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CMS Finalizes Policies to Expand At-Home Kidney Care Eligibility

Analysis  |  By Melanie Blackman  
   November 03, 2020

Additional Medicare payments will be provided for qualifying equipment and supplies for at-home dialysis machines for End-Stage Renal Disease (ESRD) patients.

The Centers for Medicare & Medicaid Services (CMS) announced expanded Medicare payment policies for at-home dialysis treatment of patients with End-Stage Renal Disease (ESRD) Monday afternoon.

The final rule will expand eligibility for 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," according to the press release.

Additional Medicare payments will be provided for qualifying equipment and supplies for at-home dialysis machines for ESRD patients.

“Medicare beneficiaries with ESRD have long been ill-served by a system that too often fails to incentivize the types of care that yield the best health outcomes for their quality of life,” CMS Administrator Seema Verma said in a statement.

According to the agency, more than 85% of ESRD patients with Medicare fee-for-service travel at least 3 times a week to receive dialysis treatment, where they are treated on average 12 hours a week.

This announcement builds upon the Trump administration’s ongoing efforts to increase access to home dialysis, specifically the Executive Order on Advancing American Kidney Health signed in July 2019.

In September, CMS announced two new care models to address chronic kidney disease and cancer care. The new care models aim to increase the usage of home dialysis and kidney transplants by shifting Medicare payments from fee-for-service payments to Medicare payments.

CMS has made multiple other policy announcements in the past month, including a vaccine mandate and a final rule on healthcare price transparency.

The organization released an interim final rule mandating that any vaccine that receives Food and Drug Administration approval will be covered under Medicare as a preventive vaccine at no cost to beneficiaries.

The organization also released a long-awaited and controversial final rule on healthcare  price transparency, which will require private group health plans and individual health insurance market plans to disclose pricing and cost-sharing information in a consumer-friendly format starting January 1, 2021.

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Related: CMS Administrator Seema Verma Discusses Price Transparency, Value-based Care, and COVID-19

Melanie Blackman is the strategy editor at HealthLeaders, an HCPro brand.

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