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HR9891119th CongressWALLET

PREVENT ESRD Act

Sponsored By: Representative Wilson, Joe [R-SC-2]

Introduced

Summary

This bill would create a ten-year multipayer Medicare demonstration to expand kidney-care services and help prevent progression to end-stage renal disease (ESRD).

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  • People with diagnosed kidney disease would gain covered access to screening (urinalysis, blood, genetic tests), FDA-approved kidney-slowing drugs, nutrition and disease-management support, and telehealth when appropriate. Screening would have zero cost-sharing.
  • Participating plans would have to cover the specified services with the lowest applicable cost-sharing and could not use utilization limits stricter than FDA labeling. Plans that reduce CKD progression enough could earn 25 percent of certified Medicare savings and may receive advance investment payments; CMS can recoup payments for noncompliance or gaming.
  • The Secretary would set annual, risk-adjusted benchmarks based on each plan’s recent history and certify savings through the CMS Chief Actuary. CMS would get $5.0 million per year for administration for fiscal years 2026 through 2038 and must produce an intermediate report at 3 years and a final report at 6 years.

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 1 benefits, 0 costs, 3 mixed.

New 10-Year Kidney Care Program

If enacted, the bill would create a 10-year multipayer Kidney Care demonstration starting no later than January 1, 2027. Plans would join voluntarily after applying and signing an agreement. If your plan joins and you have diagnosed kidney disease, the plan would be required to provide specified kidney care services. Screening during routine annual exams would be covered with zero cost-sharing for all enrollees.

Data, Quality, and Program Evaluation

If enacted, participating plans would have to submit detailed historical and plan-year kidney data, including protected health information when needed, and the Secretary must protect privacy. The Secretary would set quality-performance standards for plans and could change measures over time. The Secretary would also require independent evaluations and must report an intermediate evaluation to Congress within three years of implementation and a final evaluation within six years.

Waivers, Audits, and Plan Enforcement

If enacted, the Secretary would be able to waive certain Medicare and specified Medicaid rules as needed to run the demonstration. The Secretary would have authority to audit data, prevent duplicate Medicare payments, and terminate or recoup payments from plans that avoid high-risk enrollees or otherwise game results. The Paperwork Reduction Act would not apply to program implementation and administration.

Payments and Incentives for Plans

If enacted, participating plans that meet quality and benchmark tests would receive 25% of certified Medicare savings each program year. The Secretary would be able to give optional advance investment payments to plans for each qualifying enrollee, and those advances would be deductible from a plan's shared savings. Shared savings and advance payments for 2027–2037 would be paid from the Medicare HI and SMI Trust Funds in proportions the Secretary sets. The bill would also transfer $5 million per fiscal year for FY2026–2038 to CMS for program administration.

Sponsors & CoSponsors

Sponsor

Wilson, Joe [R-SC-2]

SC • R

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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