[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5426 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 5426
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
September 29, 2021
Mr. Rush (for himself and Mr. Smith of Missouri) 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 2021''.
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) For services furnished on or after the
date which is 1 year after the date of the enactment of
this subparagraph which are staff-assisted home
dialysis (as defined in clause (iv)(III)), the
Secretary shall increase the single payment that would
otherwise apply under this paragraph for renal dialysis
services furnished to new and respite individuals in
accordance with the payment system established under
clause (iii) by qualified providers.
``(ii)(I) Subject to subclause (II), staff-assisted
home dialysis may only be furnished during--
``(aa) with respect to an individual
described in subclause (iv)(I)(aa), one 90-day
period which may be renewed up to two 30-day
periods; and
``(bb) with respect to an individual
described in subclause (iv)(I)(bb) and
notwithstanding whether such an individual
receives any respite care under part A, any 30-
day period.
``(II) Notwithstanding the limits described in
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, or any other illness or
injury determined by the Secretary).
``(iii) The Secretary shall establish a prospective
payment system through regulations to determine the
amounts payable to qualified providers for staff-
assisted home dialysis. In establishing such system,
the Secretary may consider--
``(I) the costs of furnishing staff-
assisted home dialysis;
``(II) consultations with dialysis
providers, dialysis patients, private payers,
and MA plans;
``(III) payment amounts for similar items
and services under parts A and B; and
``(IV) payment amounts established by MA
plans under part C, group health plans, and
health insurance coverage offered by health
insurance issuers.
``(iv) In this subparagraph:
``(I) The term `new and respite individual'
means an individual described in subsection (a)
who is either--
``(aa) initiating either peritoneal
or home hemodialysis; or
``(bb) receiving home dialysis and
is unable to self-dialyze due to
illness, injury, caregiver issues, or
other temporary circumstances.
``(II) The term `qualified provider' means
a trained professional (as determined by the
Secretary, including nurses and certified
patient technicians) who furnishes renal
dialysis services and--
``(aa) meets requirements (as
determined by the Secretary) that
ensures competency in patient care and
modality usage; and
``(bb) provides in-person
assistance to a patient for at least 75
percent of staff-assisted home dialysis
sessions during a period described in
clause (ii)(i).
``(III)(aa) The term `staff-assisted home
dialysis' means home dialysis using trained
professionals to assist individuals who have
been determined to have end stage renal
disease, and the frequency of such home
dialysis is determined by such professionals in
coordination with the patient and his or her
care partner, and outlined in a patient plan of
care.
``(bb) In this subclause, the term `care
partner' means anyone who is designated by the
patient who assists 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.''.
(b) Patient Education and Training Relating to Staff-Assisted Home
Dialysis.--Section 1881(b)(5) of the Social Security Act (42 U.S.C.
1395rr(b)(5)) is amended--
(1) in subparagraph (C), by striking at the end ``and'';
(2) in subparagraph (D), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new subparagraphs:
``(D) educate patients of the opportunity to
receive staff-assisted home dialysis (as defined in
paragraph (14)(J)(iv)(III)) during the period beginning
30 days after the first day such facility furnishes
renal dialysis services to an individual and ending 60
days after such day; and
``(E) provide for nurses, certified patient
technicians, or other professionals to train patients
and their care partners in skills and procedures needed
to perform home dialysis (as defined in paragraph
(14)(J)(iv)(III)) treatment--
``(i) regularly and independently;
``(ii) through telehealth services or
through group 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)) 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; and
``(iii) in the home or resident of a
patient, in a dialysis facility, or the place
in which the patient intends to receive staff-
assisted home dialysis.''.
(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) in subparagraph (J), by striking at the end
``and'';
(B) in subparagraph (K), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(L) any remuneration relating to the furnishing
of staff-assisted home dialysis (as defined in section
1881(b)(14)(J)(iv)(III)).''.
(2) CMI model.--Section 1115A(b)(2)(B) of the Social
Security Act (42 U.S.C. 1320b-(b)(2)(B)) is amended by adding
at the end the following new clause:
``(xxviii) Making payment to anyone who is
designated by a patient who receives staff-
assisted home dialysis (as defined in section
1881(b)(14)(J)(iv)(III)) and otherwise meets
the requirements (as determined by the
Secretary), notwithstanding whether an
individual is a qualified provider (as defined
in section 1881(b)(14)(J)(iv)(II)) or otherwise
eligible for reimbursement under title
XVIII.''.
(3) Study.--Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall submit to the Committee on Energy and Commerce
of the House of Representatives and the Committee on Finance of
the Senate a report that examines racial disparities in the
utilization of the home dialysis defined in section
1881(b)(14)(J)(iv)(III) of the Social Security Act (42 U.S.C.
1395rr(b)(14)(J)(iv)(III)) and make recommendations on how to
improve access to such dialysis for communities of color.
(4) Patient decision tool.--Not later than December 31,
2023, for the purpose of section 1881(b)(14)(J) of the Social
Security Act (42 U.S.C. 1395rr(b)(14)(J)), the Secretary of
Health and Human Services shall convene a patient panel to
create a patient-centered decision tool for dialysis patients
to evaluate their lifestyle and goals and be assisted in
choosing the dialysis modality that best suits them. This tool
should include an acknowledgment that they are capable of home
dialysis and want home dialysis, if that is the modality they
choose.
(5) Patient quality of life metric.--Section 1115A(b)(2)(B)
of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is
amended by adding at the end the following new subparagraph:
``(i) A patient quality of life metric for
all patients utilizing dialysis regardless of
modality with the intent of measuring and
improving patient quality of life on
dialysis.''.
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