I 

118TH CONGRESS 

2D SESSION H. R. 8075 

To amend title XVIII of the Social Security Act to provide for Medicare 

coverage of staff-assisted home dialysis for certain hemodialysis and 

peritoneal dialysis patients and to ensure all patients are educated on 

modality options and receive the resources, information, and support 

to succeed on the modality of their choice, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 18, 2024 

Mrs. MILLER of West Virginia (for herself, Mrs. MILLER-MEEKS, Ms. STRICKLAND, and Mr. BLUMENAUER) introduced the following bill; which was 

referred to the Committee on Energy and Commerce, and in addition to 

the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for Medicare coverage of staff-assisted home dialysis for 

certain hemodialysis and peritoneal dialysis patients and 

to ensure all patients are educated on modality options 

and receive the resources, information, and support to 

succeed on the modality of their choice, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Improving Access to 

3 Home Dialysis Act of 2024’’. 

4 SEC. 2. PROVIDING FOR STAFF-ASSISTED HOME DIALYSIS 

5 FOR CERTAIN HEMODIALYSIS AND PERI6 TONEAL DIALYSIS PATIENTS. 

7 (a) IN GENERAL.—Section 1881(b)(14) of the Social 

8 Security Act (42 U.S.C. 1395rr(b)(14)) is amended by 

9 adding at the end the following new subparagraph: 

10 ‘‘(J)(i) With respect to staff-assisted home 

11 dialysis (as defined in clause (iv)(IV)) furnished 

12 on or after the date that is 1 year after the 

13 date of the enactment of this subparagraph, 

14 subject to the succeeding provisions of this sub15 paragraph, the Secretary shall increase the sin16 gle payment that would otherwise apply under 

17 this paragraph for renal dialysis services by the 

18 add-on payment amount established pursuant 

19 to clause (iii). 

20 ‘‘(ii)(I) Subject to subclause (II), staff-as21 sisted home dialysis may only be furnished— 

22 ‘‘(aa) with respect to an initializing 

23 patient (as defined in clause (iv)(I)) or a 

24 returning patient (as defined in clause 

25 (iv)(III)), for a period of up to 90 days, re26 ferred to as the ‘initial period’, which may 


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1 be extended as determined necessary by 

2 the care team of the individual in not more 

3 than 2 intervals of up to 30 days each, 

4 each of which is referred to as an ‘ex5 tended interval’; and 

6 ‘‘(bb) with respect to a temporary as7 sistance patient (as defined in clause 

8 (iv)(V)), for any 30-day period as deter9 mined necessary by the care team of the 

10 individual, notwithstanding whether such 

11 an individual receives any routine dialysis 

12 respite care during such period. 

13 ‘‘(II) Notwithstanding subclause (I), staff14 assisted home dialysis may be furnished for as 

15 long as the Secretary determines appropriate to 

16 an individual who— 

17 ‘‘(aa) is blind; 

18 ‘‘(bb) has a cognitive or neurological 

19 impairment (including a stroke, Alz20 heimer’s, dementia, amyotrophic lateral 

21 sclerosis, or any other impairment deter22 mined by the Secretary); or 

23 ‘‘(cc) has any other illness or injury 

24 that reduces mobility (including cerebral 

25 palsy, spinal cord injuries, patients on a 


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1 ventilator, or any other illness or injury de2 termined by the Secretary). 

3 ‘‘(iii) The Secretary shall, by regulation, 

4 establish an add-on payment amount for staff5 assisted home dialysis to determine the 

6 amounts payable to a qualified provider for as7 sisting in the furnishing of staff-assisted home 

8 dialysis on a frequency as determined by the 

9 Secretary and in consultation with clinicians, 

10 patients, and care partners to ensure maximum 

11 patient choice, access, and flexibility. In estab12 lishing the add-on payment under this clause, 

13 the Secretary shall consult with stakeholders, 

14 including providers of renal dialysis services, in15 dividuals receiving home dialysis, qualified pro16 viders (as defined in clause (iv)(II)), private in17 surance payers, and Medicare Advantage plans 

18 under part C. 

