Section 1 Short title
This Act may be cited as the “Kidney Disease Education Access Expansion Act of 2026”.
Kidney Disease Education Access Expansion Act of 2026
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.
Sec. 2 Expanding coverage of kidney disease education services under Medicare
Kidney disease education services and kidney disease screening—
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).”
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”.
Scope of kidney disease education services—
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—
by inserting “in an individual or group setting” after “furnished”; and
by inserting “(and, at the option of the individual, in the presence of such individual’s caregiver)” before the semicolon at the end.
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—
in subclause (II), by striking “and” at the end; and
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;”
Initial preventive physical examination— Section 1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2)) is amended—
in subparagraph (N), by adjusting the margin of such subparagraph 2 ems to the left;
by redesignating subparagraph (O) as subparagraph (P); and
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).”
Annual wellness visit— Section 1861(hhh)(2) of the Social Security Act (42 U.S.C. 1395x(hhh)(2)) is amended—
in subparagraphs (G) and (H), by adjusting the margin of each such subparagraph 1 em to the left;
by redesignating subparagraph (I) as subparagraph (J); and
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).”
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”.
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”.
in subparagraph (GG), by striking “and” at the end; and
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.
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
Kidney disease education effectiveness working group—
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)).
Composition— The working group shall consist of—
qualified entities that furnish kidney disease education services;
individuals with kidney disease and their caregivers;
health care technology specialists;
learning and educational assessment specialists; and
representatives from the Centers for Medicare & Medicaid Services.
Duties— The working group shall—
develop evidence-based methodologies for assessing patient comprehension, behavior change, and clinical outcomes resulting from kidney disease education services;
account for diverse learning styles and the impact of kidney disease on cognitive function in developing assessment tools;
recommend standardized metrics for evaluating the effectiveness of different educational approaches and delivery methods; and
provide recommendations for quality improvement strategies based on patient-centered outcomes.
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.
Kidney disease education assessment—
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)).
Scope of authority— In establishing and implementing the assessment framework under paragraph (1), the Secretary shall—
determine the specific methodologies, tools, and metrics to be used in assessing patient outcomes, educational effectiveness, and program success;
establish the frequency and timing of assessments, which may vary based on qualified entity type, patient population served, or other relevant factors;
specify data collection requirements and procedures for qualified entities providing kidney disease education services;
modify assessment criteria and procedures as needed based on evidence, outcomes data, or changes in clinical practice guidelines;
establish reporting requirements for assessment results and their use in program improvement; and
coordinate with relevant Federal agencies, professional organizations, and stakeholders to ensure assessment activities align with broader health care quality initiatives.
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.
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
in paragraph (2), by striking “and” at the end;
in paragraph (3), by striking the period at the end and inserting a semicolon;
in paragraph (4), by striking the period at the end and inserting a semicolon;
in paragraph (5), by striking the period at the end and inserting “; and”; and
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.”
Effective date— The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2027.