As the threat of COVID-19 was emerging in the United States, ASN and the broader kidney community participated in an effort organized by the Department of Health and Human Services (HHS) to develop policy recommendations that address the effects of COVID-19 on kidney patients and kidney care professionals. 

The workgroups discussed and prioritized nearly 300 COVID-19-related kidney policy recommendations across seven key issue areas. HHS has already instituted many of the recommendations ASN and other stakeholders in the community made, and the society continues to work closely with the community to advocate for the policy recommendations to improve the care of kidney patients and protect the kidney care professionals that care for them.

Key workgroup recommendations are listed below. Policies that have been finalized are listed in italics.

Patient Care

• Prioritize COVID-19 testing for patients who are slated to receive a kidney transplant or are receiving dialysis
• Increase funding for personal protective equipment (PPE) and COVID-19 tests
• Require insurers to cover 90-day supply of prescription drugs for transplant or diabetic patients decreasing the need for vulnerable individuals to travel to a pharmacy for their medication

Innovation & Technology 

• Align three prize challenges that KidneyX will launch in FY 2020 to advance their original objectives, while simultaneously addressing kidney-COVID-19 priorities and accelerating solutions

• Reframe the future "KidneyX Patient Innovators Challenge" as the "KidneyX Innovation for COVID-19" challenge to identify, lift, and scale innovations that are working on the front lines, while advancing Kidney Health EO goals
• Request HHS act as a convener and create a collection of online resources that would bring together messaging about care and resources, as an authoritative source for patients and providers on COVID-19 and kidney disease

Federal & State Support

• Direct federal assistance to help hospitals meet increased demands for dialysis from COVID-19’s toll on the kidneys.

• Dedicate funding for care providers (including family members) to provide in-home care to help dialysis patients transition to home or remain at home post-transition, including for assisted cannulation.
• Expand funding for NIH and NIDDK to study acute research questions, such as the possible link between COVID-19 and acute kidney injury, and research funding into pandemic preparedness for vulnerable populations

Telehealth

• Allow MCP visits at home and in center by telehealth thereby reducing the number and frequency of face-to-face encounters and possible opportunities for patients and health professionals to be exposed to the virus
• Equip dialysis centers for telehealth to allow for transplant evaluations.
•  Changing the nonbillable status indicator for CPT telephone codes 99441-99443 listed in the e-visits to an active status indicator to clarify that those codes are billable to compensate for when video telehealth is unavailable.

Home & In-Center Dialysis

• Permit the use of in-patient dialysis units to be used for out-patient dialysis by waiving standard conditions of coverage during the crisis in order to provide more dialysis access and enable social distancing.
• Waive the requirement that dialysis organizations must collect labs for home dialysis patients on a monthly basis to reduce the risk of exposing them to COVID-19 outside of their homes.
• Provide a 3% per-treatment add-on payment to dialysis facilities for every new patient who receives home dialysis

Reimbursement & Transportation

• Increase reimbursement levels of COVID-19-related Medicare codes to establish parity between care delivered via telehealth and care provided in person.
• Permit and reimburse for telehealth visits via telephonic communications when two-way videoconference technology is not available
• Provide reimbursement for non-emergency transportation via appropriate methods, such as ambulance transport, to ensure isolation for COVID-19 positive patients

General Policy

• Clarify that vascular access and PD catheter services performed to facilitate the provision of dialysis are essential surgical procedures that are not elective and are crucial for establishing the vascular access for ESRD patients to receive their life-sustaining dialysis treatments
• Cease sending CMS surveyors into dialysis facilities dealing with COVID19 outbreaks, as their presence distracts from providers' availability to focus on providing care and doing so safely and utilizes scare PPE resources
• Pause any deportations and/or do not enforce penalties for individuals who have overstayed visas or have an otherwise unresolved visitation or immigration status who are serving as a care partner for home dialysis patients during the pandemic

The kidney community and the federal government have made significant progress on policy addressing COVID-19’s effect on kidney patients, however, more must be done. ASN continues to advocate for these issues to provide a safe environment for kidney care professionals to provide optimal care for kidney patients during this public health crisis. In keeping with this effort, the society recently joined the National Kidney Foundation in making recommendations to HHS Secretary Alex M. Azar II regarding the unique care needs of kidney patients that must be considered as the nation begins to “re-open.”

To keep ASN members informed of COVID-19-related policy developments, ASN regularly updates a list on Kidney News Online featuring policy changes, available at: “ ASN Policy in Action During COVID-19”.