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CMS finalizes Medicare payment to support dialysis in the home

Certain new and innovative equipment and supplies will qualify for the additional Medicare payment.

Susan Morse, Managing Editor

New policy released by the Centers for Medicare and Medicaid Services promotes more dialysis treatment in the home by allowing the use of certain new equipment to qualify for an additional Medicare payment.

The final rule encourages the development of new and innovative home dialysis machines that give Medicare beneficiaries with end-stage renal disease more treatment options in the home. Certain new and innovative equipment and supplies will qualify for the additional Medicare payment.

WHY THIS MATTERS

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CMS is expanding eligibility for the transitional add-on payment adjustment for new and innovative equipment and supplies that was introduced last year to now cover qualifying new dialysis machines when they're used in the home.

Currently, more than 85% of Medicare fee-for-service beneficiaries with ESRD travel to a facility to receive their dialysis at least three times per week. They spend, on average, 12 hours each week attached to a dialysis machine away from home.

Additionally, as ESRD patients are among the most vulnerable population. Because of multiple chronic conditions and comorbidities, they have had the highest hospitalization rates due to COVID-19 among Medicare beneficiaries. The risk of hospitalization and complications highlights the importance that this population stay at home during the public health emergency.

THE LARGER TREND

The announcement builds on previous actions taken by CMS to improve care for beneficiaries with kidney disease, including CMS announcing the ESRD Treatment Choices Model that goes into effect on January 1, 2021. The model promotes greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD, in order to preserve or enhance their quality of care while reducing Medicare expenditures.

Approximately 68% of Medicare beneficiaries with ESRD also suffer from diabetes. These Medicare beneficiaries can join a prescription drug plan that will offer many types of insulin at a maximum copayment of $35 for a 30-day supply.

More than 1,600 Medicare Advantage and Part D prescription drug plans are participating in the Part D Senior Savings Model for 2021.

The Kidney Care First and Comprehensive Kidney Care Contracting Options of the Kidney Care Choices Model will test whether new care delivery and Medicare payment options can improve the quality of care and reduce the total cost of care for patients with kidney disease.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com