Expanding coverage of kidney disease education services under Medicare

(a) Kidney disease education services and kidney disease screening (1) Providers of kidney disease education services Section 1861(ggg)(2)(A) of the Social Security Act (42 U.S.C. 1395x(ggg)(2)(A)) is amended to read as follows: (A) The term qualified person means— (i) a physician (as defined in section 1861(r)(1)) or a physician assistant, registered nurse, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)), who furnishes services for which payment may be made under the fee schedule established under section 1848; (ii) a provider of services located in a rural area (as defined in section 1886(d)(2)(D)); (iii) a clinical social worker (as defined in section 1861(hh)(1)); (iv) a registered dietitian or nutrition professional (as defined in section 1861(vv)); or (v) any other individual, such as a community health worker, who is trained (in a manner determined appropriate by the Secretary) to assist in the delivery of kidney disease education services under the direction of a qualified entity described in any of clauses (i), (iii), or (iv).. (2) Eligibility for kidney disease education services Section 1861(ggg)(1)(A) of the Social Security Act (42 U.S.C. 1395x(ggg)(1)(A)) is amended by striking an individual with stage IV chronic kidney disease who, according to accepted clinical guidelines identified by the Secretary, will require dialysis or a kidney transplant and inserting an individual with hypertension, diabetes, any stage of chronic kidney disease, or other risk factors for kidney disease progression or kidney failure as determined by the qualified entity. (3) Scope of kidney disease education services (A) Permitting group services and presence of caregivers Section 1861(ggg)(1)(A) of the Social Security Act (42 U.S.C. 1395x(ggg)(1)(A)), as amended by paragraph (2), is further amended— (i) by inserting in an individual or group setting after furnished; and (ii) by inserting (and, at the option of the individual, in the presence of such individual’s caregiver) before the semicolon at the end. (B) Expanding scope of services Section 1861(ggg)(1)(C)(i) of the Social Security Act (42 U.S.C. 1395x(ggg)(1)(C)(i)) is amended— (i) in subclause (II), by striking and at the end; and (ii) by adding at the end the following new subclauses: (IV) therapeutic options to slow kidney function decline in individuals with kidney disease who are at risk of kidney disease progression or kidney failure; (V) caregiver training and support for new transplant recipients; (VI) basic transition assistance for individuals who have received a kidney transplant, including education on general post-transplant self-care, coordination of follow-up care, and referral to a transplant nephrologist or other appropriate transplant specialist for ongoing clinical management of transplant-related medical needs; and (VII) such other topics as the Secretary deems appropriate for patient safety and optimal transplant outcomes;. (b) Initial preventive physical examination Section 1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2)) is amended— (1) in subparagraph (N), by adjusting the margin of such subparagraph 2 ems to the left; (2) by redesignating subparagraph (O) as subparagraph (P); and (3) by inserting after subparagraph (N) the following new subparagraph: (O) Screening for chronic kidney disease, kidney failure, and rare kidney diseases (as determined by the Secretary) and kidney disease education services as described in subsection (ggg).. (c) Annual wellness visit Section 1861(hhh)(2) of the Social Security Act (42 U.S.C. 1395x(hhh)(2)) is amended— (1) in subparagraphs (G) and (H), by adjusting the margin of each such subparagraph 1 em to the left; (2) by redesignating subparagraph (I) as subparagraph (J); and (3) by inserting after subparagraph (H) the following new subparagraph: (I) Screening for chronic kidney disease and kidney failure through routine metabolic and urinary assessments consistent with standard clinical practice, as determined by the Secretary, and through such additional screening tests or assessments (which may include new and emerging diagnostic tools) as the Secretary determines appropriate, and a referral, as appropriate, for kidney disease education services as described in subsection (ggg).. (d) Number of kidney disease education sessions Section 1861(ggg)(4) of the Social Security Act (42 U.S.C. 1395x(ggg)(4)) is amended by striking more than 6 sessions of kidney disease education services under this title and inserting a number of sessions of kidney disease education services under this title that exceeds the number of such sessions that the Secretary, in consultation with individuals described in paragraph (1)(A), caregivers, and qualified persons (as defined in paragraph (2)), determines is appropriate. (e) Furnishing kidney disease education services through telehealth Section 1834(m)(4)(F) of the Social Security Act (42 U.S.C. 1395m(4)(F)) is amended by inserting, kidney disease education services (as defined in section 1861(ggg)) before, and any additional service. (f) Payment rules Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— (1) in subparagraph (GG), by striking and at the end; and (2) by inserting, and (II) with respect to kidney disease education services (as defined in section 1861(ggg)(1)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848 before the semicolon at the end. (g) Effective date The amendments made by this section shall apply with respect to services furnished on or after January 1, 2027.