CMS increases payment for dialysis facilities, includes oral-only drugs in the bundle
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Key takeaways:
- CMS increased the payment rate for dialysis by about 2.7% for 2025.
- CMS extended coverage to home dialysis for acute kidney injury.
- Oral-only renal drugs will be included in the payment bundle.
CMS issued a final rule increasing the End-stage Renal Disease Prospective Payment System base rate to dialysis facilities by about 2.7% to $273.82 beginning Jan. 1, 2025, according to an agency press release.
The final rate is higher than the 2.2% increase to $273.20 in the proposed rule circulated in July and up from the 2024 base rate of $271.02.
The rate will apply to home dialysis for AKI, which will be covered for the first time, “allowing Medicare beneficiaries with AKI a wider range of choices about how and where they receive renal dialysis services. ... CMS believes these changes will also support more frequent dialysis at a lower ultrafiltration rate, which may support recovery of kidney function in beneficiaries with AKI,” the release stated.
Also beginning Jan. 1, 2025, the bundled payment will include oral-only renal dialysis drugs and biologics — a move initially set to begin in 2014 but delayed until now by several laws and court challenges.
“In response to comments that we received on the proposed rule [released in July], we are finalizing a policy to pay the [transitional drug add-on payment adjustment] for phosphate binders based on 100% of the average sales price, increased by a fixed amount of $36.41 for incremental costs such as dispensing and storage of phosphate binders, which will be added to any monthly claim for which there is a [transitional drug add-on payment adjustment] payment for phosphate binders. We expect that incorporating oral-only drugs and biological products into the [End-stage Renal Disease Prospective Payment System] will increase access to these drugs,” CMS stated in the release.
In a response statement, Kidney Care Partners (KPC), a non-profit coalition of stakeholder organizations, expressed concern that “the base rate is insufficient to support adding new treatment options without adding new money.”
“We applaud CMS’s efforts both in recognizing that providing oral-only medications as part of the bundle requires additional funding, as well as creating access for AKI patients to home dialysis,” Mahesh Krishnan, MD, MPH, MBA, chair of Kidney Care Partners, said in the statement. “However, KCP has consistently raised concerns that significant changes are needed to the ESRD PPS system to maintain an appropriate level of care, access and reimbursement for the more than 557,000 Americans who rely on regular dialysis treatment.”
KPC urged support of the Chronic Kidney Disease Improvement in Research and Treatment Act of 2023 (H.R. 5027/S. 4469) to provide a permanent reimbursement pathway for innovative drugs and devices.
References:
Kidney Care Partners supports policies to expand home dialysis and improve reimbursement for phosphate-lowering drugs, remains concerned CMS has not addressed barriers to patient access to innovative treatments. https://kidneycarepartners.org/press/kidney-care-partners-supports-policies-to-expand-home-dialysis-and-improve-reimbursement-for-phosphate-lowering-drugs-remains-concerned-cms-has-not-addressed-barriers-to-patient-access-to-innovative/. Published Nov. 4, 2024. Accessed Nov. 4, 2024.
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