[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>