Medicare beneficiaries with AKI would have a wider range of choices about how and where they receive renal dialysis services.
ASN commends provisions of the proposed rule for the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Quality Incentive Program (QIP) for 2025 by the Centers for Medicare & Medicaid Services (CMS), which would allow home dialysis for patients with acute kidney injury (AKI) to be paid for by Medicare. According to the rule, which would take effect in the 2025 calendar year (CY 2025), payment for home dialysis treatments furnished to beneficiaries with AKI would be made at the same payment rate as in-center dialysis treatments—although there are some technical adjustments to that payment that ASN is examining.
“We are thrilled that CMS has reaffirmed the patient doctor relationship and has taken these steps to facilitate individual patient-centered care,” said ASN Councilor Daniel E. Weiner.
The proposed rule would permit ESRD facilities to bill Medicare for the home and self-dialysis training add-on payment adjustment for beneficiaries with AKI, and to implement this adjustment in a budget neutral manner—budget neutrality is a concern ASN continues to raise as problematic. “We are proposing changes to the ESRD facility conditions for coverage to implement this policy change,” the rule states.
Medicare beneficiaries with AKI would have a wider range of choices about how and where they receive renal dialysis services. The proposed changes would also support more frequent dialysis at a lower ultrafiltration rate, which may help recovery of kidney function for those with AKI.
The proposed rule follows years of advocacy by ASN. In a letter to CMS about a 2022 proposal regarding the ESRD PPS Quality Incentive Program, ASN emphasized that “home modalities can be at least equivalent to in-center care, when delivered with proper patient guardrails.” The letter also pointed out that “peritoneal dialysis in particular may be learned quickly, reduces rapid hemodynamic changes that may potentiate kidney injury and impede recovery, and does not require a high-risk central venous catheter.”
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