Ways and Means Advances Home Dialysis Support and Medical Equipment Fraud Bills

The House Ways and Means Committee on May 21 advanced a bill that would let Medicare pay for additional home dialysis support services and another aimed at fraud in durable medical equipment (DME) billing, according to the committee's markup record.

H.R. 8875, the Improving Home Dialysis Act, was ordered favorably reported to the House as amended by a substitute offered by Chairman Jason Smith, by a roll call vote of 28 yeas and 13 nays. H.R. 8871, the DME Scammer Prevention Act, was ordered reported, also as amended by a chairman's substitute, by 25 yeas to 19 nays, the record shows.

Medical equipment claims

The DME bill "would strengthen oversight and modernize claims processing requirements to prevent bad actors from defrauding Medicare beneficiaries and stealing taxpayer dollars," its sponsor, Rep. Aaron Bean of Florida, said in a release after the vote.

According to Bean's office, the bill would require electronic submission of claims for the DME products most susceptible to fraud within 90 days of the initial claim date, compared with the current 365-day deadline. It would also direct the Government Accountability Office to review the technology Medicare Administrative Contractors use to screen and process claims. Bean's office said more than 40,000 DME claims were submitted on paper and faxed to the Centers for Medicare & Medicaid Services in the past year.

"Rising fraud and criminal activity in the DME industry threaten to undermine our Medicare system and drive up costs," Bean said. Smith said in the same release that the measure "modernizes Medicare fraud prevention so we can prevent scams, protect tax dollars, and preserve the benefits our seniors have earned."

Before the final vote, the committee agreed 25-19 to table an appeal by Rep. Doggett of a ruling of the chair, according to the markup record.

Home dialysis services

The Improving Home Dialysis Act was introduced on May 19 by Rep. Miller of West Virginia. As introduced, the bill text would add two services to Medicare's self-care home dialysis support services beginning January 1, 2028: staff-assisted home dialysis respite care and renal mental health services furnished in the patient's home.

The bill defines staff-assisted respite care as dialysis furnished by qualified personnel, such as a registered nurse, licensed practical nurse or certified patient care technician, to a patient who is temporarily unable to dialyze independently during the first 30 days of home dialysis, or at any time when the inability is due to a physical limitation. Renal mental health services would be covered during the first 60 days after a patient starts home dialysis.

Under the introduced text, each respite session would carry a payment adjustment equal to the 2025 add-on per treatment for home and self-dialysis training, or 75% of that amount outside rural areas, capped at 20 sessions a year. Mental health sessions would be adjusted at 50% of that add-on, or 25% outside rural areas. The committee approved the bill in amended form, and the markup record does not summarize the changes.

The markup covered eight bills in all. The committee voted 44-0 to report H.R. 8163, the Provider Reimbursement Stability Act, and 27-16 to report H.R. 8883, the Protecting Seniors and Stopping Fraudsters Act. H.R. 3164, renamed the Main Street Pharmacy Access Act, was reported by voice vote, according to the record. All eight were reported to the House.