New law allows outpatient dialysis clinics to treat acute care dialysis cases

Update

On Jan. 1 2017, Medicare Part B began including coverage for renal dialysis services furnished by a facility or provider for a Medicare beneficiary with acute kidney injury (AKI).

We asked Robert Provenzano, MD, FACP, FASN, Vice President of Medical Affairs in the Office of Chief Medical Officer at DaVita Kidney Care, and Glenda Payne, MS, RN, CNN, Director of Clinical Services for Nephrology Clinic al Solutions, to dissect the new AKI law and offer their views on how it will impact the renal care team in the outpatient dialysis setting. Read more

The renal community has been trying to convince the Centers for Medicare & Medicaid Services for a number of years to allow outpatient dialysis clinics to treat patients with acute kidney injury. Dialysis providers and groups like the Renal Physicians Association have argued that such centers have more expertise than hospital-based acute care dialysis programs. Likewise, the costs to the payers, particularly Medicare, would be less.

Getting CMS to eliminate the restriction has been difficult, and the provision has been part of a larger bill focused on patient education and research that has had limited movement in Congress.

Acute kidney injury, chronic kidney disease each a risk of the other

But advocates found a new “transporter:” the controversial Trade Adjustment Assistance (TAA)/Trans-Pacific Partnership (TPA). The "trade bill" has been contentious on both sides of the issue. Nonetheless, President Obama has been a supporter – and when he signs the legislation into law, it will include a provision on coverage and payment for renal dialysis services for individuals with acute kidney injury. That measure will takes effect in 2017.

Here is the bill’s language:

Sec. 808. Coverage and payment for renal dialysis services for individuals with acute kidney injury.

(a) COVERAGE—Section 1861(s)(2)(F) of the Social Security Act (42 U.S.C. 1395x(s)(2)(F)) is amended by inserting before the semicolon the following: ‘‘, including such renal dialysis services

furnished on or after January 1, 2017, by a renal dialysis facility or provider of services paid under section 1881(b)(14) to an individual with acute kidney injury (as defined in section 1834(r)(2))’’.

(b) PAYMENT— Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:

‘‘(r) PAYMENT FOR RENAL DIALYSIS SERVICES FOR INDIVIDUALS WITH ACUTE KIDNEY INJURY—

‘‘(1) PAYMENT RATE— In the case of renal dialysis services (as defined in subparagraph (B) of section 1881(b)(14)) furnished under this part by a renal dialysis facility or provider of services paid under such section during a year (beginning with 2017) to an individual with acute kidney injury (as defined in paragraph (2)), the amount of payment under this part for such services shall be the base rate for renal dialysis services determined for such year under such section, as adjusted by any applicable geographic adjustment factor applied under subparagraph (D)(iv)(II) of such section and may be adjusted by the Secretary (on a budget neutral basis for payments under this paragraph) by any other adjustment factor under subparagraph (D) of such section.

‘‘(2) INDIVIDUAL WITH ACUTE KIDNEY INJURY DEFINED — In this subsection, the term ‘individual with acute kidney injury’ means an individual who has acute loss of renal function and does not receive renal dialysis services for which payment is made under section 1881(b)(14).’’ -by Mark Neumann