Sponsors (15)
The bill increases access to innovative dialysis drugs, devices, screening, and patient education and makes provider payments more predictable, but it does so at the cost of higher Medicare/taxpayer spending, added administrative complexity, and potential payment‑driven distortions in clinical choices.
Medicare dialysis patients gain more reliable access to new FDA‑approved dialysis drugs, biologics, and expedited‑pathway devices because qualifying products receive guaranteed transitional add‑on coverage (at least three years) and eligibility for transitional payments, reducing access disruptions when therapies first enter the market.
Dialysis providers and facilities receive more predictable and timely payment support — including a post‑TDAPA add‑on (65% per‑service calculation, inflation‑updated) and a mechanism to correct forecast errors — which improves financial stability, reduces risk of underpayment, and helps sustain service delivery and adoption of innovations.
Medicare beneficiaries (including those at risk for or with CKD) gain annual CKD screening coverage starting Jan 1, 2026, and dialysis patients can receive reimbursed kidney‑disease education at dialysis facilities, improving early detection and patient education where they already receive care.
Taxpayers and the Medicare Trust Fund will likely face higher spending because the post‑TDAPA add‑on and expanded screening/education payments are explicitly not budget‑neutral, increasing program outlays.
Higher Medicare drug and dialysis payments could raise costs for Medicare Advantage plans and potentially lead to higher premiums or cost‑sharing for enrollees if plans pass through increased spending.
Excluding patient‑level case‑mix adjustments risks mismatches between payments and clinical complexity, potentially overpaying for less complex cases and under‑incentivizing tailored care for sicker patients.
Based on analysis of 4 sections of legislative text.
Creates a permanent Medicare add‑on for qualifying new dialysis drugs (65% formula), extends TDAPA protections, adds CKD screening to wellness benefits, and changes kidney education payment rules.
Official title: To amend title XVIII of the Social Security Act to improve access to innovative treatment options for end-stage renal disease under the Medicare program, and for other purposes.
Introduced November 20, 2025 by Carol Devine Miller · Last progress November 20, 2025
Creates a permanent Medicare add‑on payment for certain new FDA‑approved renal dialysis drugs and biologicals that previously received TDAPA, requires CMS to pay TDAPA for at least three years for qualifying dialysis drugs approved since 2020, adds a forecast‑error adjustment to annual dialysis payment updates, and expands Medicare coverage to include chronic kidney disease (CKD) screening and modifies payment rules for kidney disease education so dialysis facilities can bill separately. Most major changes take effect January 1, 2026.