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CMS Proposes New Mandatory Specialty Care Models in Conjunctions with New Executive Order to Launch New Kidney Health Initiatives

July 12, 2019

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PRESS CONTACTS
Erin Hahn, Health Policy Analyst, Value Based Care
Phoebe Ramsey, Sr. Regulatory Analyst, Quality & Payment Policy

The President July 10 signed an Executive Order (EO) titled, “Executive Order on Advancing American Kidney Health.” The order directs the Department of Health and Human Services (HHS) to launch an initiative to increase awareness of kidney disease, increase kidney transplants, and ensure that fewer patients with end-stage renal disease (ESRD) receive dialysis in dialysis centers.

The specific goals of the EO are to:

-Reduce the number of Americans developing end-stage renal disease by 25% by 2030;
-Have 80% of new ESRD patients in 2025 either receiving dialysis at home or receiving a transplant; and
-Double the number of kidneys available for transplant by 2030.

As part of the effort, HHS announced its launch of a new “Advancing American Kidney Health Initiative,” including the release of a new proposed rule from the Centers for Medicare and Medicaid Services (CMS).

CMS Proposed Rule

CMS July 10 released a new proposed rule titled, “Specialty Care Models to Improve Quality of Care and Reduce Expenditures.”

The proposed rule creates a new mandatory payment model and four optional payment models to change payment incentives for kidney care. The new ESRD Treatment Choices Model would be mandatory for ESRD facilities and certain clinicians (called Managing Clinicians) located in select geographic areas. It would focus on encouraging greater use of home dialysis and kidney transplants. The four voluntary models offer various risk arrangements for nephrologists and focus on providing high quality managed care to prevent disease progression.

CMS also proposed to implement a new mandatory model on Radiation Oncology. The model is intended to test prospective episode payments to hospital outpatient departments and freestanding radiation therapy centers for radiotherapy episodes of care.

Comments on the proposed rule are due by Sept. 16. The AAMC intends to comment.

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