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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8075 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 8075
To amend title XVIII of the Social Security Act to provide for Medicare
coverage of staff-assisted home dialysis for certain hemodialysis and
peritoneal dialysis patients and to ensure all patients are educated on
modality options and receive the resources, information, and support to
succeed on the modality of their choice, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 18, 2024
Mrs. Miller of West Virginia (for herself, Mrs. Miller-Meeks, Ms.
Strickland, and Mr. Blumenauer) 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 concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for Medicare
coverage of staff-assisted home dialysis for certain hemodialysis and
peritoneal dialysis patients and to ensure all patients are educated on
modality options and receive the resources, information, and support to
succeed on the modality of their choice, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Access to Home Dialysis
Act of 2024''.
SEC. 2. PROVIDING FOR STAFF-ASSISTED HOME DIALYSIS FOR CERTAIN
HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS.
(a) In General.--Section 1881(b)(14) of the Social Security Act (42
U.S.C. 1395rr(b)(14)) is amended by adding at the end the following new
subparagraph:
``(J)(i) With respect to staff-assisted home
dialysis (as defined in clause (iv)(IV)) furnished on
or after the date that is 1 year after the date of the
enactment of this subparagraph, subject to the
succeeding provisions of this subparagraph, the
Secretary shall increase the single payment that would
otherwise apply under this paragraph for renal dialysis
services by the add-on payment amount established
pursuant to clause (iii).
``(ii)(I) Subject to subclause (II), staff-assisted
home dialysis may only be furnished--
``(aa) with respect to an initializing
patient (as defined in clause (iv)(I)) or a
returning patient (as defined in clause
(iv)(III)), for a period of up to 90 days,
referred to as the `initial period', which may
be extended as determined necessary by the care
team of the individual in not more than 2
intervals of up to 30 days each, each of which
is referred to as an `extended interval'; and
``(bb) with respect to a temporary
assistance patient (as defined in clause
(iv)(V)), for any 30-day period as determined
necessary by the care team of the individual,
notwithstanding whether such an individual
receives any routine dialysis respite care
during such period.
``(II) Notwithstanding subclause (I), staff-
assisted home dialysis may be furnished for as long as
the Secretary determines appropriate to an individual
who--
``(aa) is blind;
``(bb) has a cognitive or neurological
impairment (including a stroke, Alzheimer's,
dementia, amyotrophic lateral sclerosis, or any
other impairment determined by the Secretary);
or
``(cc) has any other illness or injury that
reduces mobility (including cerebral palsy,
spinal cord injuries, patients on a ventilator,
or any other illness or injury determined by
the Secretary).
``(iii) The Secretary shall, by regulation,
establish an add-on payment amount for staff-assisted
home dialysis to determine the amounts payable to a
qualified provider for assisting in the furnishing of
staff-assisted home dialysis on a frequency as
determined by the Secretary and in consultation with
clinicians, patients, and care partners to ensure
maximum patient choice, access, and flexibility. In
establishing the add-on payment under this clause, the
Secretary shall consult with stakeholders, including
providers of renal dialysis services, individuals
receiving home dialysis, qualified providers (as
defined in clause (iv)(II)), private insurance payers,
and Medicare Advantage plans under part C.
``(iv) In this subparagraph:
``(I) The term `initializing patient' means
an individual who initiates a home dialysis
modality, including home hemodialysis and
peritoneal dialysis.
``(II) The term `qualified provider' means
a trained professional (as determined by the
Secretary, including a registered or licensed
practical nurse and a certified patient care
technician) who--
``(aa) furnishes renal dialysis
services;
``(bb) meets requirements (as
determined by the Secretary) that
ensure competency in patient care and
modality usage; and
``(cc) during a period described in
clause (ii)(I), provides in-person
assistance to an individual for an
appropriate number of dialysis
sessions, as determined by the care
team of the individual based on the
needs of the individual, caregiver
availability, prescription, and mode of
home dialysis.
``(III) The term `returning patient' means
an individual who is returning to home dialysis
after a period of hospitalization or other non-
home dialysis modality.
``(IV)(aa) The term `staff-assisted home
dialysis' means dialysis furnished by the
individual in a home, residence, or other
approved setting with the assistance of a
qualified provider, the frequency of which is
determined by the qualified provider in
coordination with the individual, the care
partner, and the care team of the individual
and outlined in a patient plan of care.
``(bb) In this subclause, the term `care
partner' means a friend or family member who is
designated by the individual who is trained to
assist the individual with the furnishing of
home dialysis.
