Title: To amend title XVIII of the Social Security Act to create care management demonstration programs for chronic kidney disease under the Medicare program, and for other purposes.
Policy area: Health

Summary:
This bill amends title XVIII (Medicare) of the Social Security Act to establish two care-management demonstration programs for chronic kidney disease (CKD) under the Medicare program: (1) the CKD Early Detection and Treatment Demonstration Program, and (2) the Demonstration Program for Advanced CKD. A practitioner's participation in either program shall be optional.
Through each program, the Centers for Medicare & Medicaid Services (CMS) shall provide to an enrollee's participating primary-care practitioner a single, monthly, performance-based payment for covered CKD care-management services furnished to the enrollee. The amount of this payment shall be greater than the amount that the practitioner would otherwise have received under Medicare for furnishing such services to the enrollee.  The CMS shall specify applicable performance measures, in accordance with clinical guidelines.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3867 Introduced in House (IH)]

<DOC>






115th CONGRESS
  1st Session
                                H. R. 3867

    To amend title XVIII of the Social Security Act to create care 
management demonstration programs for chronic kidney disease under the 
               Medicare program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 2017

Mr. Mullin (for himself, Mr. Holding, Mr. Butterfield, and Ms. Sanchez) 
 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 subsequently 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 create care 
management demonstration programs for chronic kidney disease under the 
               Medicare program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. CARE MANAGEMENT DEMONSTRATION PROGRAMS FOR CHRONIC KIDNEY 
              DISEASE.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after section 1866E the following new section:

``SEC. 1866F. CARE MANAGEMENT DEMONSTRATION PROGRAMS FOR CHRONIC KIDNEY 
              DISEASE.

    ``(a) Demonstration Program for Earlier and Improved Detection and 
Treatment of Chronic Kidney Disease.--
            ``(1) In general.--Not later than 18 months after the 
        enactment of this section, the Secretary shall establish a 
        demonstration program (referred to in this section as the `CKD 
        early detection and treatment demonstration program') of the 
        use of the payment system described in paragraph (2) that, with 
        respect to an enrolled CKD-EDT individual (as defined in 
        paragraph (8)(D)), provides to a CKD-EDT practitioner (as 
        defined in paragraph (8)(A)) a single monthly care management 
        payment for all CKD-EDT services (as defined in paragraph 
        (8)(B)) furnished to such individual by such practitioner in a 
        month.
            ``(2) Payment system described.--The payment system 
        described in this paragraph is a payment system that, with 
        respect to all CKD-EDT services furnished in a month by a CKD-
        EDT practitioner to an enrolled CKD-EDT individual, provides a 
        care management payment to such practitioner in an amount 
        that--
                    ``(A) is greater than the amount of payment that 
                such practitioner otherwise would receive pursuant to 
                this title for furnishing such services to such 
                individual if the practitioner had not elected to 
                participate in the CKD early detection and treatment 
                demonstration program (to be calculated in a manner 
                that includes, as part of such amount that the 
                practitioner otherwise would so receive, any amounts 
                that the practitioner would receive as cost-sharing 
                amounts from the individual);
                    ``(B) with respect to a fiscal year that is after 
                the first fiscal year in which the CKD-EDT practitioner 
                participates in the CKD early detection and treatment 
                demonstration program, is, to the extent feasible, 
                adjusted based on the performance of the practitioner 
                during the prior fiscal year with respect to the 
                measures developed by the Secretary pursuant to 
                paragraph (3); and
                    ``(C) is determined through the use of a 
                computation that is developed in consultation with--
                            ``(i) chronic kidney disease patient 
                        advocates;
                            ``(ii) clinicians in the primary care 
                        community; and
                            ``(iii) such other entities as the 
                        Secretary determines appropriate.
                For purposes of applying subparagraph (A) with respect 
                to CKD-EDT services that are furnished via a 
                telecommunications system by a CKD-EDT practitioner to 
                an enrolled CKD-EDT individual, the Secretary shall 
                calculate the amount that the practitioner otherwise 
                would so receive with respect to such services in a 
                manner that makes such amount equal the amount that 
                such practitioner otherwise would so receive for such 
                services if such services had been furnished without 
                the use of a telecommunications system.
            ``(3) Measures.--
                    ``(A) In general.--For purposes of paragraph 
                (2)(B), the Secretary, in conjunction with stakeholders 
                (including chronic kidney care patient advocates, 
                clinicians in the primary care community, and experts 
                in the development or use of evidence-based guidelines 
                for the detection, diagnosis, and management of chronic 
                kidney care), shall specify measures of performance 
                with respect to the tasks described in subparagraph 
                (B). Such measures shall be in accordance with clinical 
                guidelines in existence with respect to chronic kidney 
                disease at the time of such specification.
                    ``(B) Tasks described.--The tasks described in this 
                subparagraph, with respect to a CKD-EDT practitioner, 
                are the following:
                            ``(i) Administering, as appropriate, an 
                        annual serum creatinine and urine albumin 
                        testing in accordance with published chronic 
                        kidney care practice guidelines to individuals 
                        for whom the practitioner is the primary care 
                        practitioner and that either are CKD-EDT 
                        individuals or are at the highest risk for 
                        chronic kidney disease.
                            ``(ii) Ensuring that, when appropriate, 
                        individuals that are enrolled CKD-EDT 
                        individuals with respect to the practitioner 
                        receive timely consultations, in accordance 
                        with published chronic kidney care practice 
                        guidelines, with nephrologists located in the 
                        geographic area in which the individual 
                        resides.
                    ``(C) Flexibility in measure specification.--For 
                purposes of subparagraph (A), the Secretary may specify 
                measures that the Secretary develops for purposes of 
                such subparagraph or that the Secretary did not develop 
                for such purposes.
            ``(4) Waiving of cost-sharing.--A CKD-EDT practitioner that 
        participates in the CKD early detection and treatment 
        demonstration program shall, with respect to any CKD-EDT 
        services for which payment is made under the payment system 
        described in paragraph (2), accept any payment made under such 
        paragraph for such services as payment in full for such 
        services, and may not collect any amount of cost-sharing 
        (including any amount of deductible, coinsurance, or copayment) 
        from an enrolled CKD-EDT individual for the furnishing of such 
        services to such individual.
            ``(5) Geographic distribution of providers.--To the extent 
        practicable, the Secretary shall ensure (including through 
        targeted outreach to physicians, nurse practitioners, and 
        physician assistants that are primary care practitioners with 
        respect to enrolled CKD-EDT individuals) that the individuals 
        who receive CKD-EDT services for which payment is provided 
        under the CKD early detection and treatment demonstration 
        program are evenly distributed--
                    ``(A) in different regions of the United States;
                    ``(B) in urban and rural areas; and
                    ``(C) among appropriate facilities, including--
                            ``(i) federally qualified health centers; 
                        and
                            ``(ii) community health centers that 
                        receive assistance under section 330 of the 
                        Public Health Service Act.
            ``(6) Duration and scope of demonstration.--
                    ``(A) Three-year minimum.--Subject to subparagraph 
                (C), the Secretary shall conduct the CKD early 
                detection and treatment demonstration program for a 
                period of three years.
                    ``(B) Scope.--Subject to subparagraph (C), the 
                Secretary shall enroll, subject to paragraph (10), not 
                more than 5,000 CKD-EDT individuals for participation 
                in the demonstration program. Such an individual may 
                participate in the demonstration program on a voluntary 
                basis and may terminate participation at any time.
                    ``(C) Option to extend.--The Secretary may, through 
                rulemaking, expand (including implementation on a 
                nationwide basis) the duration and the scope of the CKD 
                early detection and treatment demonstration program, to 
                the extent determined appropriate by the Secretary, 
                if--
                            ``(i) the Secretary determines that such 
                        expansion is expected to--
                                    ``(I) reduce spending under this 
                                title without reducing the quality of 
                                care; or
                                    ``(II) improve the quality of 
                                patient care without increasing 
                                spending under this title;
                            ``(ii) the Chief Actuary of the Centers for 
                        Medicare & Medicaid Services certifies that 
                        such expansion would reduce (or would not 
                        result in any increase in) net program spending 
                        under this title; and
                            ``(iii) the Secretary determines that such 
                        expansion would not deny or limit the coverage 
                        or provision of benefits under this title for 
                        applicable individuals.
            ``(7) Consultation with stakeholders.--
                    ``(A) In general.--The Secretary shall consult with 
                stakeholders regarding the establishment and 
                implementation of the CKD early detection and treatment 
                demonstration program.
                    ``(B) Timing of consultation.--The Secretary shall 
                begin to consult with stakeholders pursuant to 
                subparagraph (A) not later than six months after the 
                date of the enactment of this section.
            ``(8) Definitions.--For purposes of this section, the 
        following definitions apply:
                    ``(A) CKD-EDT practitioner.--Subject to paragraph 
                (9), the term `CKD-EDT practitioner' means, with 
                respect to an enrolled CKD-EDT individual, a physician, 
                nurse practitioner, or physician assistant who--
                            ``(i) is the primary care practitioner for 
                        such individual;
                            ``(ii) agrees, with respect to each fiscal 
                        year in which the practitioner participates in 
                        the CKD early detection and treatment 
                        demonstration program, to--
                                    ``(I) assess the at-risk patient 
                                populations of such physician, nurse 
                                practitioner, or physician assistant 
                                (as applicable) for chronic kidney 
                                disease pursuant to published clinical 
                                practice guidelines with respect to 
                                chronic kidney disease; and
                                    ``(II) submit to the Secretary the 
                                results of the assessments described in 
                                subclause (I);
                            ``(iii) uses certified EHR technology (as 
                        defined in section 1833(o)(4));
                            ``(iv) elects to participate in the CKD 
                        early detection and treatment demonstration 
                        program with respect to all enrolled CKD-EDT 
                        individuals for whom such physician, nurse 
                        practitioner, or physician assistant (as 
                        applicable) is the primary care practitioner;
                            ``(v) agrees, with respect to each fiscal 
                        year in which the practitioner participates in 
                        the demonstration program, to assess annually 
                        (pursuant to established clinical guidelines 
                        with respect to the monitoring of the 
                        progression of chronic kidney disease) all 
                        enrolled CKD-EDT individuals for whom such 
                        physician, nurse practitioner, or physician 
                        assistant (as applicable) is the primary care 
                        practitioner and that are either--
                                    ``(I) confirmed to have chronic 
                                kidney disease; or
                                    ``(II) at the highest risk of 
                                becoming an individual with confirmed 
                                chronic kidney disease;
                            ``(vi) agrees to provide to each enrolled 
                        CKD-EDT individual for whom such physician, 
                        nurse practitioner, or physician assistant (as 
                        applicable) is the primary care practitioner--
                                    ``(I) educational materials that 
                                provide background information about 
                                chronic kidney disease and that are 
                                developed by credible organizations, as 
                                specified by the Secretary, with 
                                expertise in the development of 
                                clinical guidelines and patient 
                                educational materials with respect to 
                                chronic kidney disease; and
                                    ``(II) a notification of the 
                                potential benefits that the individual 
                                may receive as a result of the 
                                practitioner participating in the CKD 
                                early detection and treatment 
                                demonstration program; and
                            ``(vii) agrees to comply with the 
                        requirements of paragraph (10).
                    ``(B) CKD-EDT services.--
                            ``(i) In general.--The term `CKD-EDT 
                        services' means administration and evaluation 
                        of such services as the Secretary may specify 
                        that are screening services and care management 
                        services for chronic kidney disease and for 
                        which, subject to clause (iv), payment may 
                        otherwise be made under this title.
                            ``(ii) Consultation required.--In 
                        determining which services to specify for 
                        purposes of clause (i), the Secretary shall 
                        consult with--
                                    ``(I) chronic kidney disease 
                                patient advocates;
                                    ``(II) clinicians in the primary 
                                care nephrologist community; and
                                    ``(III) experts in the development 
                                of evidence-based guidelines for the 
                                detection, diagnosis, and management of 
                                chronic kidney disease.
                            ``(iii) Considered services.--In specifying 
                        services for purposes of clause (i), the 
                        Secretary may, in addition to considering other 
                        services and patient benefits, consider the 
                        following services with respect to the 
                        screening, care, and management of chronic 
                        kidney disease:
                                    ``(I) Blood pressure management.
                                    ``(II) Lipid management.
                                    ``(III) Assessment for bone and 
                                mineral metabolism abnormalities, 
                                anemia, nutritional needs, mental 
                                health, and availability of family and 
                                other social support networks.
                                    ``(IV) Delivery of patient 
                                education on self-management strategies 
                                for chronic kidney disease.
                                    ``(V) Development of care plans 
                                with respect to chronic kidney disease.
                                    ``(VI) Medication reconciliation 
                                and dosage adjustments.
                                    ``(VII) Review of laboratory tests.
