House Bill Would Allow Hospice Patients to Receive Dialysis

Why It Matters

By allowing dialysis within hospice, the bill expands end‑of‑life options for ESRD patients and aligns hospice benefits with those for cancer and dementia, potentially improving patient comfort and reducing inequities in Medicare coverage.

Key Takeaways

• Hospice patients with ESRD currently receive dialysis in only 1.3% of cases.
• Bill creates separate Medicare reimbursement for palliative dialysis in hospice.
• Provides choice, preventing patients from dropping life‑saving dialysis for comfort care.
• Bipartisan support may accelerate CMS rule changes on high‑acuity palliative services.
• Aligns hospice care with cancer/dementia standards, improving equity.

Pulse Analysis

End‑stage renal disease (ESRD) patients face a stark choice: continue life‑sustaining dialysis or enter hospice for comfort care. Medicare’s current rules effectively force many to abandon dialysis when they enroll in hospice, leaving only a tiny fraction—1.3% of hospice decedents in 2024—receiving both. This disparity stems from the lack of a clear reimbursement pathway for high‑acuity palliative services, a gap that has drawn criticism from patient advocates and clinicians who argue that dialysis can be a comfort‑focused therapy when tailored to end‑of‑life goals.

The Concurrent Care for Comfort Act seeks to close that gap by explicitly permitting Medicare to reimburse renal dialysis provided by qualified facilities to hospice patients. By establishing a separate payment mechanism, the bill removes the financial barrier that has traditionally compelled patients to choose between dialysis and hospice. The legislation enjoys bipartisan sponsorship, reflecting growing recognition that ESRD patients deserve the same flexibility afforded to those with cancer or dementia. It also dovetails with the reintroduced Hospice CARE Act and recent CMS requests for information on high‑acuity palliative services, signaling a broader policy shift toward integrated end‑of‑life care.

If enacted, the bill could reshape the hospice landscape by normalizing concurrent dialysis, improving quality of life for thousands of seniors with kidney failure. For providers, the new reimbursement stream offers a clear revenue source, encouraging dialysis centers to develop palliative protocols. For Medicare, it promises more equitable resource allocation and could reduce costly hospitalizations that arise when patients forgo dialysis. Ultimately, the legislation positions the United States to align its hospice standards across disease categories, fostering a more patient‑centered approach to end‑of‑life care.