CMS proposes payment change to support dialysis at home

July 7, 2020

The Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicare End-Stage Renal Disease (ESRD) Prospective Payment System (PPS).

Under the proposal, one change involves equipment and supplies used for dialysis treatment of patients with ESRD in the home. CMS proposes expanding a transitional add-on payment adjustment for equipment and supplies (TPNIES), which was introduced last year, to cover qualifying new dialysis machines when used in the home.

CMS officials believe the proposed change would encourage the development of new and innovative home dialysis machines that would give beneficiaries more dialysis treatment options in the home, improving their quality of life.

“CMS data shows that those with ESRD have the highest rate of hospitalization of any single group, a trend consistent with having to frequently leave home to receive dialysis,” said CMS Administrator Seema Verma.

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. They spend, on average, 12 hours each week attached to a dialysis machine away from home, according to CMS.

If finalized, the rule would be implemented in 2021.

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