I haven't seen data showing that staff-assisted hemodialysis works better for patients than having the patient do his/her dialysis and/or using a care partner who is a trained family member or friend. If true, patients doing dialysis in a clinic would have better outcomes than those doing dialysis at home and I have not seen evidence of that. If you have a source for that data, please share it.
Patients who do their own dialysis or family members or friends who are care partners must prove competency just like staff in a clinic. Even though they may not have prior medical training, home HD patients and their care partners gain similar experience to technicians who provide most of the direct patient care in dialysis clinics throughout the U.S.
I don't not know the specifics of Texas regulations for home dialysis, but suspect staff who provide dialysis for patients in their homes must meet certain qualifications to do certain aspects of care. However, I don't believe the Texas regulations limit the use of trained family members or friends to assist with or perform all aspects of home dialysis (PD or HD).
If you believe CMS should change its reimbursement policies to pay for staff-assisted home dialysis, write your legislators and CMS. ESRD care is expensive and on legislators' radar screens and I suspect they are looking for ways to cut reimbursement rather than expand it.