The Centers for Medicare & Medicaid Services (CMS) on 2nd October 2020, finalized policies that allow certain new and innovative equipment and supplies used for dialysis treatment of patients with End-Stage Renal Disease (ESRD) in the home to qualify for an additional Medicare payment. This final rule encourages the development of new and innovative home dialysis machines that give Medicare beneficiaries with ESRD more dialysis treatment options in the home that can improve their quality of life.
The final rule builds upon President’s Executive Order on Advancing American Kidney Health by increasing access to it as well as supporting the agency’s key priorities in strengthening Medicare and fostering innovation.
CMS is expanding 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. This provides an additional Medicare payment when qualifying innovative equipment and supplies are used, in order to expand access to new machines and facilitate quicker availability to Medicare beneficiaries.
Currently, more than 85 percent of Medicare fee-for-service beneficiaries with ESRD travel to a facility to receive their dialysis at least 3 times per week. There, 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 covered by Medicare, due to 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 stays at home during the public health emergency to reduce the risk of exposure to the virus. In order to give dialysis patients more options to get needed care at home, CMS is finalizing innovative changes to encourage treatment.
Actions are taken by CMS to improve care for beneficiaries with kidney disease including:
- CMS announcing the ESRD Treatment Choices (ETC) Model that goes into effect January 1, 2021, that promotes greater use of it and kidney transplants for Medicare beneficiaries with ESRD in order to preserve or enhance their quality of care while reducing Medicare expenditures.
- Approximately 68 percent 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 co-payment 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 (KCF) and Comprehensive Kidney Care Contracting (CKCC) Options of the Kidney Care Choices (KCC) Model that 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.
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FAQs on Medicare Payment Changes for ESRD Home Dialysis Equipment
What is the purpose of the final rule by CMS regarding home dialysis equipment?
The CMS final rule aims to encourage the development and use of innovative home dialysis machines for End-Stage Renal Disease (ESRD) patients. This provides Medicare beneficiaries with more treatment options at home, enhancing their quality of life and reducing the need for facility-based care.
What is the Transitional Add-On Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES)?
TPNIES is a Medicare payment adjustment that provides additional reimbursement for qualifying new and innovative dialysis equipment and supplies used at home. This policy is designed to expand access to advanced home dialysis technology for ESRD patients.
Why is home dialysis being prioritized for Medicare beneficiaries with ESRD?
Home dialysis is prioritized to reduce the risk of exposure to illnesses, such as COVID-19, for ESRD patients who are highly vulnerable due to chronic conditions and comorbidities. It also minimizes the burden of frequent travel to dialysis facilities and provides a safer, more convenient treatment option.
What is the ESRD Treatment Choices (ETC) Model, and when does it take effect?
The ESRD Treatment Choices (ETC) Model, effective January 1, 2021, promotes greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD. Its goal is to improve patient outcomes and reduce Medicare expenditures.
What are the Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Options?
These options, part of the Kidney Care Choices (KCC) Model, test new care delivery and payment methods to improve the quality and cost-effectiveness of care for kidney disease patients. They focus on better care coordination and innovative payment strategies to reduce overall healthcare costs.
