HR-8376-119
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
What it does
This bill would amend Medicare (Title XVIII of the Social Security Act) to allow patients with end-stage renal disease (ESRD) who elect hospice care to also receive palliative dialysis services — dialysis used for comfort rather than treatment or life extension — as a separately covered and separately paid benefit. Currently, Medicare's hospice election generally bundles all related care into a single hospice payment, which can prevent dialysis facilities from billing separately for dialysis. The bill would cap covered palliative dialysis at 10 sessions, with the Secretary of Health and Human Services authorized to reassess and modify that limit beginning in 2029 through rulemaking.
Who benefits
Medicare-enrolled ESRD patients who elect hospice care and wish to continue dialysis for comfort — estimated at a subset of the roughly 560,000 Americans on dialysis. Renal dialysis facilities and providers who would gain a new, separate Medicare payment stream. Hospice programs that currently face pressure to absorb dialysis costs within their bundled payment. Family caregivers and patients who would have clearer access to concurrent comfort-focused dialysis. Home dialysis patients, including those using peritoneal dialysis, who are explicitly included.
Who is hurt
Medicare's overall budget, as separate payment for palliative dialysis would add new spending not currently covered outside the hospice bundle. Taxpayers and Medicare trust fund contributors who bear the cost of expanded coverage. Potentially, patients who exceed the 10-session cap and cannot access additional covered sessions. Competing hospice or palliative care providers who may face indirect reimbursement pressure if the new payment methodology is set lower than standard dialysis rates.
Supporters argue
Supporters argue that the current Medicare hospice bundling rule creates a perverse barrier: ESRD patients who elect hospice must effectively choose between comfort-focused dialysis and hospice enrollment, because dialysis costs are not separately reimbursed and hospice programs cannot absorb them. They contend that palliative dialysis — used to manage fluid overload, pain, and uremic symptoms — is a legitimate comfort measure, and that denying it forces patients into an all-or-nothing choice that contradicts the goals of hospice care. Allowing concurrent coverage aligns Medicare policy with existing pediatric concurrent care rules under the ACA.
Opponents argue
Opponents argue that the line between "palliative" and "maintenance" dialysis is clinically ambiguous and difficult to administer, creating a risk that the new benefit expands beyond its intended comfort-care purpose and adds significant, hard-to-control costs to Medicare. They contend that the 10-session cap is an arbitrary threshold unsupported by clinical evidence, and that delegating authority to the Secretary to modify that cap through rulemaking — without further congressional action — gives the executive branch broad discretion over a potentially costly new entitlement with limited legislative guardrails.
Constitutional context
Congress has broad authority to structure Medicare benefits under the Taxing and Spending Clause (Art. I, §8, cl. 1). This bill modifies an existing federal spending program and directs the Secretary to establish payment methodologies through rulemaking; post-Loper Bright (2024), courts would independently review whether the Secretary's implementing regulations stay within the statutory boundaries Congress sets here, rather than deferring to HHS's interpretation.
Checks and balances
Congress expands Medicare coverage and sets the session cap; the executive branch (HHS/CMS) gains rulemaking authority to set payment rates and, beginning in 2029, to modify the session limit — subject to judicial review under the post-Loper Bright independent-judgment standard.
Historical precedent
The ACA (2010) established concurrent care for children enrolled in hospice under Medicaid and CHIP, allowing curative treatment alongside hospice — this bill applies a similar concurrent-care concept to adult ESRD patients under Medicare.