House bill would pay for workforce, innovative drugs and expand coverage for treating CKD
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Key takeaways:
- Two legislators have re-introduced the Chronic Kidney Disease Improvement in Research and Treatment Act.
- The bill includes a requirement for HHS to complete a report on ways to improve organ donation.
U.S. House Reps. Carol Miller, R-W.Va., and Terri Sewell, D-Ala., have re-introduced The Chronic Kidney Disease Improvement in Research and Treatment Act.
If passed, H.R. 5027 “will support efforts to prevent and better understand chronic kidney disease (CKD) by ensuring appropriate reimbursement for quality care and improve patient access to the best drugs, technology and innovations along the kidney care continuum,” according to a press release from Kidney Care Partners (KCP), a coalition of dialysis providers, manufacturers, pharmaceutical companies and patient and professional associations, that expressed support for the bill.
As previously reported by Healio, the legislation was first introduced by Congress in 2014, and re-introduced in 2019 and 2021.
“West Virginia has the highest mortality rate of chronic kidney disease in the country, and I am working to change that,” Miller said in a press release from her congressional office. “The Chronic Kidney Disease Improvement in Research and Treatment Act is exactly what my constituents need ... This bill will provide the necessary resources and affordable access to treatment for patients suffering with [CKD] in communities across West Virginia and the country.”
The legislation has the support of patient groups, including the American Kidney Fund (AKF).
“It’s long been clear that Americans battling kidney disease deserve more from our health care system,” LaVarne Burton, president and CEO of the AKF, said in the press release. “The Chronic Kidney Disease Improvement in Research and Treatment Act will help ensure that all Americans have equitable access to the health services they need and deserve.”
CKD screening
According to the KCP, the legislation proposes the following:
- increase kidney disease prevention efforts by adding CKD screening to the annual wellness benefit;
- expand the Medicare Kidney Disease Education benefit to allow dialysis facilities, physicians and others to provide kidney disease education services;
- require CMS to provide a long-term payment pathway for new drugs, biologics, devices or other technologies;
- address the workforce shortage in nephrology by ensuring that kidney care providers receive accurate annual payment updates;
- include nephrologists and nonphysician practitioners in the National Health Service Corp loan forgiveness program; and
- expand patient choice and coverage by guaranteeing access to Medigap policies for Medicare beneficiaries with kidney failure.
“From expanding prevention and education resources to encouraging the development of breakthrough technologies and treatments, the Chronic Kidney Disease Improvement in Research and Treatment Act sets the stage for the future of kidney care,” John P. Butler, chair of KCP, said in the release.
Workforce
The bill would allow dialysis providers, physicians, physician assistants, nurse practitioners and clinical nurse specialists to educate patients at CKD Stage 4 and 5 about modality choices and other issues. It also calls for an add-on payment to dialysis providers who use new and innovative drugs and devices. “ ... [T]he Secretary shall ... calculate a per-treatment cost using the most recent cost and utilization data collected during a transitional payment period of not less than 3 years by dividing the total spending for such drugs or biological during such transitional period by the total number of treatments for which such drug or biological was listed on such claim,” according to the bill.
It also proposes an add-on payment to dialysis providers to help cover the increased costs of staffing a clinic. The add-on payment would be issued if CMS inaccurately calculates the costs of clinic operations in its market basket index, which is used to set the bundled payment rate for dialysis treatments.
“ ... The Secretary shall compute an adjustment to the annual update of the previous calendar year’s rate to account for forecast error” in the market basked index, which would apply “whenever the difference between the forecasted and actual percentage change in the [end-stage renal disease] market basket index exceeds the threshold of 0.5 percentage points.”
The bill calls for HHS to conduct a study to determine if any “disincentives in the payment systems under the Medicare program ... create barriers to kidney transplant and post-transplant care for beneficiaries with end-stage renal disease.” The study would also evaluate best practices for organ donation and determine if “cultural and policy barriers exist” to increase living donation rates.
The report would be due to Congress 18 months after enactment of the legislation.
References:
HR 5027. A bill to improve the understanding of, and promote access to treatment for, chronic kidney disease, and for other purposes. https://drive.google.com/file/d/1EPSDdvdIVwG99RApC89f6Dj3fNegiREV/view?pli=1. Published July 27, 2023. Accessed Aug. 1, 2023.
Kidney Care Partners applauds introduction of bipartisan Chronic Kidney Disease Improvement in Research and Treatment Act. https://kidneycarepartners.org/press/kidney-care-partners-applauds-introduction-of-bipartisan-chronic-kidney-disease-improvement-in-research-and-treatment-act/ Published July 28, 2023; Accessed Aug. 1, 2023.
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