Congress Expands Medicare Coverage for Acute Dialysis Services

July 10, 2015

On June 29, 2015, President Obama signed into law the Trade Preferences Extension Act of 2015, which provides for Medicare reimbursement for renal dialysis services furnished to individuals with acute kidney injury. This measure, which takes effect on January 1, 2017, has been long awaited by dialysis providers. Frustration surrounding Medicare reimbursement for acute dialysis services furnished in an outpatient dialysis facility dates back to a statement issued by the Centers for Medicare and Medicaid Services (CMS) on July 18, 2012. CMS took the position that hospital outpatients may receive acute dialysis only in a hospital or in locations that qualify as provider-based departments of the hospital if they want those services reimbursed by Medicare.

The July 2012 statement presented considerable confusion in the dialysis community regarding whether CMS was also stating that Medicare-certified facilities could provide acute dialysis services. The recent legislation now ensures that dialysis facilities will be reimbursed for acute dialysis treatments rendered to Medicare beneficiaries as of January 1, 2017. Specifically, Section 808 of the law amends the Medicare statutes to provide coverage for “renal dialysis services furnished … by a renal dialysis facility or provider … to an individual with acute kidney injury.” See H.B. 1295, 114th Cong. (2015). Further, payment for furnishing acute dialysis services “shall be the base rate for renal dialysis services determined for such year … as adjusted by any applicable geographic adjustment factor” or otherwise adjusted by CMS.

For further guidance on issues relating to Medicare reimbursement for dialysis services, please contact the authors or any other member of the firm’s healthcare group.