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H.R. 3636 (ih) To support sustainable and broad-based agricultural and rural development in sub-Saharan Africa, and for other purposes. ...
108th CONGRESS 1st Session H. R. 3635 To amend the Social Security Act to provide for coverage under the Medicare Program of chronic kidney disease patients who are not end- stage renal disease patients. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES November 21, 2003 Mr. Stark (for himself, Mr. McDermott, Mr. Kennedy of Rhode Island, Mr. Frost, Mrs. Christensen, Mr. Jefferson, and Mr. McNulty) 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 the Social Security Act to provide for coverage under the Medicare Program of chronic kidney disease patients who are not end- stage renal disease patients. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ``Medicare Chronic Kidney Disease Management Act of 2003''. SEC. 2. FINDINGS. Congress makes the following findings: (1) Clinical research indicates that in 2003, more than 300,000 Americans suffer from end-stage renal disease. (2) Clinical research also indicates that by 2010, the number of Americans who will suffer from end-stage renal disease is expected to exceed 600,000. (3) Clinical research also indicates that adult patients who are diagnosed as having advanced chronic kidney disease have a high likelihood of requiring treatment for end-stage renal disease within 6- to 18-month period after such diagnosis. (4) Clinical research also indicates that appropriate medical treatment, and education and counseling services, furnished during the period referred to in paragraph (3) has been found to-- (A) decrease significantly both morbidity and mortality rates for such patients when treatment for end-stage renal disease is initiated; and (B) slow down the progression from advanced kidney disease to end-stage renal disease. SEC. 3. DELAYING ONSET OF AND DECREASING MORBIDITY AND MORTALITY RATES FOR END-STAGE RENAL DISEASE. (a) Medicare Coverage of Chronic Kidney Disease Patients.-- (1) In general.--Section 226A of the Social Security Act (42 U.S.C. 426-1) is amended-- (A) by redesignating the last subsection as subsection (e); and (B) by inserting after subsection (c) the following new subsection: ``(d)(1)(A) Notwithstanding any provision to the contrary in section 226 of title XVIII, every qualified chronic kidney disease patient (as defined in paragraph (2)) shall, in accordance with the succeeding provisions of this section, be entitled to benefits under part A and eligible to enroll under part B of title XVIII, subject to the deductible, premium, and coinsurance provisions of that title. ``(B) No qualified chronic kidney disease patient may enroll under part C of title XVIII. ``(2) For purposes of this subsection, the term `qualified chronic kidney disease patient' means an individual-- ``(A) who would otherwise be described in subsection (a) but for paragraph (2) of that subsection; ``(B) who has been diagnosed with chronic kidney disease; ``(C) with respect to whom, a physician makes a certification that the individual-- ``(i) has advanced chronic kidney disease (as defined in paragraph (3)), and, in the case of such an individual who is under 18 years of age, will likely need dialysis treatments or a kidney transplant within the 18-month period beginning on the date of the certification; and ``(ii) may benefit from a program of pre-ESRD services (as defined in section 1861(ww)(1)); and ``(D) who does not have health insurance coverage, as certified by the individual, parent, or legal guardian, as the case may be. ``(3) For purposes of this subsection, the term `advanced chronic kidney disease' means with respect to kidney disease a glomerular filtration rate of 30ml/min per 1.73 m2 or less.''. (2) Conforming amendment.--Section 1811 of such Act (42 U.S.C. 1395c) is amended by inserting before the period the following: ``or who are qualified chronic kidney disease patients (as defined in section 226A(d)(2))''. (3) Effective date.--The amendments made by this subsection shall take effect on the date that is 6 months after the date of the enactment of this Act. (b) Coverage of Pre-ESRD Services.-- (1) In general.--Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended-- (A) by striking ``and'' at the end of subparagraph (U); (B) by inserting ``and'' at the end of subparagraph (V); and (C) by adding at the end the following new subparagraph: ``(W) pre-ESRD services (as defined in subsection (ww)(1)) for an individual who has been diagnosed with chronic kidney disease and, with respect to whom, a physician makes a certification described in section 226A(d)(2)(C);''. (2) Services described.--Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection: ``Pre-ESRD Services ``(ww) The term `pre-ESRD Services' means any or all of the following services: ``(1) Individual and group nutritional counseling services for the purpose of chronic kidney disease management that are furnished by a registered dietitian or nutrition professional (as defined in subsection (vv)(2)) pursuant to a referral by a physician (as defined in subsection (r)(1)). ``(2) Counseling furnished by qualified health care providers that-- ``(A) provides comprehensive information regarding the management of comorbidities, and the prevention of uremic complications; ``(B) ensures active participation of the individual in the choice of therapy or therapies; and ``(C) provides comprehensive information regarding modalities of treatment for kidney disease and end- stage renal disease, including organ transplantation, hemodialysis, peritoneal dialysis, and home dialysis. ``(3) Counseling, items and services, including tissue typing, furnished by qualified health care providers for preparation of possible organ transplantation. ``(4) Items and services furnished by qualified health care providers for the preparation of vascular access required for dialysis treatment. ``(5) Such other services as the Secretary determines appropriate, in consultation with national organizations representing individuals and entities who furnish pre-ESRD services and patients receiving such services.''. (3) Qualification criteria.