Sponsors (13)
The bill improves access to new renal drugs/devices and stabilizes payments and screening/education for dialysis patients, but it increases Medicare spending and administrative complexity while risking payment design distortions and uneven incentives for care.
Medicare beneficiaries receiving dialysis will have continued, time-limited coverage for new FDA‑approved renal drugs/biologics (and eligibility for expedited renal devices) when products first enter the market, reducing access disruptions at launch.
Dialysis providers and clinics will get more predictable, higher transitional payments (65% per‑service, inflation‑updated) plus a mechanism to adjust payments when price forecasts deviate, improving financial stability and ability to cover drug/device costs.
Medicare beneficiaries with or at risk for chronic kidney disease will gain annual CKD screening coverage and better access to kidney disease education delivered at dialysis facilities, supporting earlier detection and improved patient education/management.
Taxpayers and the Medicare Trust Fund will likely face higher costs because the post‑TDAPA add‑on and expanded payments are explicitly not budget‑neutral and increase Medicare spending for dialysis drugs, devices, screening, and education.
Medicare beneficiaries enrolled in Medicare Advantage plans could see higher premiums or reduced benefits if plans pass along increased Medicare drug and dialysis spending to enrollees.
Excluding patient‑level case‑mix adjustments may misalign payments with clinical complexity, risking overpayment for some treatments, under‑incentivizing tailored care, and creating equity/justice concerns in reimbursement.
Based on analysis of 4 sections of legislative text.
Extends transitional add‑on payments for new dialysis drugs, creates a permanent 65% post‑TDAPA add‑on to the ESRD rate, adds CKD screening to wellness visits, and changes kidney education payment rules.
Introduced November 20, 2025 by Carol Devine Miller · Last progress November 20, 2025
Requires Medicare to extend transitional add-on payments for new FDA‑approved renal dialysis drugs and biologics and to create a permanent post‑TDAPA add‑on payment to the ESRD base rate, changes how annual payment updates for dialysis are adjusted for forecast error, and adds chronic kidney disease (CKD) screening and expanded kidney disease education coverage and payment rules. Most payment and coverage changes take effect January 1, 2026, and the new permanent add‑on is set at 65% of drug expenditures per dialysis service (updated for inflation and applied after TDAPA expires).