‘‘(III) elect a preferred network 
model offered by the same or different 
Organization. 
‘‘(C) ADDITIONAL OPT-IN POPULATION IN 
CASE
OF
BENEFICIARY
RELOCATION
OR 
CHOICE.—An individual who, without applica-
tion of clause (iv) of subsection (a)(2)(C), 
would be treated as a Program-eligible bene-
ficiary, may elect to enroll in an Organization 
under the Program under this section if such 
individual agrees to receive renal dialysis serv-
ices primarily from a facility that participates 
in such Organization. For purposes of this sec-
tion (other than subparagraphs (A) and (B) of 
this paragraph, paragraph (2), and subsection 
(d)), an individual making an election pursuant 
to the previous sentence shall be treated as a 
Program-eligible beneficiary. 
‘‘(D) DEEMED RE-ENROLLMENT.—A Pro-
gram-eligible beneficiary assigned under this 
paragraph to an ESRD Integrated Care Model 
offered by an Organization with respect to a 
year is deemed, unless the individual elects oth-
erwise under this paragraph, to have elected to 
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continue such assignment with respect to the 
subsequent year. 
‘‘(E) ADDITIONAL OPPORTUNITY TO OPT 
OUT OR ELECT DIFFERENT MODEL OR ORGANI-
ZATION.—On the date that is one year after the 
effective date of the initial assignment of a Pro-
gram-eligible beneficiary to an open network 
model offered by an Organization (and annually 
thereafter), a Program-eligible beneficiary shall 
be given the opportunity to— 
‘‘(i) opt out of the Program; 
‘‘(ii) make a one-time change of as-
signment into an open network model of-
fered by a different Organization; or 
‘‘(iii) elect a preferred network model 
offered by the same or different Organiza-
tion. 
‘‘(F) CHANGE
IN
PRINCIPAL
DIAGNOSIS 
OPT OUT.—In addition to any other period dur-
ing which a Program-eligible beneficiary may, 
pursuant to this paragraph, opt out of the Pro-
gram, in the case of a Program-eligible bene-
ficiary who, after assignment under this para-
graph, is diagnosed with a principal diagnosis 
(as defined by the Secretary) other than end- 
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stage renal disease, such individual shall be 
given the opportunity to opt out of the Program 
during such period as specified by the Sec-
retary. 
‘‘(G) SPECIAL
ELECTION
PERIODS.—The 
Secretary shall offer Program-eligible bene-
ficiaries special election periods consistent with 
those described in section 1851(e)(4). 
‘‘(2) PROGRAM-ELIGIBLE BENEFICIARY NOTIFI-
CATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
notify Program-eligible beneficiaries about the 
Program under this section and provide them 
with information about receiving benefits under 
this title through an Organization. 
‘‘(B) 
REQUIREMENTS.—Notwithstanding 
any other provision of law, subject to subpara-
graph (C), such notification shall allow for eligi-
ble participating providers that are part of an 
Organization to— 
‘‘(i) inform Program-eligible bene-
ficiaries about the Program; 
‘‘(ii) distribute Program materials to 
Program-eligible beneficiaries; and 
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‘‘(iii) assist Program-eligible bene-
ficiaries in assessing the options of such 
beneficiaries under the Program. 
‘‘(C) LIMITATION ON UNSOLICITED MAR-
KETING.— 
‘‘(i) IN
GENERAL.—Under the Pro-
gram, an eligible participating provider 
may not provide marketing information or 
materials, including information, materials, 
and assistance described in subparagraph 
(B), to a Program-eligible beneficiary un-
less the Program-eligible beneficiary re-
quests such marketing information or ma-
terials. 
‘‘(ii) EXCEPTION
FOR
PROVIDERS 
TREATING
BENEFICIARIES.—An 
eligible 
participating provider that is part of an 
Organization may provide information, ma-
terials, and assistance described in sub-
paragraph (B) to a Program-eligible bene-
ficiary, without prior request of such bene-
ficiary, if such beneficiary is receiving 
renal dialysis services from such provider. 
