BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SJR 9
---------------------------------------------------------------
|AUTHOR: |Stone |
|---------------+-----------------------------------------------|
|VERSION: |May 22, 2015 |
---------------------------------------------------------------
---------------------------------------------------------------
|HEARING DATE: |June 24, 2015 | | |
---------------------------------------------------------------
---------------------------------------------------------------
|CONSULTANT: |Juan Reyes |
---------------------------------------------------------------
SUBJECT : The Chronic Kidney Disease Improvement in Research and
Treatment Act
SUMMARY : Urges the President and the Congress of the United States to
enact the Chronic Kidney Disease Improvement in Research and
Treatment Act (HR 1130). Makes other findings and declarations
about the prevalence, risks, and research efforts of chronic
kidney disease.
This resolution declares the following:
1)Approximately 50 years ago, kidney failure was a death
sentence.
2)In 1972, Congress developed the Medicare End-Stage Renal
Disease benefit. In doing so, Congress ensured that regardless
of age or income, any American would have access to
life-saving dialysis care. That was the turning point in
kidney care.
3)The Chronic Kidney Disease Improvement in Research and
Treatment Act (HR 1130) was introduced in the House of
Representatives by Representative Tom Marino to address kidney
disease care.
4)House Resolution 1130 is built on three primary tenets. First,
for individuals living with chronic diseases, especially when
those diseases are complicated by multiple comorbid
conditions, coordinated care is key to improving outcomes and
lowering health care costs. Second, increased research can
lead to a deeper understanding of kidney disease prevention
and ultimately to significant innovations in treatment.
Lastly, stability in the Medicare program is central to an
end-stage renal disease program that ensures quality and
SJR 9 (Stone) Page 2 of ?
produces optimal results.
5)If left untreated, chronic kidney disease (CKD) can progress
to kidney failure, also known as end-stage renal disease, and
early cardiovascular death.
6)More than 20 million adults in the United States, or more than
10% of the adult population, are estimated to have CKD and
most are undiagnosed.
7)Kidney disease is the ninth leading cause of death in the
United States.
8)In the United States, diabetes and [sic] are the leading
causes of kidney failure, accounting for 72% or about three
out of four new cases of kidney failure.
9)The number of kidney failure cases in the United States
population has more than tripled since 1990 and is expected to
grow because of an aging population and the increasing number
of people with conditions, such as diabetes and high blood
pressure, that place them at the risk of developing CKD.
FISCAL
EFFECT : This resolution is keyed non-fiscal.
COMMENTS :
1)Author's statement. According to the author, kidney diseases
are the ninth leading cause of death in the U.S. More than 20
million adults in the U.S., or more than 10% of the adult
population, are estimated to have CKD. Most cases are
undiagnosed. SJR 9 urges Congress, which created the Medicare
End-Stage Renal Disease benefit back in 1972, to further the
goal of treating and curing CKDs by passing HR 1130.
2)Chronic Kidney Disease. According to the National Kidney
Foundation, CKD is a condition characterized by a gradual loss
of kidney function over time in which bodily wastes are not
properly excreted from the body. Increased levels of waste
can develop into other debilitating symptoms, such as
hypertension, anemia, nerve damage, and poor nutritional
health. According to DaVita, CKD progresses over a period of
years across five stages, stages defined by the level of
functionality of the kidneys. According to the National
Institute of Health's National Library of Medicine, diabetes
and high blood pressure are the leading causes of kidney
SJR 9 (Stone) Page 3 of ?
failure.
3)HR 1130. HR 1130, introduced in February of this year, is
currently pending in the House Committee on Energy and
Commerce, specifically the Subcommittee on Health. HR 1130
includes three provisions that aim to lessen the severity of
the ninth leading cause of death in the U.S. - CKD.
The first provision is an effort to improve the understanding
of CKD through expanded research and coordination.
Specifically:
a) Requires the Comptroller General to submit a report
to Congress assessing the adequacy of federal funding in
CKD research. The report shall include:
i. Analysis of the current kidney research
projects currently funded by federal monies;
ii. Identification of knowledge gaps in areas
of CKD research;
iii. The amount of federal funding on CKD
research as compared to the amount of federal
funding to treat individuals with CKD; and,
iv. Identification of knowledge gaps in
research to assess treatment patterns associated
with providing care to minority populations that are
disproportionately affected by kidney failure.
b) Requires the Department of Health and Human Services
Agency (HHS) to establish an interagency committee
responsible for improving the coordination of CKD
research. The committee will issue reports that include
recommendations for communication and coordination among
federal agencies, procedures for monitoring Federal CKD
research activities, and ways to maximize the efficiency
of the federal CKD research investment and minimize the
potential for unnecessary duplication.
c) Requires the Secretary of HHS to issue a complete
study on:
i. The social, behavioral, and biological
factors leading to kidney disease;
ii. Efforts to slow the progression of kidney
disease in minority populations that are
SJR 9 (Stone) Page 4 of ?
disproportionately affected by such disease; and
iii. Treatment patterns associated with
providing care, under the Medicare program, the
Medicaid program, and through private health
insurance, to minority populations that are
disproportionately affected by kidney failure.
The second provision is an effort to promote access to CKD
treatments. In order to do so, HR 1130 will allow dialysis
facilities to provide kidney disease education services and
will allow physician assistants, nurse practitioners, or
clinical nurse specialists to refer individuals to those
services. Similarly, HR 1130 aims to improve access to CKD
treatment in underserved and rural areas by including dialysis
as a service provided by the National Health Service Corps in
health professional shortage areas.
The third provision is an effort to create economic stability
for providers caring for individuals with CKD. Specifically,
HR 1130 revises Medicare payments for dialysis services
provided to individuals with end stage renal disease and acute
kidney injury by ensuring that payment adjustments will not
take into account comorbidities. Additionally, the time by
which private health insurers shall not consider a group
health plan enrollee's end stage renal disease in determining
benefits is extended to a 42 month period prior to the date in
which services are furnished beginning on or after January 1,
2016. Lastly, requires HHS, no later than January 1, 2017, to
establish an ESRD Care Coordination gainsharing program for
nephrologists, renal dialysis facilities, and providers of
services that develop coordinated care organizations to
provide a full range of clinical and supportive services to
individuals determined to have end stage renal disease.
4)Support. DaVita, the sponsor of the resolution, states that
recognition of CKD as a major health care challenge is at an
all-time high among medical experts, health policy makers,
numerous health-centered non-profit organizations and the
American public. The California Dialysis Council (Council)
states that while medical advancements have permitted kidney
failure to no longer be a death sentence for patients, those
living with CKD still face very difficult medical procedures
and treatment options. Council states that medical research
and advances are needed concerning CKD.
SJR 9 (Stone) Page 5 of ?
5)Amendments. On page 2, line 15:
"WHEREAS, In the United States, diabetes and high blood
pressure are the leading?"
SUPPORT AND OPPOSITION :
Support: DaVita (sponsor)
California Dialysis Council
Oppose: None received.
-- END --