IN THE SENATE OF THE UNITED STATES
March 6, 2012
Mr. Conrad introduced the following bill; which was read twice and referred to the Committee on Finance
To amend title XVIII of the Social Security Act to improve Medicare benefits for individuals with kidney disease, and for other purposes.
Short title; table of contents
This Act may be cited as the
Kidney Disease Equitable Access, Prevention, and Research
Act of 2012.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—Providing equitable access to care for individuals with kidney disease
Sec. 101. Improving access to care through improvements in the initial survey process for renal dialysis facilities.
Sec. 102. Providing choice in primary insurer.
Sec. 103. Protecting individuals with kidney failure from unfair practices.
TITLE II—Supporting research to improve access to high quality kidney care
Sec. 201. Understanding the progression of kidney disease in minority populations.
Sec. 202. Recommendations on dialysis quality and care management research gaps.
Sec. 203. GAO study on transportation barriers to access kidney care.
TITLE III—Improving access to preventive care for individuals with kidney disease
Sec. 301. Improving access to medicare kidney disease education.
Providing equitable access to care for individuals with kidney disease
Improving access to care through improvements in the initial survey process for renal dialysis facilities
Section 1864 of the Social Security Act (42 U.S.C. 1395aa) is amended—
by redesignating subsection (e) as subsection (f);
by inserting after subsection (d) the following new subsection:
If the Secretary has entered into an agreement with any State under this section under which the appropriate State or local agency that performs any survey related to determining the compliance of a renal dialysis facility subject to the requirements of section 1881(b) and the State licensure survey requirements are consistent with or exceed such Federal requirements, the Secretary must accept the results of the State licensure survey for purposes of determining Federal certification of compliance. In the case of such an initial survey of a renal dialysis facility, the Secretary may allow any State to waive the reimbursement for conducting the survey under this section if it requests such a waiver.
In the case of a renal dialysis facility that has waited for more than 6 months to receive the results of an initial survey under this section, the Secretary shall establish a specific timetable for completing and reporting the results of the survey.
in subsection (f), as so redesignated—
Notwithstanding any other provision of law, and inserting
(1) Notwithstanding any other provision of law and except as provided in
paragraph (2); and
by adding at the end the following:
The Secretary may assess and collect fees for the initial Medicare survey from a renal dialysis facility subject to the requirements of section 1881(b) in an amount not to exceed a reasonable fee necessary to cover the costs of initial surveys conducted for purposes of determining the compliance of a renal dialysis facility with the requirements of section 1881(b). Fees may be assessed and collected under this paragraph only in such manner as would result in an aggregate amount of fees collected during any fiscal year being equal to the aggregate amount of costs for such fiscal year for initial surveys of such facilities under this section. A renal dialysis facility’s liability for such fees shall be reasonably based on the proportion of the survey costs which relate to such facility. Any funds collected under this paragraph shall be used only to conduct the initial survey of the facilities providing the fees.
Fees authorized under paragraph (2) shall be collected by the Secretary and available only to the extent and in the amount provided in advance in appropriations Acts and upon request of the Secretary, subject to the amount and usage limitations of such paragraph. Such fees so collected are authorized to remain available until expended.
Providing choice in primary insurer
Providing for patient choice
Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended—
in the last
sentence, by inserting
and before January 1, 2013, after
prior to such date); and
by adding at the
end the following new sentence:
Effective for items and services
furnished on or after January 1, 2013 (with respect to periods beginning on or
after the date that is 42 months prior to such date), clauses (i) and (ii)
shall be applied by substituting .
12-month each place it appears in the first
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 paragraph (1), 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 amendment made by paragraph (1)(B).
Providing equitable access to insurance for individuals with kidney failure
The Secretary of Health and Human Services shall clarify upon enactment of this Act that the Medicare Secondary Payer rules set forth in section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by this Act, apply to qualified health plans established under section 1311(b)(1)(B) of Public Law 111–148 (42 U.S.C. 13031(b)(1)(B)).
Protecting individuals with kidney failure from unfair practices
Section 1862(b)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)(ii)) is amended to read as follows:
may not differentiate in the benefits it provides between individuals having end stage renal disease and other individuals covered by such plan or issuer on the basis of the existence of end stage renal disease, the need for renal dialysis, or in any other manner, and such plan—
shall provide adequate, advanced, written notification to patients regarding changes to dialysis service benefits, new restrictions on out-of-network access, or reductions in rates paid for out-of-network benefits for such services;
shall allow patients to continue using their existing provider or facility of such services for at least 24 months following the date of notice of any change by the plan or issuer in the dialysis services network of the plan or issuer;
shall hold patients harmless from provider network changes with respect to such services if such changes require unreasonable drive time or disrupt the physician-patient relationship;
may not restrict the duration or number of dialysis sessions for patients, such as based on a fixed number of treatments per week, to less than the number for which payment may be made pursuant to section 1881(b)(1);
may not require assignment of benefits for such services;
shall ensure that out-of-pocket payments for such services apply to the medicare part C out-of-pocket maximums and not treated as routine for purposes of calculating beneficiary copayments;
may not deny or limit coverage for patients for such services if premiums, copayments, or other payments are made by third parties on their behalf; and
shall meet minimum network adequacy standards specified by the Secretary with respect to such services;
The amendment made by subsection (a) shall apply to group health plans as of January 1, 2014.
Supporting research to improve access to high quality kidney care
Understanding the progression of kidney disease in minority populations
Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall complete a study (and submit a report to Congress) on—
the social, behavioral, and biological factors leading to kidney disease; and
efforts to slow the progression of kidney disease in minority populations that are disproportionately affected by such disease.
Recommendations on dialysis quality and care management research gaps
Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report regarding the research gaps with respect to the development of quality metrics and care management metrics for patients with end-stage renal disease, including pediatric and home dialysis patients. Such report shall include recommendations about undertaking research to fill such gaps and prioritizing such research.
GAO study on transportation barriers to access kidney care
The Comptroller General of the United States shall conduct an evaluation of the transportation barriers facing dialysis patients that result in less than 100 percent compliance with their plan of care under the Medicare program.
Specific Matters Evaluated
In conducting the evaluation under subsection (a), the Comptroller General shall examine—
the costs associated with providing dialysis services;
the number and characteristics of patients who miss at least 2 dialysis treatments during a month or have shortened treatments because of barriers to transportation; and
the potential sources of providing dialysis patients with such transportation services.
Not later than the date that is 6 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under subsection (a) together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
Improving access to preventive care for individuals with kidney disease
Improving access to medicare kidney disease education
Section 1861(ggg)(2) of the Social Security Act (42 U.S.C. 1395x(ggg)(2)) is amended—
by striking subparagraph (B); and
in subparagraph (A)—
and at the end of clause (i);
by striking the
period at the end of clause (ii) and inserting
by redesignating clauses (i) and (ii) as subparagraphs (A) and (B), respectively; and
by adding at the end the following:
a renal dialysis facility subject to the requirements of section 1881(b)(1) with personnel—
who provide the services described in paragraph (1); and
that include a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in subsection (aa)(5)).
Payment to Renal Dialysis Facilities
Section 1881(b) of such Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following new paragraph:
For purposes of paragraph (14), the single 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 facility on an assignment-related basis under section 1848.
Providing education services to individuals with kidney failure
Section 1861(ggg)(1)(A) of the Social Security Act (42 U.S.C. 1395x(ggg)(1)(A)) is amended—
or stage V after
stage IV; and
and who is not receiving dialysis services after
The amendments made by this section apply to kidney disease education services furnished on or after January 1, 2013.