‘‘(iii) PARITY IN MARKETING.—In any 
case that an Organization participates in 
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any form of marketing, such form of mar-
keting shall be the same for all Program- 
eligible beneficiaries to which, pursuant to 
(ii), the Organization may provide informa-
tion, materials, and assistance described in 
such clause. 
‘‘(3) PROGRAM-ELIGIBLE BENEFICIARY APPEAL 
RIGHTS.—Program-eligible beneficiaries enrolled in 
an Organization shall have the same right to appeal 
any denial of benefits under this title as such a Pro-
gram-eligible beneficiary would have under this title 
if such Program-eligible beneficiary were not so en-
rolled. 
‘‘(f) PAYMENT.— 
‘‘(1) IN GENERAL.—For each Program-eligible 
beneficiary receiving care through an Organization, 
the Secretary shall make a monthly capitated pay-
ment in accordance with payment rates that would 
be determined under section 1853(a)(1)(H), as ad-
justed pursuant to paragraph (2). 
‘‘(2) APPLICATION
OF
HEALTH
STATUS
RISK 
ADJUSTMENT METHODOLOGY.—The Secretary shall 
adjust the payment amount to an Organization 
under this subsection in the same manner in which 
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the payment amount to a Medicare Advantage plan 
is adjusted under section 1853(a)(1)(C). 
‘‘(3) TREATMENT
OF
KIDNEY
ACQUISITION 
COSTS.— 
‘‘(A) EXCLUDING COSTS FOR KIDNEY AC-
QUISITIONS FROM MA BENCHMARK.—The Sec-
retary shall adjust the payment amount to an 
Organization to exclude from such payment 
amount the Secretary’s estimate of the stand-
ardized costs for payments for organ acquisi-
tions for kidney transplants in the area involved 
for the year. 
‘‘(B) FFS CONVERGE OF KIDNEY ACQUISI-
TIONS.—An Organization shall provide all bene-
fits described in subclause (I) of subsection 
(b)(2)(A)(i), except for kidney acquisition costs. 
Payment for kidney acquisition costs covered 
under this title furnished to a Program-eligible 
beneficiary shall be made in accordance with 
this title and in such amounts as would other-
wise be made and determined for such items 
and services provided to such a beneficiary not 
enrolled under the Program. 
‘‘(4) PAYMENT FOR PART D BENEFITS.—In the 
case where an Organization elects to offer part D 
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prescription drug coverage under the Program under 
this section, payments to the Organization for such 
benefits provided to Program-eligible beneficiaries by 
the Organization shall be made in the same manner 
and amounts as those payments would be made in 
the case of an organization with a contract under 
such part. 
‘‘(5) AGREEMENT
WITH
STATE
MEDICAID 
AGENCY.—In the event of an Organization that 
elects to cover benefits under title XIX for Program- 
eligible beneficiaries eligible for benefits under this 
title and title XIX such Organization shall enter into 
an agreement with the State Medicaid agency to 
provide benefits, or arrange for benefits to be pro-
vided, for which such beneficiaries are entitled to re-
ceive medical assistance under title XIX and to re-
ceive payment from the State for providing or ar-
ranging for the provision of such benefits. 
‘‘(6) AFFIRMATION OF STATE OBLIGATIONS TO 
PAY PREMIUM AND COST-SHARING AMOUNTS.— 
‘‘(A) IN GENERAL.—A State shall continue 
to make medical assistance under the State 
plan under title XIX available in the amount 
described in subparagraph (B) for the duration 
of the Program for cost-sharing (as defined in 
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section 1905(p)(3)) under this title for qualified 
medicare beneficiaries described in section 
1905(p)(1) and other individuals who are Pro-
gram-eligible beneficiaries enrolled in an Orga-
nization and entitled to medical assistance for 
premiums and such cost-sharing under the 
State plan under title XIX. 
