ESRD Prospective Payment System (PPS) Proposed 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 to CMS on ESRD Prospective Payment System (PPS) Proposed Rule
ESRD Final Rule
KCP ESRD PPS Final Rule Summary
CMS Final Rules for the Prospective Payment of Dialysis

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.

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

Immunosuppressive Drug Coverage

There is no cure for ESRD, except for a kidney transplant, which 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
Physician Fee Schedule Final 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