Informative Masterclass
How to Protect your Family’s Assets and Leave a Lasting Legacy
Save Your Spot Now!

White Plains & New City, New York Estate Planning & Elder Law Firm

Why Did Medicare Drop End-Stage Renal Disease Payment Rule?

November 26, 2021
David Parker, Esq.
An elder law attorney can help with paying for a nursing home
David Parker, White Plains and New City NY Estate Planning Attorney
David Parker, Esq.
David Parker is an attorney who specializes in Estate Planning and Elder Law and has been practicing law for 30 years. Be it Wills, Trusts, Powers of Attorney, Health Care Proxies, or Medicaid Planning, David provides comprehensive and caring counsel for seniors and their families. A large portion of David’s practice is asset protection strategies so that families do not lose their hard earned savings to nursing home care costs. He also handles probate administration for the settlement of estates.
The Biden administration dropped a final rule Friday that will reward providers that improve rates of home dialysis and kidney transplants among low-income Medicare and dual-eligible beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule that updates the payment rates for the End-Stage Renal Disease Prospective Payment System (ESRD PPS) and makes changes to the quality incentive program and the ESRD Treatment Choices (ETC) model. The changes are designed to encourage dialysis providers to decrease disparities in home dialysis and transplant rates. It’s part of a larger effort by the Biden administration.

Fierce Healthcare’s recent article entitled “Medicare drops end-stage renal disease payment rule that aims to close health equity gaps” reports that this is the first CMS Innovation Center model to directly address health equity.

“Today’s final rule is a decisive step to ensure people with Medicare with chronic kidney disease have easy access to quality care and convenient treatment options,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “Enabling dialysis providers to offer more dialysis treatment options for Medicare patients will catalyze better health outcomes, greater autonomy and better quality of life for all patients with kidney disease.”

According to the CMS Office of Minority Health’s studies on racial, ethnic and socioeconomic factors, disadvantaged people with Medicare have increased occurrences of ESRD. They’re also more likely to experience higher hospital readmissions and costs and they’re more apt to get in-center hemodialysis (versus home dialysis). Studies also indicate non-white ESRD patients are less likely to receive pre-ESRD kidney care, become waitlisted for a transplant or receive a kidney transplant.

The end-stage renal disease payment model rule includes small payment increases for dialysis facilities, including 2.5% for hospital-based facilities and 3.3% for freestanding providers. The total increases represent an estimated 2.5% increase overall from 2021.

CMS says that it’s improving access to home dialysis for patients of all socioeconomic backgrounds and is finalizing changes to the ETC model to test a new payment incentive that rewards ESRD facilities and clinicians who manage dialysis patients for achieving significant improvement in the home dialysis rate and kidney transplant rate for lower-income beneficiaries.

CMS also is approving the first-ever technology under a recently established policy that permits enhanced payments for innovative technologies that are a substantial clinical improvement relative to existing options. This will help ESRD facilities offer an additional option to beneficiaries for home dialysis at this critical time in the pandemic. Under the 2022 prospective payment system for ESRD, Medicare says it will pay about $8.8 billion to approximately 7,700 ESRD facilities for furnishing renal dialysis services. The final 2022 ESRD PPS base rate is $257.90, which is an increase of nearly $5 to the current base rate of $253.13, the agency said.

Reference: Fierce Healthcare (Oct. 31, 2021) “Medicare drops end-stage renal disease payment rule that aims to close health equity gaps”


Share This Post
Stay Informed
Subscribe To Our FREE Estate Planning, Probate and Elder Law Newsletter

Book Your Free Initial Consultation With Parker Law Firm Today
Get Started Now

The 15 minute initial phone call is designed as a simple way for you to get to know us, and for our team to learn more about your unique estate planning needs.

Book an Initial Call
Book A Call With Parker Law Firm
Parker Law Firm
White Plains Location

222 Bloomingdale Rd #301,
White Plains, NY 10605

New City Location

120 North Main Street, Suite 203,
New City, NY 10956

IMS - Estate Planning and Elder Law Practice Growth Advisors
Powered by