Sen. Cardin Speaks About Legislation on Chronic Kidney Disease
Mr. President, I rise in support of the bipartisan Chronic Kidney Disease Improvement in Research and Treatment Act of 2017, which I am introducing with Senators Blunt and Nelson today. This legislation seeks to make a real difference in the lives of Americans suffering from kidney disease and end-stage renal disease.
Kidney disease is the 9th leading cause of death in
This legislation seeks to promote research, expand patient choice, and improve care coordination for these hundreds of thousands of patients. Specifically, it would identify payment disincentives that create barriers to kidney transplants. The bill would require the Government Accountability Office (GAO) to submit a comprehensive report on how and to what extent palliative care is utilized in treating individuals with advanced kidney disease and the effect of palliative care on the quality of life and treatment outcomes of individuals with ESRD. It would also direct the
This legislation would improve access to pre-dialysis kidney education programs to better manage patients' kidney disease and even prevent kidney failure in some cases. Nephrologists and other health professionals would be incentivized to work in underserved rural and urban areas, and current payment policies would be modified to encourage home dialysis, which is not incentivized under the current Medicare payment structure. Patients with acute kidney injury would also be allowed to receive treatments through dialysis providers, therefore reducing costs associated with care provided in the more expensive hospital outpatient setting. Perhaps most importantly, our legislation would guarantee access to Medigap policies to all ESRD Medicare beneficiaries, regardless of age. Currently, Medicare patients under 65, whether disabled or ESRD beneficiaries do not have access to Medigap plans, even though Medicare is their primary insurance.
Lastly, the bill would expand the options for patients by allowing individuals diagnosed with kidney failure to enroll in the Medicare Advantage program starting in plan year 2020 and reauthorizing on a permanent basis the Medicare Advantage Special Needs Plan for patients with kidney failure.
I urge my colleagues to join me,
Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be printed in the Record, as follows:
S. 1890
Be it enacted by the
SECTION 1.
This Act may be cited as the "Chronic Kidney Disease Improvement in Research and Treatment Act of 2017".
The table of contents of this Act is as follows:
Sec. 1. Short title. Sec. 2. Table of contents.
TITLE I--IMPROVING PATIENT LIVES AND QUALITY OF CARE THROUGH RESEARCH AND INNOVATION
Sec. 101. Improving patient lives and quality of care through research and innovation.
Sec. 102. Enhancing care through new technologies.
Sec. 103. Understanding current utilization of palliative care services.
Sec. 104. Understanding the progression of kidney disease and treatment of kidney failure in minority populations.
TITLE II--EMPOWER PATIENT DECISION MAKING AND CHOICE
Sec. 201. Providing individuals with kidney failure access to managed care.
Sec. 202. Medigap coverage for beneficiaries with end-stage renal disease.
Sec. 203. Promoting access to home dialysis treatments.
TITLE III--IMPROVING PATIENT CARE AND ENSURING QUALITY OUTCOMES
Sec. 301. Maintain an economically stable dialysis infrastructure.
Sec. 302. Improve patient decision making and transparency by consolidating and modernizing quality programs.
Sec. 303. Increasing access to Medicare kidney disease education benefit.
Sec. 304. Certification of new facilities.
Sec. 305. Improving access in under served areas.
TITLE I--IMPROVING PATIENT LIVES AND QUALITY OF CARE THROUGH RESEARCH AND INNOVATION
(a) Study.--The Secretary of
(1) Any disincentives in the payment systems under the Medicare program under title XVIII of the Social Security Act that create barriers to kidney transplants and post- transplant care for beneficiaries with end-stage renal disease.
(2) The practices used by States with higher than average donation rates and whether those practices and policies could be successfully utilized in other States.
(3) Practices and policies that could increase deceased donation rates of minority populations.
(4) Whether cultural and policy barriers exist to increasing living donation rates, including an examination of how to better facilitate chained donations.
(5) Other areas determined appropriate by the Secretary.
