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H.R. 5942 (114th): Dialysis Patient Access To Integrated-care, Empowerment, Nephrologists, Treatment, and Services Demonstration Act of 2016

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The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Sep 7, 2016.


Dialysis PATIENTS Demonstration Act of 2016 or the Dialysis Patient Access to Integrated-care, Empowerment, Nephrologists, Treatment, and Services Demonstration Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to establish a demonstration program for the provision of integrated care to Medicare beneficiaries with end-stage renal disease (ESRD).

Under the voluntary program, eligible participating providers may form organizations to offer ESRD integrated care models and serve as medical homes for program-eligible beneficiaries. Such a model: (1) shall cover medical and hospital services, other than hospice care, under Medicaid; (2) must include benefits for transition into palliative care; and (3) may cover prescription drug benefits. An organization must offer at least one open network model but may also offer one or more preferred network models.

An organization shall return savings achieved under the models to program-eligible beneficiaries.

A beneficiary shall have the opportunity to: (1) opt out of the program, (2) make an assignment change into an open network model offered by a different organization, or (3) elect a preferred network model.

The bill establishes requirements regarding: (1) benefits for program-eligible beneficiaries who are also eligible for Medicaid benefits, (2) program quality and reporting, (2) ESRD integrated care strategy, (3) program operation and scope, (4) beneficiary notification, and (5) payment.