Improving Home Dialysis Act of 2026
Summary
What This Bill Does
The Improving Home Dialysis Act adds two Medicare support services for patients receiving home dialysis. Beginning January 1, 2028, Medicare would cover staff-assisted home dialysis respite care in the patient's home, not in a skilled nursing facility or nursing facility. Qualified personnel such as registered nurses, licensed practical nurses, certified patient care technicians, or other Secretary-approved professionals could assist during the first 30 days after a patient starts home dialysis or during a temporary physical limitation.
The bill also adds renal mental health services delivered in the patient's home during the 60-day period after first home dialysis. Medicare ESRD payment adjustments would be created for respite care and renal mental health services, with different add-on amounts for rural and non-rural providers, annual limits on respite sessions, and a rule that the adjustments are not budget neutral.
Who Benefits and How
Home dialysis patients benefit from staff support during transition periods and temporary physical limitations. Rural home dialysis patients benefit because the respite-care adjustment is higher for rural providers. Dialysis facilities benefit from new Medicare add-on payments for qualifying home-based support. Dialysis nurses and certified patient care technicians benefit from reimbursable roles in home dialysis respite care. Patients starting home dialysis benefit from home-based renal mental health services during the first 60 days.
Who Bears the Burden and How
CMS ESRD payment staff must create payment adjustments, define qualified personnel, and administer session limits. Dialysis facilities must document qualifying services, dates, personnel, and patient eligibility. Medicare contractors must adjudicate the new add-on claims. Non-rural providers receive smaller adjustment percentages than rural providers. The Medicare program bears higher spending because the payment adjustments are explicitly not budget neutral.
Key Provisions
- Adds Medicare staff-assisted home dialysis respite care beginning January 1, 2028.
- Adds home-based renal mental health services for the first 60 days after a patient begins home dialysis.
- Defines qualified personnel for respite care, including nurses and certified patient care technicians.
- Creates ESRD payment adjustments with rural and non-rural percentages.
- Limits respite-care payment to qualifying home dialysis days and annual session caps without budget-neutral offsets.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Adds Medicare payment support for staff-assisted home dialysis respite care and renal mental health services beginning in 2028, including home-based service definitions, qualified personnel rules, annual session limits, rural and non-rural payment adjustments, and non-budget-neutral treatment.
Key Policy Areas
Medicare, Dialysis, Home Health, Mental Health
Primary Purpose
Adds Medicare payment support for staff-assisted home dialysis respite care and renal mental health services beginning in 2028, including home-based service definitions, qualified personnel rules, annual session limits, rural and non-rural payment adjustments, and non-budget-neutral treatment.
Policy Domains
House resolution provisions
Identified Gains
- Home dialysis patients
- Rural home dialysis patients
- Dialysis facilities
- Dialysis nurses
- Certified patient care technicians
- Patients starting home dialysis
Identified Costs
- CMS ESRD payment staff
- Dialysis facilities
- Medicare contractors
- Non-rural dialysis providers
- Medicare program
Legislative Progress
ReportedOrdered to be Reported in the Nature of a Substitute …
Committee Consideration and Mark-up Session Held
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Mrs. Miller of West Virginia introduced the following bill; which …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Dialysis facilities, Dialysis nurses, Home dialysis patients
CMS ESRD payment staff, Medicare contractors
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "cms"
- → Centers for Medicare and Medicaid Services
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology