Sponsors (3)
The bill improves access to and delivery of FDA‑approved treatments for dialysis‑related amyloidosis by unbundling coverage and enabling separate billing, but it raises Medicare spending and administrative complexity and risks price-driven cost pressures on beneficiaries and taxpayers.
Medicare beneficiaries on dialysis who need FDA‑approved treatments for dialysis‑related amyloidosis will have those therapies covered separately, reducing or eliminating out‑of‑pocket cost barriers for those patients.
Dialysis facilities and hospitals can bill separately for these treatments and related supplies, improving provider revenues and making it more financially feasible to offer specialized amyloidosis care at dialysis centers.
Taxpayers and the Medicare program will face higher spending because these treatments are paid at 100% of reasonable charges outside the bundled ESRD payment.
If manufacturers or providers set high prices for these treatments or supplies, beneficiaries and taxpayers could face indirect impacts such as upward pressure on Medicare costs, premiums, or future coverage limits.
Removing these items from the ESRD bundle and shifting them to separate Part B claims could increase Medicare administrative complexity and lead to more billing disputes for providers and patients.
Based on analysis of 2 sections of legislative text.
Requires separate Medicare Part B payment (100% of reasonable charges) for FDA‑approved dialysis-related amyloidosis treatments and necessary adjuncts furnished in dialysis facilities, excluded from the ESRD bundled payment.
Official title: To amend title XVIII of the Social Security Act to provide coverage and payment under such title for certain treatments for dialysis-related amyloidosis, and for other purposes.
Introduced June 20, 2025 by Brian Babin · Last progress June 20, 2025
Adds treatments for dialysis-related amyloidosis to Medicare Part B and requires Medicare to pay for FDA-approved treatments and necessary adjunct supplies/services furnished in dialysis facilities as separate Part B items at 100% of reasonable charges. The law excludes these treatments from the ESRD prospective payment/comprehensive fee so they are not bundled into the dialysis facility payment schedule; the change takes effect on enactment.