Summary#
This bill would change Medicare rules and private insurance coverage for kidney disease education services. It broadens who can give these services, who can get them, what the sessions can cover, and how they are paid. It also requires a working group to develop ways to measure education results and asks the Health and Human Services Secretary to set up a long-term assessment framework.
Key changes in the bill:
- Providers: Adds physician assistants, registered nurses, nurse practitioners, clinical nurse specialists, clinical social workers, registered dietitians/nutrition professionals, providers in rural areas, and other trained individuals (for example, community health workers) working under qualified entities.
- Eligibility: Expands eligible people from only stage IV chronic kidney disease to people with hypertension, diabetes, any stage of chronic kidney disease, or other risk factors as determined by the qualified entity.
- Service setting and content: Allows services in individual or group settings and in the presence of caregivers. Adds topics such as ways to slow kidney decline, caregiver training for transplant recipients, basic post-transplant transition assistance, and other topics the Secretary finds appropriate.
- Screening and referral: Adds kidney disease screening and referrals to kidney education to the Medicare initial preventive physical exam and the Annual Wellness Visit.
- Session limits and telehealth: Removes the fixed 6-session cap and lets the Secretary set an appropriate number. Permits kidney education services to be furnished through telehealth.
- Payment: For Medicare, requires payment equal to 100% of the lesser of the actual charge or the amount determined under the Medicare physician payment rules (section 1848).
- Working group and assessment: Requires the Secretary to convene a working group within 180 days to develop methods for measuring patient benefit and educational effectiveness. The group must report within 18 months. The Secretary must then establish an assessment framework within 2 years after receiving the report and may change payment or coverage based on assessment results.
- Private insurance: Adds kidney disease education services to the list of preventive services under the public health law, with coverage effective for plan years starting on or after January 1, 2027.
What it means for you#
- If you have risk factors (like hypertension, diabetes) or any stage of chronic kidney disease, more education services could be available to you through Medicare and private plans.
- You could receive education in a group or one-on-one, in person or by telehealth, and you may have a caregiver present.
- New topics include options to slow kidney decline and support after a transplant.
- Qualified professionals beyond physicians could provide these services.
- Changes generally take effect January 1, 2027 for coverage rules noted in the bill.
Expenses#
- The bill sets a Medicare payment rule: Medicare must pay 100% of the lesser of the actual charge or the amount determined under section 1848 for kidney disease education services.
- No publicly available information on total federal costs, budget estimates, or how private insurers will manage costs is included in the bill text provided.
Proponents' View#
No publicly available information.
Opponents' View#
No publicly available information.