The federal government has announced a federal rulemaking proposal that would extend Medicare coverage to include in-home dialysis for patients with acute kidney injury.
Besides increasing overall expenditures in 2025 on the ESRD payment system by 2.2 percent, or around $170 million, the update includes a proposal to increase patient options for dialysis treatment for Medicare beneficiaries with acute kidney injury.
For 2025, CMS is proposing to allow Medicare beneficiaries with acute kidney injury to receive dialysis at home. The agency also proposes that dialysis facilities be allowed to bill Medicare for training patients with acute kidney injury to perform in-home dialysis. The agency also plans to update the payment rate for acute kidney injury dialysis to $273.20, which is the same as the base rate for regular dialysis.
The proposal represents a significant shift in CMS policy as, under current Medicare rules, only in-center dialysis is covered for beneficiaries with acute kidney injury who are not hospitalized.
CMS said in the announcement that dialysis-dependent patients with acute kidney injury have the potential to recover kidney function and avoid long-term dialysis. The agency added that providing such beneficiaries with more flexible treatment options like in-home dialysis would encourage more frequent dialysis at lower ultrafiltration rates, supporting recovery of kidney function in patients with acute kidney injury.
If the rule is ultimately adopted, Medicare coverage of home dialysis will be available to both patients with acute kidney injury as well as end-stage renal disease.
ESRD Payment System Updates and Other Details
The proposed rule includes several updates to the ESRD PPS base rate.Specifically, CMS said that its proposal would increase the base rate to $273.20 in 2025 from $271.02 in 2024, incorporating a 1.8 percent market basket percentage increase adjusted for productivity.
The agency estimates that the updates would increase the total payments to all ESRD facilities next year by 2.2 percent compared to 2024. Hospital-based ESRD facilities are projected to see a 3.9 percent increase in total payments while freestanding facilities will see a total payment increase of 2.1 percent.
CMS is also proposing updates to the policy of handling unusually high costs, or outliers, in providing kidney dialysis services. It wants to include more specialty drugs and biological products in the list of services considered for extra cost adjustments. These are items that were or would have been included in the composite rate prior to the establishment of the current ESRD payment system.
The agency is also proposing technical changes to how it calculates the extra cost amounts, which consist of the outlier services fixed-dollar loss (FDL) amounts and the Medicare allowable payment (MAP) amounts, in order to better match current data and costs.
For children, the threshold for the FDL extra payments would go up from $11.32 to $223.44 for 2025, while the MAP payment rate would increase from $23.36 to $58.39.
For adults, the FDL extra payment threshold would decrease from $71.76 to $49.46 while the MAP payment rate would drop from $36.28 to $33.57.
Also, CMS is proposing to revise the ESRD PPS-specific wage index methodology for next year to better reflect geographic variations in labor costs using data from the Bureau of Labor Statistics and Medicare cost reports.
