CMS tacks on new provider payment for home dialysis machines

The CMS on Monday proposed paying physicians and providers additional money if they use home dialysis machines to treat end-stage renal disease patients.

Medicare beneficiaries with end-stage renal disease are in the most at-risk group for COVID-19. CMS data released last month showed there were 1,341 hospitalizations per 100,000 people in this category. They often have other comorbities such as diabetes and heart failure, and are unable to shelter-in-place due to dialysis and other treatment requirements, the agency said.

Monday’s proposed rule would expand a transitional add-on payment to cover home dialysis machines.

“In the midst of a deadly pandemic that poses a particular threat to those with serious underlying conditions, President Trump’s call for increased access to home dialysis has never been more urgent,” CMS Administrator Seema Verma said in a statement. “Unfortunately, government rules too often stand in the way. Today’s action represents a sorely needed course direction, making it easier for ESRD facilities to make new and innovative home dialysis machines available to patients who need them.”

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.

CMS expects it will pay $10.3 billion in 2021 for renal dialysis services. It increased the prospective payment system rate from $239.33 to $255.59. The proposed rule also updated payment rates for acute kidney injury dialysis and made changes to the ESRD Quality Incentive Program.

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 have seen the change as an opportunity to drive better health outcomes.