HR 8376
Concurrent Care for Comfort Act
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Bill overview
The Concurrent Care for Comfort Act clarifies Medicare coverage for palliative dialysis services provided to individuals electing hospice care. It establishes a specific payment process for these services, separate from standard hospice bundles, and outlines a methodology for determining payment amounts starting in 2026. The bill also includes a limit on the number of palliative dialysis sessions covered per individual, with a mechanism for the Secretary to review and potentially adjust this limit in subsequent years.
Key provisions
- Clarifies coverage for palliative dialysis services furnished to individuals electing hospice care.
- Establishes a separate payment process for palliative dialysis services, distinct from standard hospice bundles.
- Creates a payment methodology to be implemented by the Secretary starting in 2026, considering comparable renal dialysis payments.
- Limits payment for palliative dialysis sessions to a maximum of ten sessions per individual.
- Provides a mechanism for the Secretary to review and potentially modify the session limit annually.
- Specifies that palliative dialysis services are provided as part of a palliative care plan certified by a physician and interdisciplinary group.
- Defines ‘palliative dialysis eligible individual’ as someone with end-stage renal disease electing hospice care.
- Maintains existing Medicare coverage for renal dialysis services for treatment or maintenance, excluding those related to hospice elections based on non-terminal conditions.
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119th CONGRESS — 2d Session
H. R. 8376
IN THE HOUSE OF REPRESENTATIVES
A BILL
To amend title XVIII of the Social Security Act to clarify the policy for coverage under the Medicare program for palliative dialysis services, and clarify separate payment for such palliative dialysis services, furnished by renal dialysis facilities and providers of services to certain individuals electing hospice care, and for other purposes.
This Act may be cited as the Concurrent Care for Comfort Act
.
Section 1812(d)(2)(A) of the Social Security Act (42 U.S.C. 1395d(d)(2)(A)) is amended by inserting , to palliative dialysis services (as defined in section 1881(b)(15)(E)) furnished by a provider of services or renal dialysis facility to a palliative dialysis eligible individual (as defined in such section),
after (if not an employee of the hospice program)
.
Section 1814(i) of the Social Security Act (42 U.S.C. 1395f(i)) is amended by adding at the end the following new paragraph:
In the case of palliative dialysis services (as defined in section 1881(b)(15)(E)) furnished by a provider of services or renal dialysis facility to a palliative dialysis eligible individual (as defined in such section) during a period of an election under section 1812(d)(1) made by such individual, the provider of services or renal dialysis facility shall bill and be paid for such dialysis in accordance with section 1881(b)(15).
Section 1881(b) of the Social Security Act (42 U.S.C. 1395r(b)) is amended by adding at the end the following new paragraph:
For 2026 and each subsequent year, the Secretary shall, taking into account the assessment and considerations described in subparagraph (B) and pursuant to rulemaking, establish a methodology for determining, with respect to a palliative dialysis eligible individual whose election under section 1812(d)(1) to receive hospice care is for a period occurring during such year, the payment amounts under this title for palliative dialysis services furnished by a provider of services or renal dialysis facility during such period to such individual in a facility or to such individual at home.
In implementing the methodology under subparagraph (A), the Secretary shall—
consider calculating payment amounts for such services based on the amounts that would otherwise be calculated under the system established under paragraph (14) for comparable renal dialysis services described in such paragraph; and
consider, after assessing the resources directly or indirectly related to furnishing palliative dialysis services necessary for providers of services and renal dialysis facilities to furnish palliative dialysis services to palliative dialysis eligible individuals in a facility or to such individuals at home, any adjustments that should be applied in calculating such payments amounts based on such assessment.
Subject to clause (ii), payment may not be made under this title for more than ten sessions of palliative dialysis services furnished to a palliative dialysis eligible individual. In the case of home dialysis, including peritoneal dialysis, this subparagraph shall be applied by converting the number of days of such dialysis to hemodialysis equivalent sessions, in accordance with the methodology specified in section 50 of Chapter 11 of the Medicare Benefit Policy Manual, or any successor to such section.
For 2029 the Secretary shall (and for any subsequent year, the Secretary may) pursuant to rulemaking—
assess the appropriateness of the limitation specified under clause (i) for such year, based on data on determinations regarding coverage of palliative dialysis services furnished to palliative dialysis eligible individuals pursuant to this paragraph and stakeholder feedback on such coverage; and
based on such assessment, determine for such year whether to apply a limit on the number of sessions of palliative dialysis services (other than the number specified under clause (i)) and, if so, specify such other number that is to be applied for such year.
For any year for which the Secretary specifies a number pursuant to subclause (I)(bb) other than the number specified in clause (i), clause (i) shall be applied as if the reference to ten sessions were a reference to such different number of treatments specified by the Secretary.
Under the methodology under subparagraph (A), the deductible and coinsurance provisions under this title that would apply with respect to kidney dialysis services for which payment may be made under this section (other than this paragraph) shall also apply with respect to palliative dialysis services furnished to a palliative dialysis eligible individual for which payment is made pursuant to this paragraph.
For purposes of this paragraph:
The term palliative dialysis services
means, with respect to a palliative dialysis eligible individual, dialysis services specified by the Secretary that are furnished to the individual (in a facility or at home) as palliative care, and not for purposes of treatment or maintenance, in accordance with a plan of care certified by the individual’s physician in consultation with the interdisciplinary group described in section 1861(dd)(2)(B), and which may include other services specified by the Secretary, such as non-emergency transportation for which payment would otherwise be available under this section in connection with receipt of maintenance dialysis services.
The term palliative dialysis eligible individual
means an individual with end-stage renal disease who makes an election under section 1812(d)(1) and who as of the date of such election was receiving renal dialysis services (as described in section 1881(b)(14)(B)).
None of the provisions of this paragraph shall affect coverage or payment under this title which would otherwise apply for renal dialysis services for treatment or maintenance for individuals with end-stage renal disease who make an election for hospice care under section 1812(d)(1) on the basis of a primary health condition other than a terminal condition that is not related to end-stage renal disease.