Deficit Reduction

KCP strongly believes that well thought out deficit reduction is vastly preferable to automatic across-the-board sequestration cuts. We propose that individuals who develop kidney failure while having coverage through a Health Insurance Exchange plan be treated the same as those who have similar private coverage outside the Exchanges today. This parity would mean that individuals in the Exchanges would have the ability to maintain their private coverage for thirty months after their diagnoses with kidney failure (that diagnosis makes them eligible for Medicare). In addition, the subsidies available to provide assistance individuals in purchasing Exchange coverage should also be available to these individuals during that thirty-month window.

The kidney care community urges the Joint Select Committee on Deficit Reduction to avoid across-the-board cuts. MedPAC has consistently recognized the extremely narrow Medicare margins of dialysis facilities. Because of Medicare becomes available to individuals upon diagnosis with kidney failure rather than age, approximately 80 percent of all dialysis patients are Medicare beneficiaries. In addition, the initial stages of the substantial payment policy reforms and the first Medicare value-based purchasing program are underway. Adding an across-the-board cut on top of these reductions included as part of the new payment system would likely create economic instability in the program.

KCP One-Pager on Avoiding Cuts
KCP One-Pager on MSP in the Exchanges
KCP Letter to the Joint Select Committee on Deficit Reduction
Patient Group Letter to the Joint Select Committee on Deficit Reduction
ASN/ASPN/RPA Letter to the Joint Select Committee on Deficit Reduction
NKF Letter to CCIIO Director Steve Larsen
US Chamber Letter to CCIIO Director Steve Larsen
Business Round Table Letter to CCIIO Director Steve Larsen

ESRD Prospective Payment System (PPS) Rule

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) required that the Secretary of the Department of Health and Human Services implement a bundled payment policy for dialysis services beginning on January 1, 2011. The Centers for Medicare and Medicaid (CMS) issued the ESRD PPS Proposed Rule on September 15, 2009, which outlines the new Medicare payment system for dialysis facilities. As the dialysis community's only broad-based coalition of kidney patient advocacy groups, health care professional organizations, and dialysis service providers and suppliers, KCP submitted comments to the Agency and is working with CMS to ensure that implementation of the bundled payment system does not result in unintended consequences that adversely affect the quality of care for dialysis patients. On July 26, 2010, CMS issued the ESRD PPS Final Rule.

KCP Comment Letter on ESRD Prospective Payment System Final Rule
KCP Comment Letter to CMS on ESRD Prospective Payment System (PPS) Proposed Rule
ESRD PPS Final Rule
KCP ESRD PPS Final Rule Summary
Davita: CMS Final Rules for the Prospective Payment of Dialysis
Statement from KCP on the CMS Final Rule for the ESRD Quality Incentive Program (QIP)
Patient Organization Letters to Congress Leadership
Interim Final Rule on Changes to the ESRD Prospective Payment System Transition Budget-Neutrality Adjustment
KCP Statement on Interim Final Rule on Changes to the ESRD Prospective Payment System Transition Budget-Neutrality Adjustment
ESRD PPS for CY 2012, ESRD QIP for PY 2013 and PY 2014 Proposed Rule
KCP Comment Letter on ESRD PPS CY 2012, ESRD QIP PY 2013 and 2014 Proposed Rule

Quality Incentive Program

KCP is strongly committed to implementing a value-based purchasing system within the Medicare ESRD program. Such a program is consistent with ongoing efforts through the Kidney Care Quality Initiative (KCQI). On July 26, 2010, CMS issued the ESRD Quality Incentive Program (QIP) Proposed Rule in accordance with the Medicare Improvements for Patients and Providers Act (MIPPA) of 2009. The Proposed Rule outlines a plan to implement a QIP for dialysis providers and facilities beginning January 1, 2012. CMS issued the ESRD QIP Final Rule on December 29, 2010.

National Coverage Decision for ESAs

CMS has initiated a national coverage analysis (NCA) for ESAs for treatment of anemia in adults with CKD including patients on dialysis and patients not on dialysis. The Agency expects to complete the analysis by June 16, 2011. KCP remains committed to ensuring patient access to effective and appropriate ESA treatment for anemia.

CMS NCA
KCP Congressional Testimony on Ensuring Kidney Patients Receive Safe and Appropriate Anemia Management Care
CMS Proposed Decision Memo
KCP Comment Letter on Proposed Decision Memo

Immunosuppressive Drug Coverage

While there is no cure for ESRD, a kidney transplant is often the treatment option associated with the best outcomes for patients. Patients who receive a kidney transplant must take anti-rejection or immunosuppressive drugs for the life of their kidney transplant. However, Medicare will only pay for these drugs for the first thirty-six months after a patient receives their transplant. These medications average $17,000 per year. Patients who are unable to pay for the medications are often forced to discontinue their use, resulting in kidney rejection and a return to Medicare-covered dialysis treatments at an annual cost of nearly $71,000 per patient.

KCP strongly urges Congress to fund the vital coverage for immunosuppressive drugs, but not at the expense of patients receiving dialysis treatments. Rather than fund this expansion of coverage through cuts to the reimbursement rates for dialysis, KCP recommended extending the Medicare Secondary Payor (MSP) provision. The MSP extension raises revenue of approximately $1.2 billion that would cover the cost of immunosuppressive drugs and also provide dialysis patients who wish to continue to rely on their private insurance coverage the ability to do so. Within the Medicare Program, patients on dialysis are the only beneficiaries who are forced to give up their private insurance coverage because of the diagnosis of a disease.

KCP Response to CJSAN Article on Immunosuppressive Drug Coverage

CKD Education

KCP spent several years seeking to obtain coverage and reimbursement for education sessions for Medicare beneficiaries with chronic kidney disease. We worked closely with Members of Congress to encourage the inclusion, and ultimately the passage, of such provisions in the Medicare Improvements for Patients and Providers Act (MIPPA). Effective educational intervention is critical to informed decision-making, effective management of co-morbidities and uremic complications, and enhanced patient participation in their own health care. We also believe that effective education has the potential to delay the onset of dialysis, resulting in improved quality of life and reduced costs to the Medicare program.

KCP Comment Letter to CMS on the Physician Fee Schedule Proposed Rule
Physician Fee Schedule Proposed Rule
KCP Comment Letter to CMS on the CY 2012 Physician Fee Schedule Proposed Rule
CY 2012 Physician Fee Schedule Proposed Rule

ESA Monitoring Policy

On July 20, 2007, the Centers for Medicare and Medicaid Services (CMS) announced changes to its policy entitled “Monitoring of Erythropoietin Stimulating Agents (ESA) for Beneficiaries with End Stage Renal Disease.” KCP appreciated the Agency's efforts to implement an appropriate policy to address proper ESA dosing for ESRD patients. We emphasized the need to ensure that the Agency’s policies do not result in adverse outcomes for Medicare beneficiaries.

KCP Comment Letter to CMS on the ESA Monitoring Policy
CMS ESA Monitoring Policy