                                    ``(VIII) Medical nutrition therapy.
                            ``(iv) Permissible inclusion of telehealth 
                        services.--The term `CKD-EDT services' may 
                        include services that are furnished via a 
                        telecommunications system by a CKD-EDT 
                        practitioner to an enrolled CKD-EDT individual 
                        and that would have been CKD-EDT services under 
                        clause (i) if such services had been furnished 
                        without the use of a telecommunications system.
                    ``(C) CKD-EDT individual.--The term `CKD-EDT 
                individual' means an individual who--
                            ``(i) is not under the care of a 
                        nephrologist or nephrology practitioner;
                            ``(ii) is an individual with confirmed 
                        chronic kidney disease at a stage equal to, or 
                        greater than, stage 3; and
                            ``(iii) is entitled to benefits under part 
                        A and enrolled under part B.
                    ``(D) Enrolled ckd-edt individual.--The term 
                `enrolled CKD-EDT individual' means a CKD-EDT 
                individual who is enrolled to participate in the 
                demonstration program under paragraph (6).
            ``(9) Integrated care strategy.--
                    ``(A) In general.--Under the demonstration, a CKD-
                EDT practitioner, with respect to enrolled CKD-EDT 
                individuals, shall develop and submit for the 
                Secretary's approval, subject to subparagraphs (B) and 
                (C), a CKD-EDT integrated care strategy.
                    ``(B) Integrated care strategy.--In assessing a 
                CKD-EDT integrated care strategy, the Secretary shall 
                consider the extent to which the strategy includes 
                elements, such as the following:
                            ``(i) Interdisciplinary care teams led by 
                        at least one nephrologist, and comprised of 
                        registered nurses, social workers, and other 
                        representatives from alternative settings 
                        described in clause (vi).
                            ``(ii) Health risk and other assessments to 
                        determine the physical, psychosocial, 
                        nutrition, language, cultural, and other needs 
                        of enrolled CKD-EDT individuals involved.
                            ``(iii) Development and at least annual 
                        updating of individualized care plans that 
                        incorporate at least the medical, social, and 
                        functional needs, preferences, and care goals 
                        of enrolled CKD-EDT individuals.
                            ``(iv) Coordination and delivery of non-
                        clinical services, such as transportation, 
                        aimed at improving the adherence of enrolled 
                        CKD-EDT individuals with care recommendations.
                            ``(v) Services, such as transplant 
                        evaluation and vascular access care.
                            ``(vi) In the case of an individual who, 
                        while enrolled in the demonstration, receives 
                        confirmation that a kidney transplant is 
                        imminent, the provision by an interdisciplinary 
                        care team described in clause (i) of counseling 
                        services to such individual on preparation for 
                        and potential challenges surrounding such 
                        transplant.
                            ``(vii) Delivery of benefits and services 
                        in alternative settings, such as the home of 
                        the enrolled CKD-EDT individuals, in 
                        coordination with the provider or other 
                        appropriate stakeholder involved in such 
                        delivery serving on an interdisciplinary care 
                        team described in clause (i).
                            ``(viii) Use of patient reminder systems.
                            ``(ix) Education programs for patients, 
                        families, and caregivers.
                            ``(x) Use of health care advice resources, 
                        such as nurse advice lines.
                            ``(xi) Use of team-based health care 
                        delivery models that provide comprehensive and 
                        continuous medical care, such as medical homes.
                            ``(xii) Co-location of providers and 
                        services.
                            ``(xiii) Use of a demonstrated capacity to 
                        share electronic health record information 
                        across sites of care.
                            ``(xiv) Use of programs to promote better 
                        adherence to recommended treatment regimens by 
                        individuals, including by addressing barriers 
                        to access to care by such individuals.
                            ``(xv) Other services, strategies, and 
                        approaches identified by the CKD-EDT 
                        practitioner to improve care coordination and 
                        delivery.
                    ``(C) Requirements.--The Secretary may not approve 
                a CKD-EDT integrated care strategy of a CKD-EDT 
                practitioner unless under such strategy the 
                pracitioner--
                            ``(i) provides services to enrolled CKD-EDT 
                        individuals through a comprehensive, 
                        multidisciplinary health and social services 
                        delivery system which integrates acute and 
                        long-term care services pursuant to 
                        regulations; and
                            ``(ii) specifies the covered items and 
                        services that will not be provided directly by 
                        the practitioner, and to arrange for delivery 
                        of those items and services through contracts 
                        meeting the requirements of regulations.
