I 
117TH CONGRESS 
1ST SESSION H. R. 5426 
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 
SEPTEMBER 29, 2021 
Mr. RUSH (for himself and Mr. SMITH of Missouri) 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 sub-
sequently 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Improving Access to 
Home Dialysis Act of 2021’’. 
SEC. 2. PROVIDING FOR STAFF-ASSISTED HOME DIALYSIS 
FOR CERTAIN HEMODIALYSIS AND PERI-
TONEAL DIALYSIS PATIENTS. 
(a) IN GENERAL.—Section 1881(b)(14) of the Social 
Security Act (42 U.S.C. 1395rr(b)(14)) is amended by 
adding at the end the following new subparagraph: 
‘‘(J)(i) For services furnished on or after 
the date which is 1 year after the date of the 
enactment of this subparagraph which are staff- 
assisted home dialysis (as defined in clause 
(iv)(III)), the Secretary shall increase the single 
payment that would otherwise apply under this 
paragraph for renal dialysis services furnished 
to new and respite individuals in accordance 
with the payment system established under 
clause (iii) by qualified providers. 
‘‘(ii)(I) Subject to subclause (II), staff-as-
sisted home dialysis may only be furnished dur-
ing— 
‘‘(aa) with respect to an individual de-
scribed in subclause (iv)(I)(aa), one 90-day 
period which may be renewed up to two 
30-day periods; and 
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‘‘(bb) with respect to an individual de-
scribed in subclause (iv)(I)(bb) and not-
withstanding whether such an individual 
receives any respite care under part A, any 
30-day period. 
‘‘(II) Notwithstanding the limits described 
in subclause (I), staff-assisted home dialysis 
may be furnished for as long as the Secretary 
determines appropriate to an individual who— 
‘‘(aa) is blind; 
‘‘(bb) has a cognitive or neurological 
impairment 
(including 
a 
stroke, 
Alz-
heimer’s, dementia amyotrophic lateral 
sclerosis, or any other impairment deter-
mined by the Secretary); or 
‘‘(cc) has any other illness or injury 
that reduces mobility (including cerebral 
palsy, spinal cord injuries, or any other ill-
ness or injury determined by the Sec-
retary). 
‘‘(iii) The Secretary shall establish a pro-
spective payment system through regulations to 
determine the amounts payable to qualified pro-
viders for staff-assisted home dialysis. In estab-
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lishing such system, the Secretary may con-
sider— 
‘‘(I) the costs of furnishing staff-as-
sisted home dialysis; 
‘‘(II) consultations with dialysis pro-
viders, dialysis patients, private payers, 
and MA plans; 
‘‘(III) payment amounts for similar 
items and services under parts A and B; 
and 
‘‘(IV) payment amounts established 
by MA plans under part C, group health 
plans, and health insurance coverage of-
fered by health insurance issuers. 
‘‘(iv) In this subparagraph: 
‘‘(I) The term ‘new and respite indi-
vidual’ means an individual described in 
subsection (a) who is either— 
‘‘(aa) initiating either peritoneal 
or home hemodialysis; or 
‘‘(bb) receiving home dialysis and 
is unable to self-dialyze due to illness, 
injury, caregiver issues, or other tem-
porary circumstances. 
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