‘‘(B) AMOUNTS
MADE
AVAILABLE
FOR 
COST-SHARING.—For purposes of subparagraph 
(A): 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the amount of medical assistance de-
scribed in this clause to be made available 
for cost-sharing pursuant to subparagraph 
(A) for an individual described in such 
subparagraph entitled to medical assist-
ance for such cost-sharing under a State 
plan under title XIX shall be equal to the 
amount of medical assistance that would 
be made available under such State plan as 
in effect as of January 1, 2016. 
‘‘(ii) AMOUNTS
IN
THE
CASE
OF
A 
STATE
THAT
INCREASES
PAYMENTS
FOR 
COST-SHARING.—If a State increases the 
amount of medical assistance made avail-
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able under the State plan under title XIX 
for cost-sharing described in subparagraph 
(A) after such date, such increased 
amounts shall be made available under 
subparagraph (A) for the remaining dura-
tion of the Program. 
‘‘(g) WAIVER AUTHORITY.— 
‘‘(1) IN GENERAL.—In order to carry out the 
Program under this section, the Secretary shall 
waive those requirements waived under section 1899 
and may waive such additional requirements con-
sistent with those waived under programs adminis-
tered through the Center for Medicare and Medicaid 
Innovation as may be necessary. 
‘‘(2) NOTICE OF WAIVERS.—Not later than 3 
months after the date of enactment of this section, 
the Secretary shall publish a notice of waivers that 
will apply in connection with the Program. The no-
tice shall include the specific conditions that an Or-
ganization must meet to qualify for each waiver, and 
commentary explaining the waiver requirements. 
‘‘(h) REPORT.—Not later than December 31, 2024, 
the Medicare Payment Advisory Commission shall submit 
to Congress an interim report on the Program.’’. 
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(b) CONFORMING AMENDMENT RELATING TO BAL-
ANCED BILLING.—Section 1866(a)(1)(O) of the Social Se-
curity Act (42 U.S.C. 1395cc(a)(1)(O)) is amended— 
(1) by inserting ‘‘with an ESRD Integrated 
Care Organization under section 1866F,’’ after 
‘‘with a PACE provider under section 1894 or 
1934,’’; 
(2) by inserting ‘‘or ESRD Integrated Care Or-
ganization’’ after ‘‘in the case of a PACE provider’’; 
(3) by striking ‘‘or PACE program eligible indi-
viduals enrolled with the PACE provider’’ and in-
serting ‘‘, Program-eligible beneficiaries enrolled in 
the ESRD Integrated Care Organization, or PACE 
program eligible individuals enrolled with the PACE 
provider’’; and 
(4) by inserting ‘‘(or in the case of a Program- 
eligible beneficiary enrolled in the ESRD Integrated 
Care Organization, the amounts that would be made 
in accordance with payment rates that would be de-
termined under section 1853(a)(1)(H))’’ after ‘‘the 
amounts that would be made’’. 
(c) EXTENSION
OF GUARANTEED ISSUE RIGHTS 
UNDER MEDIGAP.— 
(1) IN GENERAL.—Section 1882(s)(3)(B) of the 
Social Security Act (42 U.S.C. 1395ss(s)(3)(B)) is 
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amended by adding at the end the following new 
clause: 
‘‘(vii) The individual is participating 
in the demonstration program established 
under section 1866F, regardless of the du-
ration of the individual’s participation in 
the program and regardless of any pre-
vious enrollment in, or disenrollment from, 
a medicare supplemental policy under this 
section.’’. 
(2) NOTIFICATION.—The Secretary of Health 
and Human Services shall develop a process to no-
tify (and shall notify) individuals described in clause 
(vii) of section 1882(s)(3)(B) of the Social Security 
Act (42 U.S.C. 1395ss(s)(3)(B)), as added by para-
graph (1), of their guaranteed issue rights under 
such section. 
Æ 
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