            ``(10) Beneficiary protections.--
                    ``(A) Antidiscrimination.--In the case of a CKD-EDT 
                practitioner that participates in the CKD early 
                detection and treatment demonstration program that is 
                treating a CKD-EDT individual and such individual 
                elects for the practitioner not to so participate in 
                such demonstration program with respect to such 
                individual, such practitioner may not participate in 
                such demonstration program with respect to such 
                individual (but may so participate with respect to 
                other CKD-EDT individuals).
                    ``(B) No impact on quality of care.--A CKD-EDT 
                practitioner that participates in the CKD early 
                detection and treatment demonstration program may not 
                allow the participation of such practitioner in such 
                program to affect the quality of services furnished 
                under this title to an individual, regardless of 
                whether the practitioner participates in such 
                demonstration program with respect to such individual.
                    ``(C) Quality assurance; patient safeguards.--The 
                Secretary shall require that each CKD-EDT practitioner 
                that participates in the CKD early detection and 
                treatment demonstration program has in effect--
                            ``(i) a written plan of quality assurance 
                        and improvement with respect to CKD-EDT 
                        services for which payment is made under such 
                        demonstration program, and procedures 
                        implementing such plan, in accordance with 
                        regulations; and
                            ``(ii) written safeguards of the rights of 
                        enrolled CKD-EDT individuals for whom such 
                        practitioner is the primary care practitioner 
                        (including a patient bill of rights and 
                        procedures for grievances and appeals) in 
                        accordance with regulations and with other 
                        requirements of this title and Federal and 
                        State law that are designed for the protection 
                        of patients.
    ``(b) Demonstration Program for Advanced Chronic Kidney Disease.--
            ``(1) In general.--Not later than 18 months after the 
        enactment of this section, the Secretary shall establish a 
        demonstration program (referred to in this section as the 
        `advanced CKD demonstration program') of the use of the payment 
        system described in paragraph (2) that, with respect to an 
        individual entitled to benefits under part A or enrolled under 
        part B with confirmed chronic kidney disease at a stage equal 
        to, or greater than, stage 4 (as confirmed by testing serum 
        creatinine and urine albumin in alignment with evidence-based 
        chronic kidney disease clinical guidelines), provides to an 
        advanced CKD practitioner (as defined in paragraph (5)(A)) a 
        single care management payment for all advanced CKD services 
        (as defined in paragraph (5)(B)) furnished to such individual 
        by such practitioner in a month.
            ``(2) Payment system described.--The payment system 
        described in this paragraph is a payment system that, with 
        respect to all advanced CKD services furnished in a month by an 
        advanced CKD practitioner to an individual described in 
        paragraph (1), provides a care management payment to such 
        practitioner in an amount that--
                    ``(A) is greater than the amount of payment that 
                such practitioner otherwise would receive pursuant to 
                title XVIII for furnishing such services to such 
                individual if the practitioner had not elected to 
                participate in the advanced CKD demonstration program 
                (to be calculated in a manner that includes, as part of 
                such amount that the practitioner otherwise would so 
                receive, any amounts that the practitioner would 
                receive as cost-sharing amounts from the individual);
                    ``(B) with respect to a fiscal year that is after 
                the first fiscal year in which the advanced CKD 
                practitioner participates in the advanced CKD 
                demonstration program, is adjusted based on the 
                performance of the practitioner during the prior fiscal 
                year with respect to the measures developed by the 
                Secretary pursuant to paragraph (3);
                    ``(C) is determined through the use of a 
                computation that is developed in consultation with--
                            ``(i) chronic kidney disease patient 
                        advocates;
                            ``(ii) clinicians in the nephrology 
                        community;
                            ``(iii) experts in the development of 
                        evidence-based guidelines for the detection, 
                        diagnosis, and management of chronic kidney 
                        disease; and
                            ``(iv) such other entities as the Secretary 
                        determines appropriate.
                For purposes of applying subparagraph (A)(i) with 
                respect to advanced CKD services that are furnished via 
                a telecommunications system by an advanced CKD 
                practitioner to an individual described in paragraph 
                (1), the Secretary shall calculate the amount that the 
                practitioner otherwise would so receive with respect to 
                such services in a manner that makes such amount equal 
                the amount that such practitioner otherwise would so 
                receive for such services if such services had been 
                furnished without the use of a telecommunications 
                system.
