Kidney Disease Education Access Expansion Act of 2026
- Sponsor
- Rep. DelBene, Suzan K. [D-WA-1]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jun 29, 2026
Bottom line
The bill aims to improve kidney disease outcomes by dramatically increasing access to education and screening services for a wider population under both public and private insurance, while also establishing mechanisms to measure the effectiveness of these interventions.
What it actually does
This bill significantly expands coverage for kidney disease education services (KDES) under Medicare by broadening eligible providers, patient eligibility, and the scope of covered services. It also removes limits on the number of KDES sessions, allows for telehealth delivery, and increases Medicare payment to 100% of the fee schedule. Additionally, it mandates that private health insurance plans cover KDES as a preventive service and establishes a working group and assessment framework to evaluate KDES effectiveness.
Proponents argue
Proponents argue that early education and screening are critical for managing chronic kidney disease (CKD), slowing its progression, and improving patient outcomes, potentially reducing the need for costly dialysis or transplants. Expanding access to KDES through more providers, broader eligibility, and telehealth options will empower more patients to make informed decisions about their health and care options, ultimately leading to better quality of life and more efficient healthcare utilization.
Opponents contend
Opponents might raise concerns about the potential increase in federal healthcare expenditures due to expanded Medicare coverage and the mandate on private insurers, especially without clear, immediate evidence of cost savings. They may also question the administrative burden on providers and insurers to implement the new coverage rules and participate in the effectiveness assessment framework, particularly if the benefits do not outweigh the costs.
The bill is concise and relatively easy to read, allowing for a thorough understanding within a short timeframe, which is beneficial for stakeholders and policymakers.
Section 2(a)(1)
Expansion of Qualified Providers for Kidney Disease Education Services
This provision amends the Social Security Act to expand the definition of 'qualified person' who can furnish kidney disease education services (KDES) under Medicare. It adds physician assistants, registered nurses, nurse practitioners, clinical nurse specialists, clinical social workers, registered dietitians or nutrition professionals, and community health workers (trained under direction of a qualified entity) to the list of eligible providers. Previously, it was primarily physicians.
Supporters argue
Proponents argue that expanding the range of qualified providers will significantly increase access to vital kidney disease education, especially in rural or underserved areas where physician access may be limited. It leverages the expertise of various healthcare professionals who are already involved in patient care and can effectively deliver educational content.
Critics contend
No specific opposition is typically raised against expanding the types of qualified providers for educational services, as long as appropriate training and oversight are ensured. Potential concerns might relate to ensuring consistent quality of education across diverse provider types.
Tradeoffs
The tradeoff involves balancing increased access to KDES through a broader provider base against ensuring consistent quality and standardization of education delivery across these diverse professionals.
Section 2(a)(2)
Expansion of Patient Eligibility for Kidney Disease Education Services
This provision expands Medicare eligibility for KDES. Previously, only individuals with Stage IV chronic kidney disease (CKD) who were expected to require dialysis or a transplant were eligible. The bill changes this to include individuals with hypertension, diabetes, any stage of CKD, or other risk factors for kidney disease progression or kidney failure as determined by a qualified entity.
Section 2(a)(3)
Expansion of Scope for Kidney Disease Education Services
This provision expands the scope of KDES in two ways: it allows services to be furnished in individual or group settings and permits caregivers to be present. It also adds new topics to the KDES curriculum, including therapeutic options to slow kidney function decline, caregiver training and support for new transplant recipients, basic transition assistance for transplant recipients, and education on post-transplant self-care and follow-up coordination.
Section 2(b) and (c)
Integration of Kidney Disease Screening into Medicare Preventive Visits
This provision amends the Social Security Act to include screening for chronic kidney disease, kidney failure, and rare kidney diseases as part of the Initial Preventive Physical Examination (IPPE) and the Annual Wellness Visit (AWV) under Medicare. For the AWV, it specifically mentions routine metabolic and urinary assessments and a referral for KDES as appropriate.
