A proposed rule would pay for innovative dialysis equipment and support in the home setting for patients with end-stage renal disease.
Home-based dialysis equipment and supplies for patients with end state kidney disease would be eligible for additional Medicare reimbursements under a proposed rule put forward this week by the Centers for Medicare & Medicaid Services.
CMS Administrator Seema Verma said the proposed rule – the latest in a series of initiatives put forward by Medicare to improve access to kidney dialysis – is particularly timely "in the midst of a deadly pandemic that poses a particular threat to those with serious underlying conditions."
In addition to often having multiple comorbidities, ESRD patients also have the highest hospitalization rates for COVID-19 among Medicare beneficiaries.
"CMS data shows that those with ESRD have the highest rate of hospitalization of any single group, a trend consistent with having to frequently leave home to receive dialysis," Verma said.
"(This) action represents a sorely needed course direction, making it easier for ESRD facilities to make new and innovative home dialysis machines available to patients who need them," she said.
Currently, more than 85% of Medicare fee-for-service beneficiaries with ESRD travel to a facility to receive their dialysis at least three times each week, spending an average of 12 hours each week attached to a dialysis machine away from home, CMS said.
Under the proposed rule, which would take effect on January 1, 2021, CMS would:
- Expand the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES) that was introduced last year to now cover qualifying new dialysis machines when used in the home.
- Encourage under the ESRD Treatment Choices (ETC) Model the greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD to enhance care quality and reduce costs.
- Determine whether new ESRD care delivery and payment options can improve the quality of care and reduce the total cost of care for patients with kidney disease.
- Refine eligibility for the transitional drug add-on payment adjustment (TDAPA) under the ESRD PPS to target additional payments to innovative renal dialysis drugs and biological products.
“Those with ESRD have the highest rate of hospitalization of any single group, a trend consistent with having to frequently leave home to receive dialysis.”
CMS Administrator Seema Verma
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
The proposed rule would expand and encourage additional payments for innovative medical equipment and supplies that can be used to ease access to dialysis in the home.
More than 85% of Medicare fee-for-service beneficiaries with ESRD travel to receive dialysis at least three times each week, spending an average of 12 hours each week attached to a dialysis machine.
ESRD patients have the highest rate of hospitalization of any single group, a trend consistent with having to frequently leave home to receive dialysis.