Improving Home Dialysis Act of 2026
HB8875, the Improving Home Dialysis Act of 2026, would amend the Medicare statute to expand the list of self-care home dialysis support services covered under Medicare. Beginning January 1, 2028, the bill adds two new covered service categories for patients dialyzing at home: staff-assisted home dialysis respite care and renal mental health services. The bill defines both services and limits them to care furnished in the patient’s home, excluding skilled nursing facilities and nursing facilities.
The bill also creates specific Medicare payment adjustments for these services. Staff-assisted home dialysis respite care would receive a per-session add-on payment tied to the 2025 home/self-dialysis training adjustment, with a lower rate outside rural areas, and capped at 20 sessions per calendar year. Renal mental health services would receive a smaller per-session adjustment, also with a rural/non-rural differential, and capped at four sessions during the first 60 days after a patient begins home dialysis. The bill specifies that these payment adjustments are not to be made budget neutral, meaning Medicare would not offset the added spending elsewhere in the program.
In practical terms, the bill would change federal Medicare law rather than state law. It would expand coverage and reimbursement rules for Medicare beneficiaries who use home dialysis, and it would affect dialysis providers, qualified clinical staff, and mental health professionals who serve these patients. The bill also makes a conforming amendment to an existing Medicare provision to reflect the new numbering of the home dialysis support service subsection.
The overall sentiment reflected in the available legislative history appears favorable. The bill was ordered to be reported in the nature of a substitute by a 28-13 vote, indicating substantial committee support but not unanimity. No committee transcript was provided, so there is no recorded debate text to identify detailed arguments, but the vote suggests the measure had meaningful bipartisan or cross-faction backing while still drawing some opposition.
The main points of contention likely center on Medicare spending, the decision to exempt these payment adjustments from budget neutrality, and the scope of the new covered services. Supporters would likely view the bill as improving access, safety, and patient support for home dialysis, especially for new patients and those in rural areas. Opponents may be concerned about added program costs, the administrative complexity of defining qualified personnel and eligible sessions, and whether the new benefits should be limited to short introductory periods rather than broader ongoing support.
The bill would amend Title XVIII of the Social Security Act to expand Medicare coverage and payment rules for home dialysis support services. It adds staff-assisted home dialysis respite care and renal mental health services as recognized self-care home dialysis support services, and it establishes new Medicare payment adjustments, session limits, and rural-area rate differences for those services. The measure would directly affect Medicare beneficiaries receiving home dialysis, dialysis providers, and the clinicians and technicians eligible to furnish the new services.
The available voting history suggests generally positive sentiment toward the bill, with the committee ordering it reported by a 28-13 vote. That margin indicates clear support for the policy direction, but also a notable minority opposed or unconvinced. Because no transcript excerpts were provided, the record does not show detailed floor or committee arguments, but the vote pattern implies the bill was viewed favorably overall while still raising concerns for some members.
Likely areas of contention include the cost of expanding Medicare benefits, especially because the bill expressly states that the new payment adjustments are not budget neutral. Members may also disagree over the adequacy of the session caps and the narrow time windows for eligibility, as well as the rural/non-rural payment differentials. Supporters are likely focused on patient access, caregiver relief, and mental health support for home dialysis patients, while critics may question whether the new services should be covered broadly or whether the reimbursement structure is too costly or administratively burdensome.