historical data) 
and adjusted on an annual basis, based on such 
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available data, to account for any change in uti-
lization of drugs and any modification in adjus-
tors applied under this paragraph; and 
‘‘(v) take into account reasonable costs for 
determining the payment rate consistent with 
paragraph (2)(B).’’. 
(b) INCLUSION OF NETWORK FEE AS AN ALLOW-
ABLE COST.—Section 1881(b)(14) of the Social Security 
Act (42 U.S.C. 1395rr(b)(14)), as amended by subsection 
(a), is amended by adding at the end the following new 
subparagraph: 
‘‘(K) Not later than January 1, 2020, the Sec-
retary shall amend the ESRD facility cost report to 
include the per treatment network fee (as described 
in paragraph (7)) as an allowable cost or offset to 
revenue.’’. 
(c) AFFIRMATION OF AVAILABILITY OF BAD DEBT 
REIMBURSEMENT
FOR
NON-COMPOSITE
RATE
SERV-
ICES.— 
(1) REPEAL
OF
MIPPA
BAD
DEBT
RULE
OF 
CONTRUCTION.—Section 153(b)(4) of the Medicare 
Improvements for Patients and Providers Act (42 
U.S.C. 1395rr note) is repealed. 
(2) 
BAD
DEBT
PAYMENTS.—Section 
1881(b)(14) of the Social Security Act (42 U.S.C. 
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1395rr(b)), as amended by subsections (a) and (b), 
is further amended by adding at the end the fol-
lowing new subparagraphs: 
‘‘(L) Notwithstanding any other provision of 
this title, the Secretary shall provide payments for 
any unrecovered amount for any bad debt attrib-
utable to deductible and coinsurance for any item or 
service reimbursed under the system under this 
paragraph or bad debt described in section 
153(b)(4) of the Medicare Improvements for Pa-
tients and Providers Act of 2008. Such payments for 
any unrecovered amount shall be made in addition 
to payments made under such system and such drug 
designation process. 
‘‘(M) The additional payments made under sub-
paragraph (L)— 
‘‘(i) shall not be considered an adjustment 
under subparagraph (D); and 
‘‘(ii) shall not be implemented in a budget 
neutral manner.’’. 
(3) EFFECTIVE DATE.—Paragraph (1) and the 
amendments made by paragraph (2) shall apply to 
payments beginning on January 1, 2020. 
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(d) 
PRODUCTIVITY
ADJUSTMENT.—Section 
1886(b)(3)(B)(xi) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(B)(xi)) is amended— 
(1) in subclause (I), by striking ‘‘For 2012’’ 
and inserting ‘‘Subject to subclause (IV), for 2012’’; 
and 
(2) by adding at the end, the following new sub-
clause: 
‘‘(IV) For 2020 through 2024, 
the productivity adjustment described 
in subclause (II) shall be zero for a 
payment system for any year in which 
the Medicare Payment Advisory Com-
mission 
established 
under 
section 
1805 estimates that payments pro-
vided under such payment system, on 
an aggregate national basis, exceed 
costs, on an aggregate national basis, 
by 3.0 percent or less.’’. 
(e) PAYMENT FOR NEW AND INNOVATIVE DRUGS 
AND BIOLOGICALS THAT ARE RENAL DIALYSIS SERV-
ICES.—Section 1881(b)(14) of the Social Security Act (42 
U.S.C. 1395ww(b)(14)), as amended by subsections (a), 
(b), and (c), is further amended by adding the following 
new subparagraph: 
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‘‘(N) PAYMENT FOR NEW AND INNOVATIVE 
DRUGS, BIOLOGICALS, AND DEVICES THAT ARE 
RENAL DIALYSIS SERVICES.— 
‘‘(i) IN
GENERAL.—For drugs or 
biologicals determined to be within a func-
tional category, the Secretary, in consulta-
tion with stakeholders, shall ensure that 
the single payment amount is adequate to 
cover the cost of new innovative drugs or 
biologicals and increase the single payment 
amount if it is not. The Secretary shall use 
the cost and utilization data collected dur-
ing the two-year transitional period, as set 
forth in the final regulation entitled ‘Medi-
care Program; End-Stage Renal Disease 
Prospective Payment System, Payment for 
Renal Dialysis Services Furnished to Indi-
viduals With Acute Kidney Injury, End- 
Stage Renal Disease Quality Incentive Pro-
gram, Durable Medical Equipment, Pros-
thetics, Orthotics and Supplies (DMEPOS) 
Competitive Bidding Program (CBP) and 
Fee Schedule Amounts, and Technical 
Amendments To Correct Existing Regula-
tions Related to the CBP for Certain 
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DMEPOS’ published on November 14, 
2018 (83 Fed. Reg. 56922 et seq.). 
‘‘(ii) MONEY
TO
FOLLOW
THE
PA-
TIENT.—The Secretary through notice and 
comment rulemaking shall implement a 
policy for any drug or biological that is not 
provided to the average patient that results 
in the amount by which the single payment 
amount is increased pursuant to this 
clause shall be paid only when a provider 
or renal dialysis facility has demonstrated 
that it has administered the drug or bio-
logical to a patient.’’. 
(f) 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 2021 and in con-
sultation with stakeholders, the Secretary of Health and 
Human Services shall establish a process for identifying 
and determining appropriate payment amounts for incor-
porating new devices and technologies into the bundled 
payment under such system. 
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TITLE III—IMPROVING THE AC-
CURACY AND TRANSPARENCY 
OF END-STAGE RENAL DIS-
EASE QUALITY PROGRAMS 
SEC. 301. IMPROVE PATIENT DECISION MAKING AND 
TRANSPARENCY 
BY 
CONSOLIDATING 
AND 
MODERNIZING QUALITY PROGRAMS. 
(a) MEASURES.—Section 1881(h)(2) of the Social 
Security Act (42 U.S.C. 1395rr(h)(2)) is amended— 
(1) by striking subparagraph (A) and inserting 
the following: 
‘‘(A) IN GENERAL.—The measures speci-
fied under this paragraph with respect to the 
year involved shall be selected in consultation 
with stakeholders to promote improvement in 
beneficiary outcomes and shared decision-mak-
ing with beneficiaries and their caregivers. 
When selecting measures specified under this 
paragraph, the Secretary shall take into ac-
count clinical gaps in care, underutilization that 
may lead to beneficiary harm, patient safety, 
and outcomes.’’. 
(2) by adding at the end the following new sub-
paragraphs: 
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‘‘(F) WEIGHTING LIMITATION.—No single 
measure specified by the Secretary or individual 
measure within a composite measure so speci-
fied may be weighted less than 10 percent of 
the total performance score. 
‘‘(G) STATISTICALLY
VALID
AND
RELI-
ABLE.—In specifying measures under subpara-
graph (A), the Secretary shall only specify 
measures that have been shown to be statis-
tically valid and reliable through testing.’’. 
(b) ENDORSEMENT.—Section 1881(h)(2)(B) of the 
Social Security Act (42 U.S.C. 1395rr(h)(2)(B)) is 
amended— 
(1) in clause (ii), by adding at the end the fol-
lowing new sentence: ‘‘The exception under the pre-
ceding sentence shall not apply to a measure that 
the entity with a contract under section 1890(a) (or 
a similar entity) considered but failed to endorse.’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(iii) 
COMPOSITE
MEASURES.— 
Clauses (i) and (ii) shall apply to com-
posite measures in the same manner as 
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such clauses apply to individual meas-
ures.’’. 