``(cc) In this subclause, the term `patient
plan of care' has the meaning given such term
in section 494.90 of title 42, Code of Federal
Regulations (or any successor regulations).
``(V) The term `temporary assistance
patient' means an individual who is receiving
home dialysis and is temporarily unable to
perform functions necessary to home dialysis
due to illness, injury, caregiver
unavailability, or other temporary
circumstances not to exceed 30 days.''.
(b) Patient Education and Training Relating to Staff-Assisted Home
Dialysis.--
(1) In general.--Section 1881(b)(5) of the Social Security
Act (42 U.S.C. 1395rr(b)(5)) is amended--
(A) in subparagraph (C), by striking at the end
``and'';
(B) in subparagraph (D), by striking the period at
the end and inserting a semicolon; and
(C) by adding at the end the following new
subparagraphs:
``(E) educate individuals on the opportunity to
receive staff-assisted home dialysis (as defined in
paragraph (14)(J)(iv)(IV)) during the periods described
in paragraph (14)(J)(ii); and
``(F) provide for registered or licensed nurses,
certified patient care technicians, or other qualified
providers (as determined by a physician) to train
individuals and their care partners in skills and
procedures needed to furnish staff-assisted home
dialysis, including--
``(i) in a group-training environment with
other individuals and their care partners when
appropriate and in accordance with the Federal
regulations (concerning the privacy of
individually identifiable health information)
promulgated under section 264(c) of the Health
Insurance Portability and Accountability Act of
1996;
``(ii) via telehealth (following an initial
period of in-person competency training, in
accordance with standards specified by the
Secretary);
``(iii) through interdisciplinary team
training (as described in the interpretive
guidance relating to tag number V590 of
`Advance Copy--End Stage Renal Disease (ESRD)
Program Interpretive Guidance Version 1.1'
(published on October 3, 2008)); and
``(iv) in the home or residence of an
individual, in a dialysis facility, in a stand-
alone training facility, or the place in which
the individual has been approved to perform
home dialysis by the care team.''.
(2) Effective date.--The amendments made by this subsection
shall take effect on the date that is one year after the date
of the enactment of this Act.
(c) Other Provisions.--
(1) Anti-kickback statute.--Section 1128B(b)(3) of the
Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
(A) by moving subparagraphs (J) and (K) 2 ems to
the left;
(B) in subparagraph (K), by striking ``and'' at the
end;
(C) in subparagraph (L), by striking the period at
the end and inserting ``; and''; and
(D) by adding at the end the following new
subparagraph:
``(M) any remuneration relating to the furnishing of staff-
assisted home dialysis (as defined in section
1881(b)(14)(J)(iv)(IV)).''.
(2) Study.--Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall submit, to the Committee on Finance of the Senate and the
Committees on Energy and Commerce and Ways and Means of the
House of Representatives, a report that--
(A) examines racial disparities in the utilization
of home dialysis (as defined in section
1881(b)(14)(J)(iv)(IV) of the Social Security Act (42
U.S.C. 1395rr(b)(14)(J)(iv)(IV)), as added by
subsection (a)), and makes recommendations on how to
improve access to home dialysis for communities of
color;
(B) examines coverage for, and utilization of, home
dialysis in rural communities, and makes
recommendations on how to improve access to home
dialysis for such rural communities; and
(C) analyzes clinical and quality of life outcomes
for patients, disaggregated by geographic and
demographic indicators, who receive different dialysis
modalities, including staff-assisted home dialysis,
unassisted home dialysis, and dialysis furnished in a
facility.
(3) Patient decision tool.--Not later than December 31,
2025, for the purposes of section 1881(b)(14)(J)) of the Social
Security Act (42 U.S.C. 1395rr(b)(14)(J)), as added by
subsection (a), the Secretary shall convene a patient panel to
develop a patient-centered decision tool to assist dialysis
patients in evaluating their lifestyle and goals and in
choosing the dialysis setting and modality. Such tool shall
include an acknowledgment that the patient is capable of home
dialysis and wants home dialysis, if that is the modality such
patient chooses.
(4) Patient quality of life metric.--Section
1881(h)(2)(A)(iv) of the Social Security Act (42 U.S.C.
1395rr(h)(2)(A)(iv)) is amended--
(A) in subclause (II), by striking ``and'' at the
end;
(B) in subclause (III), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(IV) patient quality of life for
all individuals utilizing dialysis
regardless of modality, with the intent
of measuring and improving patient
quality of life on dialysis.''.
<all>
Introduced in House
Introduced in House
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 concerned.
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 concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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