(b) Report.--Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to
(a) Agreement With
(b) Contents.--In conducting the study under subsection (a), the
(a) Study.--
(1) In general.--The Comptroller General of
(A) how palliative care can be utilized to improve the quality of life of those with kidney disease and facilitate care tailored to their individual goals and values;
(B) the successful use of palliative care in the care of patients with other chronic diseases and serious illnesses;
(C) the utilization of palliative care at any point in an illness, including when used at the same time as curative treatment; and
(D) other areas determined appropriate by the Comptroller General.
(2) Definition of palliative care.--In this section, the term "palliative care" means patient and family centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Such term includes care that is furnished throughout the continuum of the illness that addresses physical, intellectual, emotional, social, and spiritual needs and that facilitates patient autonomy, access to information and choice.
(b) Report.--Not later than 1 year after the date of the enactment of this Act, the Comptroller General shall submit to the
(a) Study.--The Secretary of
(1) the social, behavioral, and biological factors leading to kidney disease;
(2) efforts to slow the progression of kidney disease in minority populations that are disproportionately affected by such disease; and
(3) treatment patterns associated with providing care, under the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and through private health insurance, to minority populations that are disproportionately affected by kidney failure.
(b) Report.--Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit to
TITLE II--EMPOWER PATIENT DECISION MAKING AND CHOICE
(a) Permanent Extension of
(b) Accelerated Access to Medicare Advantage.--Section 17006(a)(3) of the 21st Century Cures Act (Public Law 114- 255) is amended by striking "2021" and inserting "2020."
(c) Accelerated MedPAC Risk Adjustment Report.--Section 17006(f)(2)(A)(i)(II) of the 21st Century Cures Act (Public Law 114-255) is amended by striking "2020" and inserting "2019."
(a) Guaranteed Availability of Medigap Policies to All ESRD Medicare Beneficiaries.--
(1) In general.--Section 1882(s) of the Social Security Act (42 U.S.C. 1395ss(s)) is amended--
(A) in paragraph (2)--
(i) in subparagraph (A), by striking "is 65" and inserting the following: "is--
"(i) 65 years of age or older and is enrolled for benefits under part B; or
"(ii) is entitled to benefits under 226A(b) and is enrolled for benefits under part B."; and
(ii) in subparagraph (D), in the matter preceding clause (i), by inserting "(or is entitled to benefits under 226A(b))" after "is 65 years of age or older"; and
(B) in paragraph (3)(B)--
(i) in clause (ii), by inserting "(or is entitled to benefits under 226A(b))" after "is 65 years of age or older"; and
(ii) in clause (vi), by inserting "(or under 226A(b))" after "at age 65".
(2) Effective date.--The amendments made by paragraph (1) shall apply to medicare supplemental policies effective on or after
(b) Additional Enrollment Period for Certain Individuals.--
(1) One-time enrollment period.--
(A) In general.--In the case of an individual described in subparagraph (B), the Secretary of
(B) Enrollment period.--The enrollment period established under subparagraph (A) shall begin on
(2) Individual described.--An individual described in this paragraph is an individual who--
(A) is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act under section 226A(b) of such Act (42 U.S.C. 426-1);
(B) is enrolled for benefits under part B of such title XVIII; and
(C) would not, but for the provisions of, and amendments made by, subsection (a) be eligible for the guaranteed issue of a medicare supplemental policy under paragraph (2) or (3) of section 1882(s) of such Act (42 U.S.C. 1395ss(s).
(a) In General.--Section 1881(b)(3) of the Social Security Act (42 U.S.C. 1395rr(b)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively;
(2) in clause (ii), as redesignated by subparagraph (A), strike "on a comprehensive" and insert "subject to subparagraph (B), on a comprehensive";
(3) by striking "With respect to" and inserting "(A) With respect to"; and
(4) by adding at the end the following new subparagraph:
"(B) For purposes of subparagraph (A)(ii), an individual determined to have end-stage renal disease receiving home dialysis may choose to receive the monthly end-stage renal disease-related visits furnished on or after
(b) Originating Site Requirements.--
(1) In general.--Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended--
(A) in paragraph (4)(C)(ii), by adding at the end the following new subclauses:
"(IX) A renal dialysis facility, but only for purposes of section 1881(b)(3)(B).
