; and (2) by adding at the end the following new sentence: Effective for items and services furnished on or after January 1, 2018 (with respect to periods beginning on or after the date that is 42 months prior to such date), clauses (i) and (ii) shall be applied by substituting 42-month for 12-month each place it appears. . (b) Effective date The amendments made by this subsection shall take effect on the date of enactment of this Act. For purposes of determining an individual’s status under section 1862(b)(1)(C) of the Social Security Act ( 42 U.S.C. 1395y(b)(1)(C) ), as amended by subsection (a), an individual who is within the coordinating period as of the date of enactment of this Act shall have that period extended to the full 42 months described in the last sentence of such section, as added by the amendment made by subsection (a)(2). III Improving patient care and ensuring quality outcomes 301. Maintain an economically stable dialysis infrastructure (a) In general Section 1881(b)(14) of the Social Security Act ( 42 U.S.C. 1395rr(b)(14) ) is amended— (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 January 1, 2018, under the system under this paragraph— (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