People who receive dialysis at home, and the nephrologists who care for them, need additional options in order to receive care, and reduce risk of infection, during the COVID-19 pandemic. Thanks to the work of the American Society of Nephrology (ASN) and other members of the kidney community, important actions to protect these vulnerable patients have been enacted into law.
On Friday, March 27, 2020, the CARES Act* was signed into law. Section 3705 of this act eliminates a statutory requirement for a nephrologist to conduct a face-to-face evaluation of a home dialysis patient, allowing the Department of Health and Human Services (HHS) to issue emergency waivers so the entire visit can be conducted via telehealth. The emergency waiver authority will remain in place during the COVID-19 emergency period.
After much dialogue with the American Society of Nephrology (ASN) and other members of the kidney community, the Centers for Medicare and Medicaid Services (CMS) today clarified its guidance on deferring nonessential surgical procedures during the COVID-19 Public Health Emergency. The clarification clearly identifies Arteriovenous Fistulas, Arteriovenous Grafts, Peritoneal Dialysis Catheters, and intravenous catheters as planned procedures that are essential for establishing the vascular access that “is crucial for End Stage Renal Disease (ESRD) patients to receive their life-sustaining dialysis treatments.” Since the issuance of the original guidance, many ASN members have expressed their serious concerns that these procedures were being grouped with elective surgeries and, subsequently, being denied. Go to the ASN COVID-19 Response page for more information.
Given the enormous impact of the 2019 Novel Coronavirus (COVID-19) on the healthcare system, the American Society of Nephrology (ASN) and other members of the kidney community have requested regulatory relief for clinicians and facilities on multiple fronts over the past few weeks. The Centers for Medicare & Medicaid Services (CMS) and other agencies within the Department of Health and Human Services are responding in kind. The following is an update for ASN members on several major steps of importance to nephrologists and their patients that CMS has taken, particularly:
Calling attention to the unique needs of kidney patients in the COVID-19 Pandemic and advocating for specific policy changes to meet those needs was ASN President Anupam Agarwal, MD, FASN’s focus during a meeting Wednesday afternoon with President Donald Trump. The meeting also included Vice President Mike Pence, US Department of Health and Human Services Secretary Alex M. Azar, JD, Centers for Disease Control and Prevention Director Robert Redfield, MD, Centers for Medicare and Medicaid Services Administrator Seema Verma, and Coronavirus Response Coordinator Ambassador Deborah Birx, MD, as well as representatives from 15 other medical professional societies.
The approximately 500,000 Americans on dialysis and 222,000 Americans with kidney transplants are among the most vulnerable to the spread of the novel coronavirus, COVID-19. ASN is coordinating with the federal government to address the spread of COVID-19 and ensure the highest quality of care for those affected by kidney disease.
In a letter to the Secretary of Health and Human Services (HHS) Secretary, Alex Azar, ASN suggests multiple temporary policy changes in the context of this pandemic that affect those living with kidney disease including:
In the wake of the Coronavirus Disease-2019 (COVID-19) Pandemic, the Medicare program is expanding telehealth coverage enabling clinicians to provide a wider range of health care services to their patients without those patients having to travel to a health care facility thereby reducing exposure. The American Society of Nephrology (ASN) strongly supports this bold move. Retroactive to March 6, 2020, Medicare, under waiver authority, will temporarily allow and pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
A new CPT® code, 87635, has been released for immediate use for novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States. The code became effective Friday, March 13, 2020, for reporting of novel coronavirus tests across the entire healthcare system. Because of the immediate release and use of the code, clinicians will need to manually upload this code descriptor into their electronic health record (EHR) system. This CPT code will arrive as part of the complete CPT code set in the data file for 2021 later this year in the Microbiology subsection of the Pathology and Laboratory section.
On February 27, Senators Bill Cassidy, M.D. (R-LA) and Dick Durbin (D-IL) introduced legislation to extend Medicare coverage of immunosuppressive drugs for kidney transplant patients. A top priority for ASN, the common-sense legislation would extend Medicare coverage of immunosuppressive medications for kidney transplant patients beyond the current 36-month limitation, ensuring that kidney transplant patients do not face losing their transplant due to an inability to afford their medications. “Our bill ensures that kidney transplant patients can afford the medication they need to survive and won’t have to skip or ration doses,” said Durbin. “Extending this coverage under Medicare is bipartisan and commonsense, and I urge my Senate colleagues to support this legislation.”
The Executive Order on Advancing American Kidney Health (Section 8) directed the Secretary of Health and Human Services (HHS) to propose a regulation to remove financial barriers to living organ donation essentially:
ASN supported the proposed rule on Removing Financial Disincentives to Living Organ Donation issued by Health Resources and Services Administration (HRSA) of HHS and recommended further changes in its comment letter to the agency February 18, 2020.
NIDDK is establishing a nominal payline for new (Type 1) and renewal or competing continuation (Type 2) R01 applications of 16th percentile in FY 2020, which is higher than the 13th percentile in FY 2019.