Section 2(d)
Removal of Session Limits for Kidney Disease Education Services
This provision amends the Social Security Act to remove the current limit of 'not more than 6 sessions' for kidney disease education services under Medicare. Instead, it allows for a number of sessions that the Secretary, in consultation with patients, caregivers, and qualified persons, determines is appropriate.
Section 2(e)
Telehealth Coverage for Kidney Disease Education Services
This provision amends the Social Security Act to explicitly include kidney disease education services (KDES) as a service that can be furnished through telehealth under Medicare.
Section 2(f)
Increased Medicare Payment for Kidney Disease Education Services
This provision amends the Social Security Act to increase the Medicare payment rate for kidney disease education services (KDES). It specifies that the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule established under section 1848.
Section 3(a)
Kidney Disease Education Effectiveness Working Group
This provision mandates the Secretary of Health and Human Services to convene a working group within 180 days of enactment. The group will develop and evaluate methodologies for measuring patient benefit and educational effectiveness from KDES. It will include qualified entities, patients, caregivers, health tech specialists, learning specialists, and CMS representatives. The working group is tasked with developing evidence-based methodologies, accounting for diverse learning styles, recommending standardized metrics, and providing quality improvement strategies.
Section 3(b)
Kidney Disease Education Assessment Framework
This provision requires the Secretary to establish a comprehensive assessment framework within two years of receiving the working group's report. This framework will evaluate the success and effectiveness of KDES, determining specific methodologies, tools, metrics, assessment frequency, data collection requirements, and reporting requirements. The Secretary can implement this through guidance, regulations, or pilot programs and will use results for continuous program improvement, potentially adjusting payment policies or coverage criteria.
Section 4
Mandate for Private Health Insurance Coverage of Kidney Disease Education Services
This provision amends the Public Health Service Act to include kidney disease education services (KDES), as defined in the Social Security Act, as a preventive service that private health insurance plans must cover without cost-sharing. This applies to plan years beginning on or after January 1, 2027.
The bill removes the explicit limit of 'not more than 6 sessions' for kidney disease education services under Medicare, instead granting the Secretary the authority to determine an 'appropriate' number of sessions in consultation with stakeholders.
Section 2(d)
Why it matters:This is standard legislative practice to delegate detailed implementation rules to the executive branch, allowing for flexibility and adaptation based on clinical evidence and stakeholder input, rather than rigid statutory limits.
Case for: Supporters argue that this flexibility allows the program to adapt to evolving clinical guidelines and individual patient needs, ensuring that education is tailored and effective without arbitrary caps.
Case against: Critics might express concern that broad Secretarial discretion could lead to inconsistent application, potential delays in establishing clear guidelines, or future limitations that might not fully align with patient or provider expectations.
Estimated impact: This provision could significantly increase or decrease the total number of KDES sessions provided, depending on the Secretary's determination, thereby impacting overall Medicare expenditures and patient engagement.
The Secretary is granted broad authority in establishing and implementing the Kidney Disease Education Assessment framework, including determining specific methodologies, tools, metrics, assessment frequency, data collection requirements, and reporting requirements, and the ability to modify these as needed.
Section 3(b)(2)
Why it matters:This is a common legislative technique to empower agencies with the necessary flexibility to develop and refine complex programs without requiring constant legislative amendments, especially for technical and evolving areas like assessment methodologies.
Case for: Proponents argue that granting the Secretary this flexibility is essential for creating an effective and adaptable assessment framework that can incorporate new research, technologies, and clinical practices over time, ensuring the program remains relevant and impactful.
Case against: Critics might express concern that such broad authority could lead to an overly burdensome or prescriptive assessment framework for providers, or that the criteria might not fully reflect the diverse realities of KDES delivery without sufficient ongoing stakeholder input.
Estimated impact: The specific design and implementation of the assessment framework, which will be determined by the Secretary, will dictate the administrative burden on providers and the ultimate effectiveness of the KDES program in achieving its goals.