19 ‘‘(iv) In this subparagraph: 

20 ‘‘(I) The term ‘initializing patient’ 

21 means an individual who initiates a home 

22 dialysis modality, including home hemo23 dialysis and peritoneal dialysis. 

24 ‘‘(II) The term ‘qualified provider’ 

25 means a trained professional (as deterVerDate Sep 11 2014 03:04 May 01, 2024 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8075.IH H8075

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1 mined by the Secretary, including a reg2 istered or licensed practical nurse and a 

3 certified patient care technician) who— 

4 ‘‘(aa) furnishes renal dialysis 

5 services; 

6 ‘‘(bb) meets requirements (as de7 termined by the Secretary) that en8 sure competency in patient care and 

9 modality usage; and 

10 ‘‘(cc) during a period described 

11 in clause (ii)(I), provides in-person as12 sistance to an individual for an appro13 priate number of dialysis sessions, as 

14 determined by the care team of the in15 dividual based on the needs of the in16 dividual, caregiver availability, pre17 scription, and mode of home dialysis. 

18 ‘‘(III) The term ‘returning patient’ 

19 means an individual who is returning to 

20 home dialysis after a period of hospitaliza21 tion or other non-home dialysis modality. 

22 ‘‘(IV)(aa) The term ‘staff-assisted 

23 home dialysis’ means dialysis furnished by 

24 the individual in a home, residence, or 

25 other approved setting with the assistance 


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1 of a qualified provider, the frequency of 

2 which is determined by the qualified pro3 vider in coordination with the individual, 

4 the care partner, and the care team of the 

5 individual and outlined in a patient plan of 

6 care. 

7 ‘‘(bb) In this subclause, the term ‘care 

8 partner’ means a friend or family member 

9 who is designated by the individual who is 

10 trained to assist the individual with the 

11 furnishing of home dialysis. 

12 ‘‘(cc) In this subclause, the term ‘pa13 tient plan of care’ has the meaning given 

14 such term in section 494.90 of title 42, 

15 Code of Federal Regulations (or any suc16 cessor regulations). 

17 ‘‘(V) The term ‘temporary assistance 

18 patient’ means an individual who is receiv19 ing home dialysis and is temporarily un20 able to perform functions necessary to 

21 home dialysis due to illness, injury, care22 giver unavailability, or other temporary cir23 cumstances not to exceed 30 days.’’. 

24 (b) PATIENT EDUCATION AND TRAINING RELATING

25 TO STAFF-ASSISTED HOME DIALYSIS.— 


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1 (1) IN GENERAL.—Section 1881(b)(5) of the 

2 Social Security Act (42 U.S.C. 1395rr(b)(5)) is 

3 amended— 

4 (A) in subparagraph (C), by striking at the 

5 end ‘‘and’’; 

6 (B) in subparagraph (D), by striking the 

7 period at the end and inserting a semicolon; 

8 and 

9 (C) by adding at the end the following new 

10 subparagraphs: 

11 ‘‘(E) educate individuals on the oppor12 tunity to receive staff-assisted home dialysis (as 

13 defined in paragraph (14)(J)(iv)(IV)) during 

14 the periods described in paragraph (14)(J)(ii); 

15 and 

16 ‘‘(F) provide for registered or licensed 

17 nurses, certified patient care technicians, or 

18 other qualified providers (as determined by a 

19 physician) to train individuals and their care 

20 partners in skills and procedures needed to fur21 nish staff-assisted home dialysis, including— 

22 ‘‘(i) in a group-training environment 

23 with other individuals and their care part24 ners when appropriate and in accordance 

25 with the Federal regulations (concerning 


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1 the privacy of individually identifiable 

2 health information) promulgated under 

3 section 264(c) of the Health Insurance 

4 Portability and Accountability Act of 1996; 

5 ‘‘(ii) via telehealth (following an initial 

6 period of in-person competency training, in 

7 accordance with standards specified by the 

8 Secretary); 

9 ‘‘(iii) through interdisciplinary team 

10 training (as described in the interpretive 

11 guidance relating to tag number V590 of 

12 ‘Advance Copy—End Stage Renal Disease 

13 (ESRD) Program Interpretive Guidance 

14 Version 1.1’ (published on October 3, 

15 2008)); and 

16 ‘‘(iv) in the home or residence of an 

17 individual, in a dialysis facility, in a stand18 alone training facility, or the place in 

19 which the individual has been approved to 

20 perform home dialysis by the care team.’’. 

