Medicare Advantage Proposal Includes Steps to Implement Kidney Care Plan

This week's proposal for Medicare Advantage (MA) and its prescription drug benefit includes steps to implement quality-of-life improvements for patients with kidney failure, first outlined in an executive order in July.

Wednesday’s proposed rule for 2021-2022 would end barriers that patients with end-stage renal disease (ESRD) face when they try to enroll in MA plans. This could let patients with kidney failure take advantage of new features that some MA plans offer, such as transportation or nutrition services.

A CMS fact sheet says the proposed rule implements MA and Medicare fee-for-service (FFS) payment changes called for under the 21st Century Cures Act. These include FFS coverage of kidney acquisition costs for MA beneficiaries and exclusion of such costs from MA benchmarks (the base rate for Medicare plan bids).

The plan represents the latest element of the Trump administration’s comprehensive approach to renal care, which seeks to keep patients from advancing to dialysis. For those who do, the plan promotes transplants and home dialysis options. The July 10, 2019, executive order was accompanied by the announcement of Kidney Care First, later called Kidney Care Choices, in which dialysis facilities, nephrologists, and other providers form accountable care organizations to create financial incentives to better manage patients with stage 4 and 5 chronic kidney disease.

The new model was scheduled to take effect January 1, 2020, and a home infusion benefit is set to take effect in 2021. However, implementation of the rule has been delayed.

Other parts of CMS’ kidney care planning include a December proposal to expand reimbursement for expenses of living donors, such as lost wages and child care. For years, there have been barriers to these steps because of the ethical bar on donors being paid, but advocates say these steps would allow more donation by healthy family members.

The rules also establish quality metrics for organ procurement organizations and take other steps to increase the number of available transplantable kidneys from deceased donors. Some estimates say the plan could increase the number of available kidneys by 5000 a year.

The efforts won praise in December from the National Kidney Foundation (NKF). “These changes will help ensure living donors are made financially whole after giving the gift of life,” the group said in a statement. “NKF looks forward to working closely with the administration and Congress to expand financial resources available to living donors under the [National Living Donor Assistance Center] program.”

Such efforts make sense not only to improve the quality of life for patients, but also to reduce costs for Medicare, since ESRD is one of the most expensive and debilitating conditions that health systems face. Dialysis costs an average of $89,000 a year and these patients are more likely to be hospitalized; 20% die within a year, and 50% die within 5 years.

Approximately 37 million Americans have CKD and 725,000 have ESRD. At present, an estimated 95,000 Americans await a kidney transplant, according to NKF.