--The Secretary of Health and Human Services shall establish such criteria as the Secretary determines appropriate for qualifications required for individuals to furnish pre-ESRD services under section 1861(ww) of the Social Security Act, as added by paragraph (2), after consulting with representatives of the following: (A) Physicians, including board certified nephrologists. (B) Certified nephrology nurses. (C) Certified nephrology dietitians. (D) Certified nephrology nutritionists. (E) Certified nephrology social workers. (F) Kidney patient organizations. (G) Health educators. (H) Dialysis facilities. (I) Transplant centers. (J) Network administrative organization designated under section 1881(c) of the Social Security Act (42 U.S.C. 1395rr(c)). (K) Such other individuals with appropriate expertise as the Secretary may specify. (c) Payment Amount.-- (1) In general.--Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended-- (A) by striking ``and'' before ``(U)''; and (B) by inserting before the semicolon at the end the following: ``, and (V) with respect to pre-ESRD services, the amount paid shall be 80 percent of the amount determined under the fee schedule established under section 1834(e)''. (2) Establishment of fee schedule.--Section 1834 of such Act (42 U.S.C. 1395m) is amended by inserting after subsection (d) the following new subsection: ``(e) Fee Schedule for Pre-ESRD Services.-- ``(1) In general.--The Secretary shall establish a fee schedule for payment for pre-ESRD services in accordance with the requirements of this subsection. ``(2) Considerations.--In establishing such fee schedule, the Secretary shall-- ``(A) establish mechanisms to promote the efficient delivery of care; ``(B) establish definitions for pre-ESRD services which link payments to the type of services provided; ``(C) consider appropriate regional and operational differences; and ``(D) consider adjustments to payment rates to account for inflation and other relevant factors. ``(3) Consultation.--In establishing the fee schedule for pre-ESRD services under this subsection, the Secretary shall consult with various national organizations representing individuals and entities who furnish pre-ESRD services and patients receiving such services. ``(4) Coding system.--The Secretary may require the claim for any services for which the amount of payment is determined under this subsection to include a code (or codes) under a uniform coding system specified by the Secretary that identifies the services furnished.''. (3) Permitting dialysis facilities to bill for pre-esrd services furnished in the facility.--Section 1881(b) is amended by adding at the end the following new paragraph: ``(12) A renal dialysis facility may provide for the furnishing of some or all pre-ESRD services (as defined in section 1861(ww)(2). The facility may submit to the Secretary a claim for payment for such services furnished in the facility, and the Secretary shall not require the facility, or the employee of the facility who is qualified to furnish such services, to apply for a separate provider number for purposes of payment under this title.''. (d) Annual Reports to Congress.-- (1) In general.--Not later than 18 months after the date of the enactment of this Act, and annually thereafter, the Secretary of Health and Human Services shall submit to Congress reports on the matters described in paragraph (2) with respect to pre-ESRD services (described in section 1861(ww) of the Social Security Act) furnished during the preceding year. (2) Matters described.--Reports under paragraph (1) shall include-- (A) an assessment of the number of medicare beneficiaries who are entitled to pre-ESRD services; (B) an assessment of the number of medicare beneficiaries who are furnished such services under the medicare program; (C) an analysis of the patient outcomes and costs of furnishing care to the medicare beneficiaries who are furnished such pre-ESRD services as compared to such outcomes and costs with respect to other beneficiaries for the same health conditions; (D) an evaluation of patient satisfaction; and (E) such recommendations for legislative and administrative action as the Secretary determines appropriate. SEC. 4. DEMONSTRATION PROJECT FOR HOME DIALYSIS PEER EDUCATION. (a) Establishment.--Subject to the succeeding provisions of this section, the Secretary shall establish demonstration projects to evaluate methods through which peer education may-- (1) slow down or prevent the progress of kidney disease to end-stage renal disease in medicare beneficiaries; (2) improve the management of co-morbid conditions associated with kidney disease; (3) improve choice in selection of renal replacement therapies (including home dialysis); and (4) improve other outcomes (such as employment). (b) Conduct Through Kidney Patient Organizations.--The Secretary shall carry out the demonstration projects in collaboration with kidney patient organizations with demonstrated expertise in kidney patient peer education programs. (c) Payment.--Payment under the demonstration project shall be made by the Secretary in such amounts and using such methodology as the Secretary determines to be appropriate. (d) Voluntary Participation.--Participation of medicare beneficiaries in the demonstration projects shall be voluntary. (e) Demonstration Projects Sites.--Not later than 1 years after the date of the enactment of this Act, the Secretary shall conduct no fewer than 2 demonstration projects established under this section. Of those demonstration projects, the Secretary shall conduct at least one in an urban area and one in a rural area. (f) Duration.--The Secretary shall carry out the demonstration projects over a period of three years. (g) Evaluation and Report.-- (1) Evaluations.--The Secretary shall conduct evaluations of the clinical and cost effectiveness of the demonstration projects. (2) Reports.--After the conclusion of the demonstration projects under this section, the Secretary shall submit to Congress a report on the evaluation, and shall include in the report the following: (A) An analysis of the patient outcomes and costs of furnishing care to the medicare beneficiaries participating in the projects as compared to such outcomes and costs to other beneficiaries for the same health conditions. (B) Evaluation of patient satisfaction under the demonstration projects. (C) Such recommendations regarding the extension or
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