CMS on Monday signed off on its proposal to pay providers extra money if they use home dialysis machines to treat end-stage renal disease patients.
The final rule expands a transitional add-on payment to cover home dialysis machines that CMS Administrator Seema Verma touted in July when the agency proposed it, saying the COVID-19 highlighted the need to increase home dialysis access.
CMS expects it will pay $9.3 billion in 2021 for renal dialysis services. It increased the prospective payment system rate from $239.33 to $253.13. The proposed rule also updated payment rates for acute kidney injury dialysis and made changes to the ESRD Quality Incentive Program. The changes take effect Jan. 1.
Medicare beneficiaries with end-stage renal disease are in the most at-risk group for COVID-19. CMS data released in June showed there were 1,341 hospitalizations per 100,000 people in this category. They often have other comorbidities such as diabetes and heart failure and cannot shelter-in-place due to dialysis and other treatment requirements.
About 750,000 Americans have ESRD, and 530,000 have Medicare benefits. Approximately 85% of ESRD patients travel three times a week or more to receive dialysis treatment.
The Trump administration has made moves to change dialysis care, including changing how the treatment is paid for and what kind of insurance seniors with the disease are eligible for. In May, the agency finalized changes allowing ESRD patients to enroll in Medicare Advantage plans in 2021. Some insurers saw the change as an opportunity to drive better health outcomes.