HR 1245 IHCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to provide coverage for kidney disease education services under the Medicare Program, and for other purposes.CommentsClose CommentsPermalink

February 28, 2007

Mr. KIRK (for himself and Mr. MCDERMOTT) 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 concernedCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to provide coverage for kidney disease education services under the Medicare Program, and for other purposes.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE.

This Act may be cited as the `Kidney Disease Educational Benefits Act of 2007'.CommentsClose CommentsPermalink

SEC. 2. MEDICARE COVERAGE OF KIDNEY DISEASE EDUCATION SERVICES.

(a) Coverage of Kidney Disease Education Services-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--CommentsClose CommentsPermalink





(A) in subsection (s)(2)--CommentsClose CommentsPermalink





(i) in subparagraph (Z), by striking `and' at the end;CommentsClose CommentsPermalink





(ii) in subparagraph (AA), by adding `and' at the end; andCommentsClose CommentsPermalink





(iii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(BB) kidney disease education services (as defined in subsection (ccc));'; andCommentsClose CommentsPermalink





(B) by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(ccc) Kidney Disease Education Services- (1) The term `kidney disease education services' means educational services that are--CommentsClose CommentsPermalink





`(A) furnished to an individual with kidney disease who, according to accepted clinical guidelines identified by the Secretary, will require dialysis or a kidney transplant;CommentsClose CommentsPermalink





`(B) furnished, upon the referral of the physician managing the individual's kidney condition, by a qualified person (as defined in paragraph (2)); andCommentsClose CommentsPermalink





`(C) designed--CommentsClose CommentsPermalink





`(i) to provide comprehensive information regarding--CommentsClose CommentsPermalink





`(I) the management of comorbidities;CommentsClose CommentsPermalink





`(II) the prevention of uremic complications; andCommentsClose CommentsPermalink





`(III) each option for renal replacement therapy (including home and in-center, as well as vascular access options and transplantation); andCommentsClose CommentsPermalink





`(ii) to ensure that the individual has the opportunity to actively participate in the choice of therapy.CommentsClose CommentsPermalink





`(2) The term `qualified person' means--CommentsClose CommentsPermalink





`(A) a physician (as described in subsection (r)(1));CommentsClose CommentsPermalink





`(B) an individual who--CommentsClose CommentsPermalink





`(i) is--CommentsClose CommentsPermalink





`(I) a registered nurse;CommentsClose CommentsPermalink





`(II) a registered dietitian or nutrition professional (as defined in subsection (vv)(2));CommentsClose CommentsPermalink





`(III) a clinical social worker (as defined in subsection (hh)(1));CommentsClose CommentsPermalink





`(IV) a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)); orCommentsClose CommentsPermalink





`(V) a transplant coordinator; andCommentsClose CommentsPermalink





`(ii) meets such requirements related to experience and other qualifications that the Secretary finds necessary and appropriate for furnishing the services described in paragraph (1); orCommentsClose CommentsPermalink





`(C) a renal dialysis facility subject to the requirements of section 1881(b)(1) with personnel who--CommentsClose CommentsPermalink





`(i) provide the services described in paragraph (1); andCommentsClose CommentsPermalink





`(ii) meet the requirements of subparagraph (A) or (B).CommentsClose CommentsPermalink





`(3) The Secretary shall develop the requirements under paragraph (2)(B)(ii) after consulting with physicians, health educators, professional organizations, accrediting organizations, kidney patient organizations, dialysis facilities, transplant centers, network organizations described in section 1881(c)(2), and other knowledgeable persons.CommentsClose CommentsPermalink





`(4) In promulgating regulations to carry out this subsection, the Secretary shall ensure that each beneficiary who is entitled to kidney disease education services under this title receives such services in a timely manner that ensures that the beneficiary receives the maximum benefit of those services.CommentsClose CommentsPermalink





`(5) The Secretary shall monitor the implementation of this subsection to ensure that beneficiaries who are eligible for kidney disease education services receive such services in the manner described in paragraph (4).CommentsClose CommentsPermalink





`(6) No individual shall be eligible to be provided more than 6 sessions of kidney disease education services under this title.'.CommentsClose CommentsPermalink





(2) PAYMENT UNDER PHYSICIAN FEE SCHEDULE- Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(BB),', after `(2)(AA),'.CommentsClose CommentsPermalink





(3) 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:CommentsClose CommentsPermalink





`(14) For purposes of paragraph (12), the single composite weighted formulas determined under such paragraph shall not take into account the amount of payment for kidney disease education services (as defined in section 1861(ccc)). Instead, payment for such services shall be made to the renal dialysis facility on an assignment-related basis under section 1848.'.CommentsClose CommentsPermalink





(4) LIMITATION ON NUMBER OF SESSIONS- Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--CommentsClose CommentsPermalink





(A) by striking `and' at the end of subparagraph (M);CommentsClose CommentsPermalink





(B) by striking the semicolon at the end of subparagraph (N) and inserting `, and'; andCommentsClose CommentsPermalink





(C) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(O) in the case of kidney disease education services (as defined in section 1861(ccc)), which are performed in excess of the number of sessions covered under such section;'.CommentsClose CommentsPermalink





(5) ANNUAL REPORT TO CONGRESS- Not later than April 1, 2008, and annually thereafter, the Secretary of Health and Human Services shall submit to Congress a report on the number of medicare beneficiaries who are entitled to kidney disease education services (as defined in section 1861(ccc) of the Social Security Act, as added by paragraph (1)) under title XVIII of such Act and who receive such services, together with such recommendations for legislative and administrative action as the Secretary determines to be appropriate to fulfill the legislative intent that resulted in the enactment of that subsection.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by this section shall apply to services furnished on or after January 1, 2008.CommentsClose CommentsPermalink