This article is more than 5 years old. Information may no longer be current.
Proposed restrictions on payment for more frequent dialysis may be eased in the mid-West
Click Here to Manage Email Alerts
Medicare administrative contractor Wisconsin Physicians Services, one of seven contractors that proposed payment restrictions more than a year ago for more frequent dialysis, released revised language recently retracting the restrictions.
Wisconsin Physicians Services (WPS), which covers states in the mid-West, has proposed to add the language, “Some patients due to chronic or long-term conditions may require dialysis that exceeds the usually covered 14 treatments per month” to its local coverage determination (LCD) rule regarding payment for dialysis sessions that are prescribed more than three times a week. The number of additional treatments and the reasoning behind the order would need to be present in the dialysis documentation, the contractor wrote.
The effective date, according to WPS, would be Feb. 16. However, the contractor must release the final regulation first and allow for a 45-day comment period before implementation.
Three other MACs – Palmetto GBA, Noridian and National Government Services (NGS) – have also proposed revised language that eases the restrictions on coverage for more frequent dialysis. In the proposed change from Palmetto, which is similar to Noridian, and NGS, the language reads: “However, on occasion, acute, and occasionally chronic, conditions may require additional sessions during the month. These may be considered for additional payment.”
The three remaining MACs had not submitted any changes at presstime.
If the policy is published and implemented, it would be a major victory for home dialysis advocates, who protested when the seven MACs originally proposed language in September 2017 that would restrict coverage of dialysis to three treatments per week. More frequent sessions would be covered only if the nephrologist and care team could show acute events were taking place that medically justified more treatments. Once the acute event was resolved, however, the MAC would terminate coverage for additional treatments. Without medical justification, that policy would eliminate coverage for patients who choose nocturnal dialysis at home more than three times a week or for those patients who wanted to do dialysis for a short period each day.
The MACs offered public hearings on the proposed rules in November and December 2017, where they received comments and testimony from more than 400 nephrologists and kidney care advocates against the more restrictive coverage.
References: