CMS is taking action to close health equity gaps by providing Medicare patients living with End-Stage Renal Disease (ESRD) with greater access to care. Through the ESRD Prospective Payment System (PPS) annual rulemaking, CMS is making changes to the ESRD Quality Incentive Program (QIP) and the ESRD Treatment Choices (ETC) Model, and updating ESRD PPS payment rates. The changes to the ETC Model policies aim to encourage dialysis facilities and health care providers to decrease disparities in rates of home dialysis and kidney transplants among ESRD patients with lower socioeconomic status, making the model one of the agency’s first CMS Innovation Center models to directly address health equity.

“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,” said CMS Administrator Chiquita Brooks-LaSure. “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.”

According to CMS Office of Minority Health’s studies on racial, ethnic and socioeconomic factors, disadvantaged people with Medicare have higher rates of ESRD. They are also more likely to experience higher hospital readmissions and costs, as well as more likely to receive in-center hemodialysis (vs. home dialysis). Studies also indicate non-white ESRD patients are less likely to receive pre-ESRD kidney care, become waitlisted for a transplant, or receive a kidney transplant.

CMS is improving access to home dialysis for patients of all socioeconomic backgrounds. For example, CMS is finalizing changes to the ETC Model to test a new payment incentive that rewards ESRD facilities and clinicians who manage dialysis patients for achieving significant improvement in the home dialysis rate and kidney transplant rate for lower-income beneficiaries. In addition, CMS is approving the first ever technology under a recently established policy that allows for enhanced payments for innovative technologies that represent a substantial clinical improvement relative to existing options. This approval will help ESRD facilities offer an additional option to beneficiaries for home dialysis at this critical time in the pandemic.

Consistent with President Biden’s Executive Order 13985 on “Advancing Racial Equity and Support for Underserved Communities through the Federal Government,” CMS is addressing health inequities and improving patient outcomes in the U.S. through improved data collection for better measurement and analysis of disparities across programs and policies. In response to the proposed rule, CMS received valuable feedback on potential opportunities to collect and leverage diverse sets of data such as race, ethnicity, Medicare/Medicaid dual eligible status, disability status, LGBTQ+ and socioeconomic status, to better measure disparities. CMS also received feedback on various methodical approaches to advance equity through the ESRD Quality Incentive Program (ESRD QIP). This valuable stakeholder feedback will help guide future rulemaking to improve health equity.

The rule finalizes policies for the ESRD QIP that address the circumstances of the COVID-19 public health emergency and functionality challenges relating to the implementation of a new data collection system. These challenges include a special scoring and payment policy under which no facility will receive a payment reduction under the ESRD QIP for the upcoming year, especially since such payment reductions would have been based on performance during the height of the pandemic in 2020.

CMS’ proposed rule included several requests for information (RFIs) for the agency to consider as part of its goal to increase access to dialysis treatments at home. Commenters’ responses to the RFIs included specific suggestions for improving Acute Kidney Injury (AKI) payment and the ESRD PPS.

More Information:

• Fact sheet
• Final rule

Beginning October 2021, the Pennsylvania Department of Human Services (DHS) will begin terminating state-funded Medicaid coverage for individuals who are found ineligible for the program. There are roughly 2,400 state-funded Medicaid recipients at risk of termination; all will receive renewal packets giving them a chance to demonstrate eligibility before DHS takes action to terminate. It is vital that recipients complete their renewals on time and in full. State-funded Medical Assistance recipients are immigrants, and many have limited English proficiency. Many are also seniors and/or disabled. As a reminder, DHS now has many forms (PA60, application for benefits; PA600HC, application for healthcare only; and the PA 1663, Employability Assessment Form) translated into six languages—Spanish, Chinese, Russian, Vietnamese, Cambodian, and Arabic—and they can be found in the DHS Medical Assistance Eligibility Handbook.

The state’s decision to terminate state-funded coverage does not affect the majority of Medicaid enrollees, since most people are getting federally-funded Medicaid, which is still protected under the Federal Public Health Emergency (PHE) and its continuous coverage protections.

Individuals who believe their Medicaid coverage has been improperly stopped can call the Pennsylvania Health law Project Helpline at 1-800-274-3258 or email them at staff@phlp.org.

The Pennsylvania Department of Human Services (DHS), Office of Medical Assistance Programs (OMAP) released MA Bulletin 99-21-06, “Guidelines for the Delivery of Physical Health Services via Telemedicine.” The purpose of this bulletin is to notify providers that, effective Sept. 30, 2021, the DHS is expanding the scope of services for which telemedicine may be used, expanding the scope of providers who may render MA covered services to beneficiaries using interactive telecommunication technology to include all enrolled providers, if permitted according to their scope of practice, licensure, or certification and establishing ongoing guidelines for services rendered via telemedicine. Key points from the Bulletin:

• The MA Program will pay for MA covered services rendered to beneficiaries via telemedicine when clinically appropriate and allowable according to the provider’s scope of practice. Services rendered via telemedicine must be provided according to the same standard of care as if delivered in-person. Providers are encouraged to establish protocols for the use of telemedicine. MA MCOs may, but are not required to, allow for the use of telemedicine.
• Providers are to obtain consent prior to rendering a service via telemedicine from the beneficiary receiving services or their legal guardian. Providers must also allow beneficiaries to elect to return to in-person services at any time.
• Providers should fully document the services rendered and the telecommunication technology used to render the service in the MA beneficiary’s medical record. If the service was rendered using audio-only technology, providers are to document that the services were rendered using audio-only technology and the reason audio/video technology could not be used. Providers should obtain the location of the beneficiary at the time each service is rendered via telemedicine should there be a need for emergency medical services.
• DHS added Place of Service (POS) 02 (telemedicine) for providers to identify services that are rendered via telemedicine. Providers are no longer required to utilize the GT modifier to indicate the use of telemedicine and are instead to use POS 02. Providers are to indicate in the beneficiary’s medical record when telemedicine services are rendered via audio-only.

This bulletin obsoletes MA bulletin 09-12-31 et al., Consultations Performed Using Telemedicine, issued May 23, 2012 and, Provider Quick Tips #229 and #242, Telemedicine Guidelines Related to COVID-19.

Pennsylvania Governor Tom Wolf signed HB 1861 to “allow temporary regulatory flexibilities to continue the emergency response to the COVID-19 pandemic by requiring the state agencies to issue a final report of the regulatory suspensions and terminations.” The bill allows for additional temporary extensions for regulatory statues, rules and regulations which are in effect on Sept. 30, 2021, to be extended until March 31, 2022, unless they were already terminated by the authority which initially authorized the suspension. The extension includes the following regulatory statutes:

• Regulatory statutes, rules or regulations enforced by the Department of Health.
• Regulatory statutes, rules or regulations enforced by the Department of Human Services.
• Regulatory statutes, rules or regulations enforced by the Bureau of Professional and Occupational Affairs.

The latest feature article in The Rural Monitor spotlights a New Mexico doula program that reaches American Indian, Hispanic, and other populations who lack nearby labor/delivery units, a Minnesota program helping moms experiencing incarceration, and a North Dakota program training postpartum doulas to care for families impacted by opioid use disorder and other substance use.

Read the article here:  Rural Doulas Supporting Maternal and Infant Health.