Medicare ESRD Reimbursement Reform: Impacts and Legislative Measures

Kidney Care Partners redirected its lobbying efforts, focusing on Medicare's reimbursement system for end-stage renal disease (ESRD) in the third quarter of 2026, highlighting financial challenges and legislative advocacy.

This shift is instrumental given the $110,000 spent on lobbying, a sharp reduction from $325,000 in the same period last year. Key proposals under consideration include the Kidney Care Access Protection Act of 2025, the Restore Protections for Dialysis Patients Act, and the Improving Home Dialysis Act of 2026. These efforts aim to address whether Medicare's payment structure adequately supports innovative dialysis treatments while maintaining access to private insurance.

Legislation and Proposed Reforms

Amid these discussions, two critical bills, H.R.6214 introduced by Rep. Carol Miller and S.2730 by Sen. Marsha Blackburn, are in the legislative pipeline. These propose extended transitional payments for new dialysis drugs and devices for three years and ensure Medicare Advantage plans reimburse dialysis providers at traditional rates. With rural providers struggling against inflationary pressures, these bills could potentially redefine the financial landscape for over 35 million Americans managing kidney disease.

The historical context that underpins these legislative efforts includes a 2022 Supreme Court ruling in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita, which affected ESRD patient insurance options. This decision and its impact continue to echo through congressional discussions, prompting a sustained push for reform in Medicare reimbursement and patient coverage.

Current Legislative Activities

H.R.8875, another critical piece of legislation introduced by Rep. Miller, is undergoing review in the House. This bill suggests coverage for staff-assisted home dialysis respite care and renal mental health services. It has cleared the House Ways and Means Committee, indicating bipartisan interest in expanding care options for patients requiring dialysis.

Key Industry Stakeholders

Several organizations are deeply involved in these legislative campaigns:

• Kidney Care Council and U.S. Renal Care Inc. support alongside Ardelyx Inc. and Fresenius Medical Care Holdings Inc.
• H.R.8875 is backed by the National Kidney Foundation Inc. and the Nonprofit Kidney Care Alliance, underscoring the collective industry effort to enhance funding and services for those in need.

This quarter saw Kidney Care Partners transition from utilizing four lobbying firms in the prior year to just one. As legislative discussions progress, the outcome of these bills will be critical in shaping how the insurance and healthcare sectors adapt to the evolving needs of ESRD patients and the associated financial frameworks.