            ``(3) Measures.--
                    ``(A) In general.--For purposes of paragraph 
                (2)(B), the Secretary, in conjunction with stakeholders 
                (including chronic kidney care patient advocates, 
                clinicians in the nephrology community, experts in the 
                development of evidence-based guidelines for the 
                detection, diagnosis, and management of chronic kidney 
                care, and such other entities as the Secretary 
                determines appropriate), shall specify measures of 
                performance with respect to the tasks described in 
                subparagraph (B). Such measures shall be in accordance 
                with clinical guidelines in existence with respect to 
                chronic kidney disease at the time of such 
                specification.
                    ``(B) Tasks described.--The tasks described in this 
                subparagraph are the following:
                            ``(i) Reducing costs associated with 
                        hospitalizations of individuals described in 
                        paragraph (1) that are furnished CKD-EDT 
                        services by such practitioner.
                            ``(ii) Providing education to such 
                        individuals regarding the importance of 
                        avoidance of non-steroidal anti-inflammatory 
                        drugs for patients with confirmed chronic 
                        kidney disease.
                            ``(iii) Providing appropriate prescription 
                        of kidney-protective blood pressure medications 
                        to such individuals for such chronic kidney 
                        disease (unless contra-indicated for 
                        individuals with confirmed chronic kidney 
                        disease), elevated urine albumin, and elevated 
                        blood pressure in alignment with evidence-based 
                        guidelines.
                            ``(iv) Providing such individuals, as 
                        appropriate, with planned starts of renal 
                        replacement therapy through the receipt by such 
                        individuals of preemptive kidney transplants, 
                        the initiation of home dialysis, the initiation 
                        of outpatient in-center hemodialysis through 
                        arteriovenuous fistula or arteriovenous graft, 
                        or supportive care.
                    ``(C) Flexibility in measure specification.--For 
                purposes of subparagraph (A), the Secretary may specify 
                measures that the Secretary develops for purposes of 
                such subparagraph or that the Secretary did not develop 
                for such purposes.
            ``(4) Application of early detection and treatment 
        demonstration program provisions.--The Secretary shall, under 
        this subsection, apply the provisions of paragraphs (4), (5), 
        (6), (7), and (10) of subsection (a) to the advanced CKD 
        demonstration program, advanced CKD practitioners, advanced CKD 
        services, and individuals described in paragraph (1) to the 
        same extent that such provisions apply under subsection (a) to 
        the CKD early detection and treatment demonstration program, 
        CKD-EDT practitioners, CKD-EDT services, and enrolled CKD-EDT 
        individuals, respectively.
            ``(5) Definitions.--For purposes of this section, the 
        following definitions apply:
                    ``(A) Advanced ckd practitioner.--Subject to 
                paragraph (6), the term `advanced CKD practitioner' 
                means, with respect to an individual described in 
                paragraph (1), a nephrologist who--
                            ``(i) participates in the Medicare program 
                        under this title;
                            ``(ii) subject to subsection (a)(10)(A) as 
                        applied pursuant to paragraph (4), elects to 
                        participate in the advanced CKD demonstration 
                        program with respect to all individuals 
                        described in paragraph (1) who receive care 
                        from the nephrologist;
                            ``(iii) agrees to provide to each 
                        individual described in paragraph (1) who 
                        receives care from the nephrologist--
                                    ``(I) educational materials that 
                                provide background information about 
                                chronic kidney disease and that are 
                                developed by credible organizations 
                                with expertise in the development of 
                                clinical guidelines and patient 
                                educational materials with respect to 
                                chronic kidney disease; and
                                    ``(II) a notification of the 
                                potential benefits that the individual 
                                may receive as a result of the 
                                practitioner participating in the 
                                advanced CKD demonstration program; and
                            ``(iv) agrees to comply with the 
                        requirements of subsection (a)(10), as applied 
                        pursuant to paragraph (4).
                    ``(B) Advanced ckd services.--
                            ``(i) In general.--The term `advanced CKD 
                        services' means, with respect to individuals 
                        described in paragraph (1), such services as 
                        the Secretary may specify that are care and 
                        management services for chronic kidney disease 
                        and that, subject to clause (iv), are services 
                        for which payment may otherwise be made under 
                        this title.
