This bill changes how Medicare pays for care and services related to end-stage renal disease (ESRD). It extends transitional add-on payments for new dialysis drugs, biological products, devices, and supplies to at least 3 years for items furnished on or after January 1, 2026. It creates a permanent post-transitional add-on payment for new renal dialysis drugs and biologicals and explains how that add-on will be calculated (using recent utilization and price data and set at 65 percent of a calculated per-service amount). The bill clarifies which drugs count as renal dialysis services and excludes certain drugs for comorbid conditions approved after December 31, 2025. It makes breakthrough-designated devices eligible for transitional add-on payments and allows capital-related assets to be included. The bill requires Medicare Advantage plans to make direct payment adjustments to providers for transitional payments for drugs, biologicals, devices, and supplies for people with ESRD. It adds a process to adjust the ESRD market-basket update to account for forecast error starting in 2026. The bill also expands Medicare coverage by adding chronic kidney disease screening to the annual wellness benefit and expands the Medicare kidney disease education benefit to include stage V, to allow additional clinician types to assist, and to let renal dialysis facilities provide and be paid separately for education services. Most changes take effect January 1, 2026.
The bill directs additional and ongoing add-on payments to providers and states that the permanent post-transitional add-on payment provision "shall not be implemented in a budget neutral manner." The bill does not include dollar cost estimates or totals in the text provided. No publicly available information on estimated federal costs or budgetary scoring is included in the provided material.
No publicly available information.
No publicly available information.