The Kidney Care Access Protection Act seeks to enhance Medicare beneficiaries' access to innovative treatments for end-stage renal disease (ESRD). It extends the transitional drug add-on payment adjustment (TDAPA) period for new renal dialysis drugs and biological products to at least three years for those furnished after January 1, 2026. Furthermore, the bill establishes a permanent add-on adjustment to the base rate for claims involving these innovative drugs, effective January 1, 2026, which will not be budget neutral.

The legislation also revises the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES), extending its duration to at least three years for new renal dialysis devices furnished after January 1, 2026. It makes breakthrough devices eligible for TPNIES and includes capital-related assets in these adjustments. Additionally, the bill clarifies that certain new drugs for comorbid conditions in ESRD patients, approved after December 31, 2025, and not substituting existing therapies, will not be included in the ESRD prospective payment system base rate and will be separately payable.

To ensure comprehensive coverage, the Act mandates that Medicare Advantage plans make direct payment adjustments to providers for these innovative drugs and devices for ESRD enrollees, mirroring the traditional Medicare payment amounts and durations, starting January 1, 2026. Finally, it introduces a forecast error adjustment to the annual update of ESRD payment amounts, beginning in 2026, to improve the accuracy and stability of payments by accounting for discrepancies between forecasted and actual price changes in renal dialysis services.