TMHome Dialysis Gets a Federal Push: What HHS's Kidney Care Plan Means for Home Care
Home dialysis just got a federal push. On October 20, the U.S. Department of Health and Human Services launched its Kidney Care National Plan, a department-wide strategy built around three priorities: preventing kidney failure, improving dialysis care while expanding patient choice, and reforming transplantation. For home-based care teams, the middle priority is the one to read closely, because it explicitly calls for expanding access to care in the home.
What the plan says about home dialysis
According to the HHS fact sheet, home dialysis use climbed from 10.5% of dialysis patients in 2017 to 16% in 2023, the highest level in more than a decade. HHS says it will look at streamlining certification and updating requirements to make more home-based care possible, review the conditions for coverage for dialysis facilities, and evaluate whether dialysis could be offered in alternative settings. It also points to market concentration, noting that two companies control roughly 74% of the dialysis market. None of this is a final rule yet. It is a list of opportunities HHS says it will consider, so the details will matter when proposals actually show up.
Why home health and home care agencies should pay attention
Kidney care is already one of the most expensive corners of Medicare. Home Health Care News reports that Medicare spending on people with end-stage renal disease reached $55.3 billion in 2023. It also notes that home health providers have not widely offered dialysis or specialized kidney care, partly because of reimbursement barriers. That is starting to shift, with Elara Caring and DaVita agreeing earlier this year to develop a kidney-specific home-based care model. Even agencies that never touch a dialysis machine will see more of these patients: people managing diabetes, blood pressure, medications, and fatigue at home, often with a family member doing a lot of the work between visits.
Practical steps worth taking now
Start by knowing which of your current clients are on dialysis or have advanced kidney disease, and who their nephrology and dialysis contacts are. Make sure aides and nurses know what to watch for and who to call, and that visit notes capture changes in weight, swelling, or appetite clearly enough for the next person to act on. If you are thinking about partnerships with dialysis providers or nephrology groups, this is a good moment to start those conversations, since policy is clearly moving toward more care at home. Teams using CareSync® can keep that kind of coordination visible in one place, comparing planned visits with completed ones so nobody has to guess what happened on a given day.
The plan is a signal more than a rulebook for now. Watch for proposed changes to dialysis facility rules and any new payment models that follow, because those will decide how much of this growth reaches home-based care providers. Agencies that already understand their kidney patients will be in the best position when it does.