Kidney Disease Education Access Expansion Act of 2026

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9509 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9509

To amend title XVIII of the Social Security Act and title XXVII of the
   Public Health Service Act with respect to the coverage of kidney
disease education services under Medicare and private health insurance.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 29, 2026

Ms. DelBene (for herself and Mr. Joyce of Pennsylvania) 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 subsequently 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 and title XXVII of the
   Public Health Service Act with respect to the coverage of kidney
disease education services under Medicare and private health insurance.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Kidney Disease Education Access
Expansion Act of 2026''.

SEC. 2. 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.

SEC. 3. KIDNEY DISEASE EDUCATION EFFECTIVENESS WORKING GROUP; KIDNEY
              DISEASE EDUCATION ASSESSMENT.

    (a) Kidney Disease Education Effectiveness Working Group.--
            (1) In general.--Not later than 180 days after the date of
        enactment of the Kidney Disease Education Access Expansion Act
        of 2026, the Secretary of Health and Human Services (in this
        section referred to as the ``Secretary'') shall convene a
        working group to develop and evaluate methodologies for
        measuring patient benefit and educational effectiveness from
        kidney disease education services under section 1861(ggg) of
        the Social Security Act (42 U.S.C. 1395x(ggg)).
            (2) Composition.--The working group shall consist of--
                    (A) qualified entities that furnish kidney disease
                education services;
                    (B) individuals with kidney disease and their
                caregivers;
                    (C) health care technology specialists;
                    (D) learning and educational assessment
                specialists; and
                    (E) representatives from the Centers for Medicare &
                Medicaid Services.
            (3) Duties.--The working group shall--
                    (A) develop evidence-based methodologies for
                assessing patient comprehension, behavior change, and
                clinical outcomes resulting from kidney disease
                education services;
                    (B) account for diverse learning styles and the
                impact of kidney disease on cognitive function in
                developing assessment tools;
                    (C) recommend standardized metrics for evaluating
                the effectiveness of different educational approaches
                and delivery methods; and
                    (D) provide recommendations for quality improvement
                strategies based on patient-centered outcomes.
            (4) Report.--Not later than 18 months after the working
        group is convened under paragraph (1), the working group shall
        submit a report to the Secretary and Congress and make publicly
        available its recommendations for measuring and improving
        kidney disease education effectiveness.
    (b) Kidney Disease Education Assessment.--
            (1) Establishment of assessment framework.--Not later than
        2 years after the Secretary receives the report of the working
        group under subsection (a)(4), the Secretary shall, taking into
        account the recommendations included in such report, establish
        a comprehensive assessment framework to evaluate the success
        and effectiveness of kidney disease education services provided
        under section 1861(ggg) of the Social Security Act (42 U.S.C.
        1395x(ggg)).
            (2) Scope of authority.--In establishing and implementing
        the assessment framework under paragraph (1), the Secretary
        shall--
                    (A) determine the specific methodologies, tools,
                and metrics to be used in assessing patient outcomes,
                educational effectiveness, and program success;
                    (B) establish the frequency and timing of
                assessments, which may vary based on qualified entity
                type, patient population served, or other relevant
                factors;
                    (C) specify data collection requirements and
                procedures for qualified entities providing kidney
                disease education services;
                    (D) modify assessment criteria and procedures as
                needed based on evidence, outcomes data, or changes in
                clinical practice guidelines;
                    (E) establish reporting requirements for assessment
                results and their use in program improvement; and
                    (F) coordinate with relevant Federal agencies,
                professional organizations, and stakeholders to ensure
                assessment activities align with broader health care
                quality initiatives.
            (3) Implementation flexibility.--The Secretary may
        implement the assessment framework under paragraph (1) through
        guidance, regulations, pilot programs, or other mechanisms as
        deemed appropriate, and may phase implementation across
        different qualified entity types or geographic regions as
        necessary.
            (4) Continuous improvement.--The Secretary shall use
        assessment results to identify opportunities for program
        improvement, best practices, and evidence-based modifications
        to kidney disease education services, and may adjust payment
        policies, coverage criteria, or quality measures based on
        assessment findings.

SEC. 4. INCLUDING KIDNEY DISEASE EDUCATION SERVICES AS A PREVENTIVE
              SERVICE UNDER PRIVATE HEALTH INSURANCE.

    (a) In General.--Section 2713(a) of the Public Health Service Act
(42 U.S.C. 300gg--13(a)) is amended--
            (1) in paragraph (2), by striking ``and'' at the end;
            (2) in paragraph (3), by striking the period at the end and
        inserting a semicolon;
            (3) in paragraph (4), by striking the period at the end and
        inserting a semicolon;
            (4) in paragraph (5), by striking the period at the end and
        inserting ``; and''; and
            (5) by adding at the end the following new paragraph:
            ``(6) kidney disease education services, as defined in
        section 1861(ggg) of the Social Security Act.''.
    (b) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2027.
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