(c) REQUIREMENTS FOR DIALYSIS FACILITY COM-
PARE STAR RATING PROGRAM.—Section 1881(h)(6) of 
the Social Security Act (42 U.S.C. 1395rr(h)(6)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(E) REQUIREMENTS FOR ANY DIALYSIS 
FACILITY COMPARE STAR RATING PROGRAM.— 
To the extent that the Secretary maintains a 
dialysis facility compare star rating program, 
under such a program the Secretary shall— 
‘‘(i) assign stars using the same meth-
odology and total performance score re-
sults from the quality incentive program 
under this subsection; 
‘‘(ii) determine the stars using the 
same methodology used under such quality 
incentive program; and 
‘‘(iii) not use a forced bell curve when 
determining the stars or rebaselining the 
stars.’’. 
(d) INCENTIVE PAYMENTS.— 
(1) IN GENERAL.—Section 1881(h)(1) of the 
Social Security Act (42 U.S.C. 1395rr(h)(1)) is 
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amended by adding at the end the following new 
subparagraph: 
‘‘(D) INCENTIVE PAYMENTS.— 
‘‘(i) IN GENERAL.—In the case of a 
provider of services or a renal dialysis fa-
cility that the Secretary determines exceeds 
the attainment performance standards 
under paragraph (4) with respect to a 
year, the Secretary may make a bonus 
payment to the provider or facility (pursu-
ant to a process established by the Sec-
retary). 
‘‘(ii) FUNDING.—The total amount of 
bonus payments under clause (i) in a year 
shall be equal to the total amount of re-
duced payments in a year under subpara-
graph (A). 
‘‘(iii) NO
EFFECT
IN
SUBSEQUENT 
YEARS.—The provisions of subparagraph 
(C) shall apply to a bonus payment under 
this subparagraph in the same manner 
subparagraph (C) applies to a reduction 
under such subparagraph.’’. 
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(2) EFFECTIVE DATE.—The amendments made 
by this section shall apply to items and services fur-
nished on or after January 1, 2020. 
TITLE IV—EMPOWERING 
PATIENTS 
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)— 
(i) in subparagraph (A), by striking 
‘‘is 65’’ and all that follows through the 
period at the end and inserting the fol-
lowing: ‘‘is— 
‘‘(i) 65 years of age or older and is 
enrolled for benefits under part B; or 
‘‘(ii) is 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 
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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, 
2021. 
(b) ADDITIONAL ENROLLMENT PERIOD FOR CER-
TAIN INDIVIDUALS.— 
(1) ONE-TIME ENROLLMENT PERIOD.— 
(A) IN GENERAL.—In the case of an indi-
vidual described in paragraph (2), the Secretary 
of Health and Human Services shall establish a 
one-time enrollment period during which such 
an individual may enroll in any Medicare sup-
plemental policy under section 1882 of the So-
cial Security Act (42 U.S.C. 1395ss) of the in-
dividual’s choosing. 
(B) ENROLLMENT
PERIOD.—The enroll-
ment period established under subparagraph 
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(A) shall begin on January 1, 2021, and shall 
end June 30, 2021. 
(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)); 
(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) 
of section 1882(s) of such Act (42 U.S.C. 
1395ss(s)). 
SEC. 402. ALLOWING INDIVIDUALS WITH KIDNEY FAILURE 
TO RETAIN ACCESS TO PRIVATE INSURANCE. 
(a) IN GENERAL.—Section 1862(b)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend-
ed— 
(1) in the last sentence, by inserting ‘‘and be-
fore January 1, 2020’’ after ‘‘prior to such date’’; 
and 
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(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2020 (with respect to periods 
beginning on or after the date that is 42 months 
prior to such date), clauses (i) and (ii) shall be ap-
plied by substituting ‘42-month’ for ‘12-month’ each 
place it appears.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this subsection shall take effect on the date of enactment 
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 sub-
section (a), an individual who is within the coordinating 
period as of the date of enactment 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 amend-
ment made by subsection (a)(2). 
Æ 
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H3912
tkelley on DSKBCP9HB2PROD with BILLS