HISTORY OF ESRD REFORM
HOW THE MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT BECAME LAW IN THE 110TH CONGRESS Pub.L.No.110-275

February 27, 2007
Representatives John Lewis (D-GA) and Dave Camp (R-MI) and Senator Kent Conrad (D-ND) introduced the “Kidney Care Quality and Education Act” (H.R. 1193 / S. 691). The bill would:

• create public and patient education initiatives to increase awareness about chronic kidney disease (CKD) and to help patients learn self-management skills;
• establish a three-year Quality Initiative that would reward quality improvement and attainment based on a composite score for measures developed in cooperation with the kidney care community;
• provide Medicare coverage for CKD education services for Medicare-eligible patients; establish a uniform training for patient care dialysis technicians;
• seek to understand the barriers to the adoption of different treatment modalities by patients; and
• link the need for an annual update mechanism for the Medicare ESRD composite rate with an improved quality system.

July 13, 2007
Representatives John Lewis (D-GA) and Dave Camp Senators Max Baucus (D-MT), Chuck Grassley (R-IA), Jay Rockefeller (D-WV), and Orrin Hatch (R-UT) announced an agreement to reauthorize and expand the State Children’s Health Insurance Program (SCHIP), which expires on September 30.

July 24, 2007
Representative John Dingell (D-MI) introduced the “Children's Health and Medicare Protection (CHAMP) Act of 2007” (H.R. 3162). The bill includes provisions to reauthorize SCHIP and make reforms within Medicare, including the ESRD program.

August 1, 2007
The House approved the CHAMP Act by a vote of 225-204 primarily along party lines.

August 2, 2007
The Senate passed its SCHIP Reauthorization legislation, by 68-31 – a veto proof majority. The legislation does not contain any Medicare provisions.

September 2007
The House Leadership indicated that the Chamber would adopt an SCHIP proposal that closely resembles the Senate bill, which was funded by a 61-cent increase on the federal tobacco excise tax. The Medicare provisions in the House CHAMP Act were put off for consideration in a Senate bill at a later date.

October and November 2007
The Senate Finance Committee continued negotiations on a Medicare package.

December 18, 2007
The Senate introduced and passed the “Medicare, Medicaid, and SCHIP Extension Act of 2007” (S. 2499) by unanimous consent, providing a six-month delay in the implementation of physician payment cuts. The narrow package did not include ESRD reforms.

December 19, 2007
The short-term Medicare package was also passed by the House of Representatives under Suspension of the Rules.

December 29, 2007
The President signed S. 2499 into law – Pub. L. No.
110-173.

June 9, 2008
Senate Finance Committee Chairman Max Baucus (D-MT) introduced the “Medicare Improvements for Patients and Providers Act of 2008” (S. 3101). The bill was introduced with Senators John Rockefeller (D-WV), Olympia Snowe (R-ME), and Gordon Smith (R-OR). The bill included an 18-month physician payment fix and critical ESRD reforms, including educational provisions will raise awareness of kidney disease and help those diagnosed with it to delay the onset of kidney failure and an automatic inflation adjustment to ensure that providers can meet essential staffing demands.

June 11, 2008
Senate Finance Committee Ranking Member Charles Grassley (R-IA) introduced a Republican Medicare package, the “Preserving Access to Medicare Act of 2008” (S. 3118). The ESRD provisions included were similar to those in S. 3101.

June 12, 2008
The Senate blocked debate on the Democrats’ Medicare bill. The Senate fell six votes short of the 60 votes required. Nine Republicans voted in favor of cloture, including Senators Norm Coleman (MN), Susan Collins (ME), Elizabeth Dole (NC), Lisa Murkowski (AK), Pat Roberts (KS), Gordon Smith (OR), Olympia Snowe (ME), Arlen Specter (PA), and Ted Stevens (AK). Five Democrats and two Republicans did not vote – Senators Hillary Clinton (NY), Dan Inouye (HI), Ted Kennedy (MA), Mary Landrieu (LA), and Barack Obama (IL), and Republicans John Sununu (NH) and John McCain (AZ). Majority Leader Reid blocked Senate Minority Leader Mitch McConnell’s efforts to bring the Republican Medicare package authored by Senator Grassley to the floor.

June 20, 2008
House Ways and Means Committee Chairman Charlie Rangel (D-NY) and House Energy and Commerce Committee Chairman John Dingell (D-MI) introduced a Medicare package in the House. The “Medicare Improvements for Patients and Providers Act of 2008” (H.R. 6331) built upon Chairman Baucus’ bill and includes identical ESRD provisions.

June 24, 2008
The House passed by a veto-proof majority of 355-59 H.R.
6331.

June 24, 2008
The House passed by a veto-proof majority of 355-59 H.R.
6331.

June 26, 2008
The Senate fell one vote short of the 60 required to achieve cloture on the House-passed bill. Republican Senators Norm Coleman (MN), Susan Collins (ME), Elizabeth Dole (NC), Lisa Murkowski (AK), Pat Roberts (KS), Gordon Smith (OR), Olympia Snowe (ME), Ted Stevens (AK), and George Voinovich (OH) joined the Democrats in voting in favor of cloture.

June 30, 2008
The short-term physician payment fix expired.

July 9, 2008
The Senate again voted on the motion to proceed to consider H.R. 6331. In a surprise move, Senator Ted Kennedy (D-MA) returned for the first time since his surgery to vote in favor of cloture on the bill. Having reached the necessary 60 votes to invoke cloture, nine Republicans, who previously voted against cloture, voted in favor of the motion. The votes of Senators Kay Bailey Hutchison (TX), Johnny Isakson (GA), Saxby Chambliss (GA), Mel Martinez (FL), John Warner (VA), Bob Corker (TN), Arlen Specter (PA), John Cornyn (TX), and Lamar Alexander (TN) enabled the Senate to pass the Medicare package by 69-30, a veto-proof margin. The legislation passed the Senate by Unanimous Consent without amendment.

July 15, 2008
As expected, President Bush vetoed H.R. 6331, noting his objections to changes affecting Medicare Advantage (MA) plans and the Medicare prescription drug program.

July 15, 2008
Both the House and Senate voted to override the President’s veto. The House voted by a margin of 383-41, and the Senate voted 70-26. This was only the fourth veto override of the Bush Administration. The kidney care provisions are enacted in Pub. L. No.
110-275!

Medicare Improvements for Patients and Providers Act of 2008
Section by Section Summary

ROLL CALL VOTING OF H.R. 6331

H.R. 6331 - Roll Call Vote 443 (U.S. House of Representatives)

H.R. 6331 - Roll Call Vote 491 – Veto Override (U.S. House of Representatives)

H.R. 6331 - Roll Call Vote 177 - Veto Override (U.S. Senate)

KIDNEY CARE QUALITY AND EDUCATION ACT (S.691/H.R. 1193) BACKGROUND AND HISTORY