21 (2) EFFECTIVE DATE.—The amendments made 

22 by this subsection shall take effect on the date that 

23 is one year after the date of the enactment of this 

24 Act. 

25 (c) OTHER PROVISIONS.— 


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1 (1) ANTI-KICKBACK STATUTE.—Section 

2 1128B(b)(3) of the Social Security Act (42 U.S.C. 

3 1320a–7b(b)(3)) is amended— 

4 (A) by moving subparagraphs (J) and (K) 

5 2 ems to the left; 

6 (B) in subparagraph (K), by striking 

7 ‘‘and’’ at the end; 

8 (C) in subparagraph (L), by striking the 

9 period at the end and inserting ‘‘; and’’; and 

10 (D) by adding at the end the following new 

11 subparagraph: 

12 ‘‘(M) any remuneration relating to the fur13 nishing of staff-assisted home dialysis (as defined in 

14 section 1881(b)(14)(J)(iv)(IV)).’’. 

15 (2) STUDY.—Not later than 2 years after the 

16 date of the enactment of this Act, the Secretary of 

17 Health and Human Services (in this section referred 

18 to as the ‘‘Secretary’’) shall submit, to the Com19 mittee on Finance of the Senate and the Committees 

20 on Energy and Commerce and Ways and Means of 

21 the House of Representatives, a report that— 

22 (A) examines racial disparities in the utili23 zation of home dialysis (as defined in section 

24 1881(b)(14)(J)(iv)(IV) of the Social Security 

25 Act (42 U.S.C. 1395rr(b)(14)(J)(iv)(IV)), as 


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1 added by subsection (a)), and makes rec2 ommendations on how to improve access to 

3 home dialysis for communities of color; 

4 (B) examines coverage for, and utilization 

5 of, home dialysis in rural communities, and 

6 makes recommendations on how to improve ac7 cess to home dialysis for such rural commu8 nities; and 

9 (C) analyzes clinical and quality of life out10 comes for patients, disaggregated by geographic 

11 and demographic indicators, who receive dif12 ferent dialysis modalities, including staff-as13 sisted home dialysis, unassisted home dialysis, 

14 and dialysis furnished in a facility. 

15 (3) PATIENT DECISION TOOL.—Not later than 

16 December 31, 2025, for the purposes of section 

17 1881(b)(14)(J)) of the Social Security Act (42 

18 U.S.C. 1395rr(b)(14)(J)), as added by subsection 

19 (a), the Secretary shall convene a patient panel to 

20 develop a patient-centered decision tool to assist di21 alysis patients in evaluating their lifestyle and goals 

22 and in choosing the dialysis setting and modality. 

23 Such tool shall include an acknowledgment that the 

24 patient is capable of home dialysis and wants home 

25 dialysis, if that is the modality such patient chooses. 


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1 (4) PATIENT QUALITY OF LIFE METRIC.—Sec2 tion 1881(h)(2)(A)(iv) of the Social Security Act (42 

3 U.S.C. 1395rr(h)(2)(A)(iv)) is amended— 

4 (A) in subclause (II), by striking ‘‘and’’ at 

5 the end; 

6 (B) in subclause (III), by striking the pe7 riod at the end and inserting ‘‘; and’’; and 

8 (C) by adding at the end the following new 

9 subclause: 

10 ‘‘(IV) patient quality of life for 

11 all individuals utilizing dialysis re12 gardless of modality, with the intent 

13 of measuring and improving patient 

14 quality of life on dialysis.’’. 

Æ 


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