This bill adds two types of services to Medicare’s list of self-care home dialysis support services, starting January 1, 2028: (1) staff-assisted home dialysis respite care and (2) renal mental health services. It defines who can provide each service, when the services may be used, and how Medicare payment add-ons will be calculated and limited.
Staff-assisted home dialysis respite care means a qualified person (for example, a registered nurse, licensed practical nurse, certified patient care technician, or another medical professional the Secretary specifies) gives dialysis to a patient at the patient’s home when the patient cannot safely dialyze alone during a 30-day period that begins when the patient starts home dialysis (or at any time if the inability is due to a physical limitation). Training requirements for the personnel are set by the Secretary.
Renal mental health services are the services named in 42 C.F.R. 494.90(a)(6) and must be provided during the first 60 days after a patient starts home dialysis by someone who meets the standard in 42 C.F.R. 494.140(d).
The bill requires Medicare payment adjustments (add-ons) for each session of these services. For staff-assisted respite care, the per-session add-on equals the 2025 add-on per treatment amount for home and self-dialysis training (75 percent of that amount if the care is not furnished in a rural area). Payments are limited to 20 sessions per calendar year and only on days the patient is dialyzing at home. For renal mental health services, the per-session add-on equals 50 percent of the 2025 add-on per treatment amount (25 percent if not in a rural area). Payments are limited to 4 sessions during the 60-day initiation period and only on days the patient is dialyzing at home. The bill states these payment adjustments are not required to be budget neutral. The bill also makes a small technical cross-reference change in the Social Security Act.