CMS Finalizes Policy to Improve Kidney Care for Low-Income Medicare Patients

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To help close health equity gaps, CMS finalized a rule that will update payment rates and improve incentives for providers to encourage them to increase access to home dialysis and kidney transplants for low-income patients with end-stage renal disease.

CMS announced a final rule that will encourage providers to improve rates of home dialysis and kidney transplants among low-income Medicare patients with end-stage renal disease, which represents one of the agency’s first CMS Innovation Center models to directly address health equity.

The rule updates payment rates for the End-Stage Renal Disease (ESRD) Prospective Payment System and will change the ESRD Quality Incentive Program (QIP) and the ESRD Treatment Choices (ETC) model.

“Today’s final rule is a decisive step to ensure people with Medicare with chronic kidney disease have easy access to quality care and convenient treatment options….Enabling dialysis providers to offer more dialysis treatment options for Medicare patients will catalyze better health outcomes, greater autonomy and better quality of life for all patients with kidney disease,” said CMS administrator Chiquita Brooks-LaSure, in a statement.


According to studies conducted by the CMS Office of Minority Health examining racial, ethnic, and socioeconomic factors, disadvantaged people with Medicare have higher risks of ESRD and experience higher hospital readmissions and related costs. They are also more likely to receive in-center hemodialysis instead of home dialysis. Additionally, non-White ESRD patients are less likely to receive pre-ESRD kidney care, be waitlisted for a transplant, and receive a kidney transplant.

In addition to altering the ETC model to test new payment incentives for improving home dialysis and transplant rates for lower-income individuals, CMS’ approval of the first-ever technology that allows for enhanced payments for innovative technologies will help ESRD facilities offer an additional option to Medicare beneficiaries for home dialysis during the COVID-19 pandemic.

Under the rule, Medicare will be expected to pay an estimated $8.8 billion to approximately 7700 ESRD facilities for furnishing renal dialysis services in 2022. CMS projected that the updates would increase the total payments by 2.5% for all ESRD facilities and 3.3% for all hospital-based ESRD facilities compared with 2021.

CMS claimed that the changes are consistent with President Joe Biden’s executive order (13985) “Advancing Racial Equity and Support for Underserved Communities through the Federal Government” and are exploring potential opportunities to collect and leverage data sets on race, ethnicity, Medicare/Medicaid dual eligible status, disability status LGBTQ+, and socioeconomic status to better measure disparities and help guide future rulemaking to improve health equity.

The rule also finalizes policies for the ESRD QIP that addressed the COVID-19 pandemic and functionality challenges regarding implementing a new data collection system, such as special scoring and payment policy under which facilities will not receive payment reductions under the QIP for the upcoming year, which would have been based on performance during the height of the pandemic in 2020.