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New Medicare Rule Encourages Home Dialysis, More Kidney Donations

Feds promise increased financial support for living donors


spinner image Father and son walking arm in arm, father's t-shirt says transplant recipient, son's t-shirt says kidney donor.
Neil Ketchledge, 54, received a kidney donation from his son Korbyn. Here they walk near their Kennesaw, Georgia home three days after the transplant surgery.
ZUMA Press, Inc. / Alamy Stock Photo

It should become easier for Medicare beneficiaries to get their dialysis treatments at home, and an increased number of people could get financial help if they want to donate a kidney for transplantation, under a new regulation that will take effect in 2021.

Under the new rule, about one-third of Medicare patients dealing with end-stage renal disease (ESRD) will be enrolled in a program that “rewards more convenient, comfortable options like home dialysis and incentivizes rather than discourages transplants,” Health and Human Services (HHS) Secretary Alex Azar said Friday in a call with reporters.

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Officials at the Centers for Medicare & Medicaid Services (CMS) also said that ESRD patients, whose health is already vulnerable, could potentially be exposed to other illnesses, including COVID-19, when they have to travel to dialysis centers to get this lifesaving care. ESRD patients have among the highest rate of COVID diagnoses among Medicare beneficiaries.

One way CMS will help people get their dialysis at home is by increasing how much Medicare will pay providers to encourage such care. And, beginning in July 2022, the government will base some of its payments to kidney specialists and dialysis facilities on how much they increase home dialysis rates.

In addition to moving more patients from dialysis centers to home dialysis because it is more convenient, the shift is expected to save Medicare about $23.5 million over about five years, according to Seema Verma, CMS administrator. Verma said that though ESRD patients make up only 1 percent of Medicare beneficiaries, they account for 7 percent — $35.9 billion — of Medicare spending each year.

Among dialysis patients, about 12 percent now get their treatments at home, with the rest getting their care at dialysis centers. About 37 million Americans — more than 11 percent of the population — are battling chronic kidney disease, and more than 800,000 have ESRD.

Financial help for kidney donors

The new regulation also increases government support for people to donate their organs, including financial compensation for lost wages, child care and elder care. “No generous American who wants to save a life by becoming a kidney donor should face barriers to doing so,” Azar said.

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Since 2006, the National Living Donor Assistance Center has reimbursed donors up to $6,000 for expenses associated with their organ donation, including travel, lodging, meals and other incidentals. The new rule expands what will be considered incidental expenses to include lost wages, child care and elder care. Currently, to be eligible, donors must have an income of 300 percent of the federal poverty guideline or less. The new rule expands that to 350 percent of poverty. Donors do not have to be Medicare beneficiaries to qualify for assistance.

"We believe there are many potential living organ donors who would like to donate an organ to a family member or friend or a complete stranger but cannot afford the loss of income incurred during the required weeks out of work needed for a transplant surgery and the recovery time,” said Thomas Engels, administrator of HHS’ Health Resources and Services Administration.

Providers will also be reimbursed based on how well they do in expanding the number of kidney donors. As of last week, 92,000 Americans were waiting for a kidney transplant.

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