What does Preamble of Kidney Care Access Protection Act do?

This bill, formally titled '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,' aims to improve access to innovative treatment options for end-stage renal disease within the Medicare program.

What does SHORT TITLE. of Kidney Care Access Protection Act do?

This Act is formally titled the Kidney Care Access Protection Act.

What does REFINING THE END-STAGE RENAL DISEASE PAYMENT SYSTEM TO of Kidney Care Access Protection Act do?

This section aims to refine the End-Stage Renal Disease (ESRD) Payment System to improve access to innovative treatment options. The Secretary is required to extend the transitional drug add-on payment adjustment (TDAPA) period for new renal dialysis drugs and biological products approved on or after January 1, 2020, for at least 3 years. A permanent post-TDAPA adjustment will be established for new renal dialysis drugs and biological products, calculated based on utilization and average sales price data. The calculation of the post-TDAPA add-on adjustment will consider wholesale acquisition cost if recent sales price data is unavailable. The add-on adjustment amount will be 65% of the calculated amount and updated annually to account for inflation. The definition of renal dialysis services is clarified to exclude drugs or biological products used to treat comorbid diseases unless they substitute for a drug included in the ESRD prospective payment system base rate. The transitional add-on payment adjustment for new and innovative equipment and supplies will be extended for at least 3 years for new renal dialysis devices. Devices designated for expedited development and priority review are eligible for the transitional add-on payment adjustment. Capital-related assets will be included in the calculation of the transitional add-on payment adjustment for new and innovative equipment and supplies.

What does ENSURING MEDICARE ADVANTAGE SUPPORTS KIDNEY CARE INNOVATIVE of Kidney Care Access Protection Act do?

This section amends Section 1853(c) of the Social Security Act to provide direct payment adjustments to providers of services or renal dialysis facilities. These adjustments apply to new renal dialysis drugs or biological products receiving a transitional drug add-on payment adjustment, and to items or services receiving a transitional add-on payment adjustment for new and innovative equipment and supplies. The payment amount will equal the amount determined under the end-stage renal disease prospective payment system. These payments will continue for the duration of the transitional payment period. Section 1851(i) of the Social Security Act is amended to include references to 1853(c)(8).

What does ENSURING ACCURACY AND STABILITY IN KIDNEY CARE PAYMENT. of Kidney Care Access Protection Act do?

This section amends Section 1881(b)(14)(F)(i) of the Social Security Act. The amendment modifies subclause (I) to include subclauses (II), (III), and (IV). It inserts language into subclause (II) referencing subclause (IV). A new subclause (IV) is added, establishing a forecast error adjustment. Beginning in 2026, the Secretary will compute an adjustment to the increase factor to account for forecast error. The initial adjustment in 2026 will consider the cumulative forecast error for 2021 and 2022. Subsequent adjustments will consider the forecast error from the most recent year with final data. The forecast error adjustment applies when the difference between forecasted and actual percentage changes in prices exceeds 0.5 percentage points.

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Kidney Care Access Protection Act

Last updated: 9/8/2025 · Introduced: 9/8/2025

Author: Marsha Blackburn (R-TN)

TL;DR (AI)

The bill extends and modifies payment adjustments for new drugs, biological products, equipment, and supplies used in end-stage renal disease (ESRD) treatment, aiming to improve access to innovative options.
Medicare Advantage plans will directly reimburse providers for ESRD treatments and innovative equipment at rates equivalent to the existing end-stage renal disease prospective payment system.
Beginning in 2026, the bill establishes a forecast error adjustment to stabilize kidney care payments by accounting for discrepancies between predicted and actual price changes.

119th Congressin committeeHR. 6214(In Committee)Official page

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