                            ``(ii) Consultation required.--In 
                        determining which services to specify for 
                        purposes of clause (i), the Secretary shall 
                        consult with--
                                    ``(I) chronic kidney disease 
                                patient advocates;
                                    ``(II) clinicians in the nephrology 
                                community;
                                    ``(III) experts in the development 
                                of evidence-based guidelines for the 
                                detection, diagnosis, and management of 
                                chronic kidney disease; and
                                    ``(IV) such other entities as the 
                                Secretary determines appropriate.
                            ``(iii) Considered services.--In specifying 
                        services for purposes of clause (i), the 
                        Secretary may, in addition to considering other 
                        services, consider the following services with 
                        respect to the care and management of chronic 
                        kidney disease:
                                    ``(I) Kidney disease education 
                                benefit sessions.
                                    ``(II) Patient care planning 
                                (including patient choice of renal 
                                replacement therapy or palliative or 
                                advanced care planning).
                                    ``(III) Comorbidities assessment 
                                and management (with respect to 
                                conditions such as anemia, bone and 
                                mineral abnormalities, and 
                                cardiovascular disease).
                                    ``(IV) Mental health assessment and 
                                referral.
                                    ``(V) Practitioner consultation and 
                                coordination with cardiologists, 
                                endocrinologists, mental health 
                                specialists, primary care 
                                practitioners, and other appropriate 
                                health care providers and suppliers.
                                    ``(VI) Vascular or peritoneal 
                                dialysis access assessments and 
                                coordinations with surgeons.
                                    ``(VII) Referrals and coordinations 
                                with transplant centers.
                                    ``(VIII) Medication reconciliations 
                                and coordinations with pharmacists.
                                    ``(IX) Medical nutrition therapy 
                                administered by dieticians.
                            ``(iv) Permissible inclusion of telehealth 
                        services.--The term `advanced CKD services' may 
                        include services that are furnished via a 
                        telecommunications system by an advanced CKD 
                        practitioner to an individual described in 
                        paragraph (1) and that would have been advanced 
                        CKD services under clause (i) if such services 
                        had been furnished without the use of a 
                        telecommunications system.
            ``(6) Participation of care teams.--
                    ``(A) In general.--With respect to an individual 
                described in paragraph (1), a nephrologist for such 
                individual may participate in a care team described in 
                subparagraph (B) that, with respect to the furnishing 
                of advanced CKD services to such individual, 
                participates in the advanced CKD demonstration program 
                as an advanced CKD practitioner. In applying this 
                subsection, such group shall be treated as such an 
                advanced CKD practitioner.
                    ``(B) Care team described.--A care team described 
                in this subparagraph, with respect to an individual 
                described in paragraph (1), is, subject to subparagraph 
                (C), a group of providers--
                            ``(i) each of which participates in the 
                        Medicare program under this title;
                            ``(ii) each of which elects to participate 
                        in the advanced CKD demonstration program with 
                        respect to all individuals described in 
                        paragraph (1) for whom the nephrologist 
                        described in subparagraph (A) is the 
                        nephrologist; and
                            ``(iii) that agrees to provide to each 
                        individual described in paragraph (1) for whom 
                        the nephrologist described in subparagraph (A) 
                        is the nephrologist--
                                    ``(I) educational materials that 
                                provide background information about 
                                chronic kidney disease and that are 
                                developed by credible organizations 
                                with expertise in the development of 
                                clinical guidelines and patient 
                                educational materials with respect to 
                                chronic kidney disease; and
                                    ``(II) a notification of the 
                                potential benefits that the individual 
                                may receive as a result of the 
                                practitioner participating in the 
                                advanced CKD demonstration program.
                    ``(C) Permissible assembly and administration by 
                third party-administrator organizations.--
                            ``(i) In general.--A care team described in 
                        subparagraph (B) may be assembled and 
                        administered by a third party-administrator 
                        organization.
                            ``(ii) Third party-administrator 
                        organization.--For purposes of this paragraph, 
                        the term `third party-administrator 
                        organization' means the following:
                                    ``(I) A Medicare Advantage plan 
                                described in section 1851(a)(2) or a 
                                Medicare Advantage organization 
                                offering such a plan.
                                    ``(II) A prescription drug plan (as 
                                defined in section 1860D-41(a)(14)).
                                    ``(III) A medicaid managed care 
                                organization (as defined in section 
                                1903(m)).''.
                                 <all>