This bill aims to clarify and establish a distinct policy within the Medicare program for individuals receiving palliative dialysis services while concurrently enrolled in hospice care. It amends the Social Security Act to ensure that these specific dialysis services are covered and paid for separately, rather than being bundled into the overall hospice payment. Specifically, the legislation directs the Secretary of Health and Human Services to develop a new payment methodology for palliative dialysis services furnished to palliative dialysis eligible individuals starting in 2026. This methodology will consider existing renal dialysis payment systems and necessary resource adjustments for providing care in facilities or at home. The bill initially limits payment to no more than ten sessions of palliative dialysis, with a conversion for home dialysis to hemodialysis equivalent sessions. The Secretary is granted authority to assess and modify this session limit for 2029 and subsequent years, based on data and stakeholder feedback. Furthermore, the standard Medicare deductible and coinsurance provisions applicable to kidney dialysis services will also apply to these palliative dialysis services. The bill defines "palliative dialysis services" as those furnished as palliative care, not for treatment or maintenance, and certified by a physician, and clarifies that it applies to ESRD patients already receiving dialysis when they elect hospice.