Including certain additional services as self-care home dialysis support services under the Medicare program

(a)

In general

Section 1881(b)(9) of the Social Security Act (42 U.S.C. 1395rr(b)(9)) is amended—(1)in subparagraph (C), by striking and at the end;(2)by redesignating subparagraph (D) as subparagraph (F); (3)by inserting after subparagraph (C) the following new subparagraphs:

(D)beginning January 1, 2028, staff-assisted home dialysis respite care furnished to a patient in the place of residence used as such patient’s home (other than a skilled nursing facility or a nursing facility (as defined in section 1919(a)));(E)beginning January 1, 2028, renal mental health services furnished to a patient in the place of residence used as such patient’s home (other than a skilled nursing facility or a nursing facility (as defined in section 1919(a))); and

; and

(4)by adding at the end the following flush matter:

For purposes of subparagraph (D), the term staff-assisted home dialysis respite care means dialysis services furnished by qualified personnel to a patient dialyzing at home who is temporarily unable to competently dialyze at home independently during the 30-day period beginning on the first day that the patient initiates home dialysis (or, in the case of a patient whose temporary inability to competently dialyze is attributable to a physical limitation, at any time). For purposes of the preceding sentence, the term qualified personnel means a registered nurse, a licensed practical nurse, a certified patient care technician, or another qualified medical professional specified by the Secretary, who meets requirements (as determined by the Secretary) that ensure competency in patient care and modality usage, including completing training specific to staff-assisted home dialysis respite care as specified by the Secretary. For purposes of subparagraph (E), the term renal mental health services means services described in section 494.90(a)(6) of title 42, Code of Federal Regulations (or a successor regulation), furnished to a patient dialyzing at home during the 60-day period beginning on the first day that the patient initiates home dialysis by an individual who meets the standard specified in section 494.140(d) of title 42, Code of Federal Regulations (or a successor regulation).

(b)

Payment adjustments for certain self-care home dialysis support services

(1)

In general

Section 1881(b)(14) of the Social Security Act (42 U.S.C. 1395rr(b)(14)) is amended—(A)in subparagraph (D)—(i)in clause (iii), by striking and at the end;(ii)by redesignating clause (iv) as clause (vi); and(iii)by inserting after clause (iii) the following new clauses:

(iv)shall include a payment adjustment for staff-assisted home dialysis respite care (as described in paragraph (9)(D)) in accordance with subparagraph (J);(v)shall include a payment adjustment for renal mental health services (as described in paragraph (9)(E)) in accordance with subparagraph (K); and

; and

(B)by adding at the end the following new subparagraphs:

(J)(i)For purposes of subparagraph (D)(iv), subject to clause (ii), a payment adjustment shall be made for each session of staff-assisted home dialysis respite care (as described in paragraph (9)(D)) furnished during a year equal to the amount of the add-on per treatment adjustment for home and self-dialysis training furnished in 2025 (or, in the case of such care that is not furnished in a rural area (as defined for purposes of such subparagraph), 75 percent of such amount).(ii)In no case may a payment adjustment under subparagraph (D)(iv) be made for staff-assisted home dialysis respite care furnished to an individual—(I)for more than 20 sessions in a calendar year; or(II)on a day when such individual was not dialyzing at home.(iii)Any payment adjustment under subparagraph (D)(iv) for staff-assisted home dialysis respite care shall not be made in a budget neutral manner.(K)(i)For purposes of subparagraph (D)(v), subject to clause (ii), a payment adjustment shall be made for each session of renal mental health services (as described in paragraph (9)(E)) furnished during a year equal to 50 percent (or 25 percent, in the case of such services that are not furnished in a rural area (as defined for purposes of subparagraph (D))) of the amount of the add-on per treatment adjustment for home and self-dialysis training furnished in 2025.(ii)In no case may a payment adjustment under subparagraph (D)(v) be made for renal mental health services furnished to an individual—(I)for more than 4 sessions occurring during the 60-day period beginning on the first day that the individual initiates home dialysis; or(II)on a day when such individual was not dialyzing at home.(iii)Any payment adjustment under subparagraph (D)(v) for renal mental health services shall not be made in a budget neutral manner.

(2)

Conforming amendment

Section 1834(r)(1) of the Social Security Act (42 U.S.C. 1395m(r)(1)) is amended by striking subparagraph (D)(iv)(II) and inserting subparagraph (D)(vi)(II).