HouseH.R. 9509119th Congress
Kidney Disease Education Access Expansion Act of 2026
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[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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