"(X) The home of an individual, but only for purposes of section 1881(b)(3)(B)."; and
(B) by adding at the end the following new paragraph:
"(5) Treatment of home dialysis monthly esrd-related visit.--The geographic requirements described in paragraph (4)(C)(i) shall not apply with respect to telehealth services furnished on or after
(2) No facility fee if originating site for home dialysis therapy is the home.--Section 1834(m)(2)(B) of the
(A) by redesignating clauses (i) and (ii) as subclauses (I) and (II), and indenting appropriately;
(B) in subclause (II), as redesignated by subparagraph (A), by striking "clause (i) or this clause" and inserting "subclause (I) or this subclause";
(C) by striking "site.--With respect to" and inserting "site.--
"(i) In general.--Subject to clause (ii), with respect to"; and
(D) by adding at the end the following new clause:
"(ii) No facility fee if originating site for home dialysis therapy is the home.--No facility fee shall be paid under this subparagraph to an originating site described in paragraph (4)(C)(ii)(X).".
(c) Conforming Amendment.--Section 1881(b)(1) of the Social Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking "paragraph (3)(A)" and inserting "paragraph (3)(A)(i)".
(d) Exclusion From Remuneration for Purposes of Applying Civil Monetary Penalties.--
(1) In general.--Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 1320a-7a(i)(6)) is amended--
(A) in subparagraph (H)(iv), by striking "; or" at the end;
(B) in subparagraph (I), by striking the period at the end and inserting "; or"; and
(C) by adding at the end the following new subparagraph:
"(J) the provision of telehealth or remote patient monitoring technologies to individuals under title XVIII by a health care provider for the purpose of furnishing telehealth or remote patient monitoring services.".
(2) Effective date.--The amendments made by this subsection shall apply to services furnished on or after the date of the enactment of this Act.
TITLE III--IMPROVING PATIENT CARE AND ENSURING QUALITY OUTCOMES
(a) In General.--Section 1881(b)(14) of the Social Security Act (42 U.S.C. 1395rr(b)(14)) is amended--
[[Page S6227]]
(1) in subparagraph (D), in the matter preceding clause (i), by striking "Such system" and inserting "Subject to subparagraph (J), such system"; and
(2) by adding at the end the following new subparagraph: "(J) For payment for renal dialysis services furnished on or after
"(i) the payment adjustment described in clause (i) of subparagraph (D)--
"(I) shall not take into account comorbidities; and
"(II) shall only take into account age for purposes of distinguishing between individuals who are under 18 years of age and those who are 18 years of age and older but shall not include any other adjustment for age;
"(ii) the Secretary shall reassess any adjustments related to patient weight under such clause;
"(iii) the payment adjustment described in clause (ii) of such subparagraph shall not be included;
"(iv) the standardization factor described in the final rule published in the
"(v) take into account reasonable costs for determining the payment rate consistent with paragraph (2)(B).".
(b) Inclusion of Network Fee as an Allowable Cost.--Section 1881(b)(14) of the Social Security Act (42 U.S.C. 1395rr(b)(14)), as amended by subsection (a), is amended by adding at the end the following new subparagraph:
"(K) Not later than
(a) Measures.--Section 1881(h)(2) of the Social Security Act (42 U.S.C. 1395rr(h)(2)) is amended by adding at the end the following new subparagraphs:
"(F) Weighting limitation.--No single measure specified by the Secretary or individual measure within a composite measure so specified may be weighted less than 10 percent of the total performance score.
"(G) Statistically valid and reliable.--In specifying measures under subparagraph (A), the Secretary shall only specify measures that have been shown to be statistically valid and reliable through testing.".
(b) Endorsement.--Section 1881(h)(2)(B) of the Social Security Act (42 U.S.C. 1395rr(h)(2)(B)) is amended--
(1) in clause (ii), by adding at the end the following new sentence: "The exception under the preceding sentence shall not apply to a measure that the entity with a contract under section 1890(a) (or a similar entity) considered but failed to endorse."; and
(2) by adding at the end the following new clause:
"(iii) Composite measures.--Clauses (i) and (ii) shall apply to composite measures in the same manner as such clauses apply to individual measures.".
