Early this month Congress reached agreement to avoid the so-called “fiscal cliff” that would have raised taxes on everyone and triggered across-the-board budget cuts. The legislation that was ultimately signed into law will also have a significant impact on Medicare’s End-Stage Renal Disease (ESRD) program. Learn more below about the legislation’s provisions regarding future ESRD bundled payments and potential across-the-board cuts.
January also marked the beginning of a new Congress and the start of the President’s second term. In the coming weeks and months, Congress and the President are expected to continue to negotiate federal spending cuts and entitlement reforms in an effort to address long-term deficit reduction. AKF will continue to monitor these negotiations to ensure that the interests of kidney patients are represented.
Nikia Okoye Director of Government Relations
Fiscal Cliff Legislation Makes Changes to ESRD Bundled Payment System
One of the lesser-known provisions of the American Taxpayer Relief Act of 2012 was a one-year fix to the Medicare Sustainable Growth Rate (SGR)—a formula that determines Medicare payments to physicians. To help offset the cost of the SGR fix and prevent a sharp decline in Medicare physician reimbursements, Congress directed that the Medicare ESRD Prospective Payment System (bundle) be re-calculated to reflect the most current ESRD drug utilization data from 2012, a change that Congress estimates could save billions of dollars over the next decade.
In December, the U.S. Government Accountability Office (GAO) issued a report finding that Medicare may be overpaying for dialysis care through the new bundled payment due to a decline in ESA drug use in recent years. Medicare had calculated the current bundled payment rate based on 2007 drug utilization levels, and GAO recommended that Congress consider requiring Medicare to re-calculate the ESRD bundled payment rate to reflect the most current available data.
Congress adopted this recommendation in the fiscal cliff legislation, and as a result Medicare reimbursements to dialysis facilities will be updated beginning in January 2014. Congress also delayed for two years the implementation of oral-only ESRD drugs in the bundle, now scheduled to take effect on January 1, 2016.
Sequestration Delayed—There is Still Time to Take Action!
The fiscal cliff package delayed the implementation of automatic cuts to Medicare and its ESRD program that were scheduled to take effect this month. These cuts are part of sequestration—a series of federal budget cuts that were enacted as a result of the failed Super Committee negotiations of 2011. These cuts are now scheduled to take effect at the beginning of March, and the Medicare ESRD program could see a reduction of up to 2 percent.
AKF and the kidney care community have been strongly advocating against these cuts that may threaten kidney patients’ access to quality care. Help protect kidney patients from these harmful cuts by sending a message to your representatives in Congress today! Click here to take action on this important issue.
New Congress Begins
The 113th U.S. Congress was sworn in January 3, marking the beginning of a new Congress that will run through January 2015. As a result of the recent Congressional elections and redistricting, your federal representatives in the U.S House and Senate may have changed. You can look up your federal legislators at any time by using the Find Your Legislators feature on our Advocacy webpage.
AKF Comments on Essential Health Benefits Regulations
In December, AKF submitted comments to the Centers for Medicare and Medicaid Services (CMS) on a proposed rule to set standards for essential health benefits—a set of items and services that health plans will be required to offer beginning in January 2014. CMS has outlined an approach that would give each state the flexibility to define its essential health benefits package through the selection of an existing benchmark plan, rather than prescribe a specific list of items and services that all health plans must provide. AKF recommends that CMS specifically clarify coverage of ESRD as an essential health benefit. Click here to read AKF’s comments.
Do you have a question about one of the topics discussed in this newsletter? Are there other issues that are directly impacting you or a loved one that you would like to discuss?
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