Medicare expands home dialysis support—but only for the first 60 days

What it does

This bill expands Medicare coverage for home dialysis patients by adding two new support services: staff-assisted respite care (allowing a nurse or technician to take over dialysis temporarily during the first 30 days of home treatment) and renal mental health counseling (up to 4 sessions in the first 60 days). Medicare will pay providers a per-session add-on fee for these services, starting January 1, 2028, with higher payments in rural areas and no requirement to offset costs elsewhere in the dialysis payment system.

Why we flagged it

The bill's core mechanism is straightforward: it adds two new reimbursable services to Medicare's home dialysis benefit and establishes payment rates. This is a standard coverage-expansion bill, not a rider or hidden carve-out.

What the text implies

• Non-budget-neutral payment means these services will increase total Medicare dialysis spending without offsetting reductions elsewhere, potentially raising program costs by tens of millions annually depending on uptake.
• Rural payment premiums (100% for respite, 75% for mental health vs. lower urban rates) may incentivize providers to concentrate services in rural areas, affecting access patterns.
• The 30-day respite-care window and 60-day mental-health window are front-loaded; patients initiating home dialysis receive intensive support early, but ongoing mental health needs after 60 days are not addressed by this bill.
• Qualified personnel definition defers to CMS rulemaking; the actual scope of who can deliver respite care (e.g., whether family members with training qualify) will be determined post-enactment, creating implementation uncertainty.
• Dialysis providers (DaVita, Fresenius, Renal Care Group) may capture much of the payment uplift if they employ or contract the respite-care staff, rather than independent mental-health providers.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Home dialysis patients gain access to critical support services—respite care reducing caregiver burnout and mental health counseling addressing the psychological burden of self-management—at no out-of-pocket cost. The non-budget-neutral payment structure ensures these services are genuinely added, not shifted from other dialysis care.

Who stands to gain

• dialysis service providers (DaVita, Fresenius Medical Care, Renal Care Group)
• mental health professionals and counselors serving dialysis patients
• nursing and technician staffing agencies serving home dialysis programs
• pharmaceutical and device manufacturers (indirect: expanded home dialysis adoption may increase dema

Named in the bill

Medicare (Centers for Medicare & Medicaid Services), Social Security Act Section 1881, DaVita (DVA), Fresenius Medical Care (FMS), Renal Care Group, Fresenius Kabi (part of Fresenius), Baxter International (BAX), B. Braun, Code of Federal Regulations Title 42 Section 494

Where it stands

2 cosponsors: 2 Republicans.

• May 19, 2026 — Introduced · Congress.gov: “Introduced in House”
• May 19, 2026 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”
• May 21, 2026 — Markup held in committee · Congress.gov: “Committee Consideration and Mark-up Session Held”
• May 21, 2026 — Reported out of committee · Congress.gov: “Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 28 - 13”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

6 lobbying clients named this bill on 6 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $1,470,000 in lobbying spend. A filing names 6 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 82% of bills with at least one filing.

Carol Miller, the sponsor, reported $1,295,500 in PAC receipts in the 2026 cycle. $8,500 of that came from 1 PAC tied to these lobbying clients.

• Davita Inc — $980,000 on 1 filing
• American Kidney Fund — $240,000 on 1 filing
• Nonprofit Kidney Care Alliance — $90,000 on 1 filing
• Kidney Care Partners — $70,000 on 1 filing
• American Society of Nephrology — $60,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.