(c) Requirements for Dialysis Facility Compare Star Rating Program.--Section 1881(h)(6) of the Social Security Act (42 U.S.C. 1395rr(h)(6)) is amended by adding at the end the following new subparagraph:
"(E) Requirements for any dialysis facility compare star rating program.--To the extent that the Secretary maintains a dialysis facility compare star rating program, under such a program the Secretary--
"(i) shall assign stars using the same methodology and total performance score results from the quality incentive program under this subsection;
"(ii) shall determine the stars using the same methodology used under such quality incentive program; and
"(iii) shall not use a forced bell curve when determining the stars or rebaselining the stars.".
(d) Hospitals Required to Provide Information.--Section 1881 of the Social Security Act (42 U.S.C. 1395rr) is amended by adding at the end the following new subsection:
"(i) Hospitals Required to Provide Information.--
"(1) In general.--The Secretary shall establish a process under which a hospital or a critical access hospital shall provide a renal dialysis facility with health and treatment information with respect to an individual who is discharged from the hospital or critical access hospital and who subsequently receives treatment at facility.
"(2) Elements.--Under the process established under paragraph (1)--
"(A) the request for the health information may be initiated by the individual prior to discharge or upon request by the renal dialysis facility after the patient is discharged; and
"(B) the information must be provided to the facility within 7 days of the request being made.".
(e) Incentive Payments.--Section 1881(h)(1) of the Social Security Act (42 U.S.C. 1395rr(h)(1)) is amended by adding at the end the following new subparagraph:
"(D) Incentive payments.--
"(i) In general.--In the case of a provider of services or a renal dialysis facility that the Secretary determines exceeds the attainment performance standards under paragraph (4) with respect to a year, the Secretary may make a bonus payment to the provider or facility (pursuant to a process established by the Secretary).
"(ii) Funding.--The total amount of bonus payments under clause (i) in a year shall be equal to the total amount of reduced payments in a year under subparagraph (A).
"(iii) No effect in subsequent years.--The provisions of subparagraph (C) shall apply to a bonus payment under this subparagraph in the same manner subparagraph (C) applies to a reduction under such subparagraph.".
(f) Effective Date.--The amendments made by this section shall apply to items and services furnished on or after
(a) In General.--Section 1861(ggg) of the Social Security Act (42 U.S.C. 1395x(ggg)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by inserting "or stage V" after "stage IV"; and
(B) in subparagraph (B), by inserting "or of a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)) assisting in the treatment of the individual's kidney condition" after "kidney condition"; and
(2) in paragraph (2)--
(A) by striking subparagraph (B); and
(B) in subparagraph (A)--
(i) by striking "(A)" after "(2)";
(ii) by striking "and" at the end of clause (i);
(iii) by striking the period at the end of clause (ii) and inserting "; and";
(iv) by redesignating clauses (i) and (ii) as subparagraphs (A) and (B), respectively; and
(v) by adding at the end the following:
"(C) a renal dialysis facility subject to the requirements of section 1881(b)(1) with personnel who--
"(i) provide the services described in paragraph (1); and
"(ii) is a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in subsection (aa)(5)).".
(b) Payment to Renal Dialysis Facilities.--Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following new paragraph:
"(15) 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.".
(c) Effective Date.--The amendments made by this section apply to kidney disease education services furnished on or after
(a) Certification.--
(1) In general.--Section 1865(a)(1) of the Social Security Act (42 U.S.C. 1395bb(a)(1)) is amended by striking "or the conditions and requirements under section 1881(b)".
(2) Effective date.--The amendment made by paragraph (1) shall take effect on the date of enactment of this Act and apply to a finding made on or after such date.
(b) Timing for Acceptance of Requests From Accreditation Organizations.--Not later than 6 months after the date of the enactment of this Act, the Secretary of
(a) Definition of Primary Care Services.--Section 331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 254d(a)(3)(D)) is amended by inserting "and includes renal dialysis services" before the period at the end.
(b) National Health Service Corps Scholarship Program.--
Section 338A(a)(2) of the Public Health Service Act (42 U.S.C. 254l(a)(2)) is amended by inserting ", including nephrology health professionals" before the period at the end.
(c) National Health Service Corps Loan Repayment Program.--
Section 338B(a)(2) of the Public Health Service Act (42 U.S.C. 254l-1(a)(2)) is amended by inserting ", including nephrology health professionals" before the period at the end.
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