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ESRD Medicare

Holland & Knight LLP

CMS Previews Changes to Medicare Advantage Capitation Rates, Parts C and D Payment Policies

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The Centers for Medicare & Medicaid Services (CMS) released its Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies on Jan....more

Benesch

Dialysis & Nephrology Digest - January 2024

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NY Governor vetoes noncompete ban bill after opposition from health, business groups - Kathy Hochul vetoed a bill passed by both houses of the NY legislature in June that would’ve imposed bans of non-compete clauses in...more

Benesch

Dialysis & Nephrology Digest - November 2023

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Fresenius hiring Ascension Capital exec to head care delivery - The appointment of Craig Cordola as CEO of the dialysis company’s care delivery segment takes effect Jan. 1. He was at Ascension Capital for the past six...more

McGuireWoods LLP

CMS Issues End-Stage Renal Disease Prospective Payment System Final Rule for 2024

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On Oct. 27, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that will increase payments to end-stage renal disease (ESRD) facilities in calendar year (CY) 2024. The ESRD prospective payment system...more

McDermott+

End-Stage Renal Disease Prospective Payment System CY 2024 Final Rule

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On October 27, 2023, the Centers for Medicare & Medicaid Services (CMS) released the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Calendar Year (CY) 2024 final rule (CMS-1782-F). The rule finalizes minimal...more

Benesch

Dialysis & Nephrology Digest - August 2023

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NY non-compete ban still receiving pushback as Governor waits to sign off - While NY Governor Kathy Hochul waits to sign off on one of the country’s toughest bans on non-compete agreements, many lobby groups from the...more

Benesch

Dialysis & Nephrology Digest - June 2023

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Benesch: MN ban on non-compete agreements includes carveout for business sale, dissolution - Benesch Law notes the bill only awaits the signature of MN’s Governor and could become law as early as July 1. It would prevent...more

Benesch

Dialysis & Nephrology Digest - April 2023

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ME trial reminiscent of DaVita anti-poaching case that also ended in acquittal; DOJ strategy questioned - In Apr. 2022, juries in TX and CO acquitted healthcare companies charged by the DOJ’s Antitrust Division. In the CO...more

Benesch

Dialysis & Nephrology Digest - March 2023

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Correction to our January 31, 2023 newsletter article, “Dialysis Provider Satellite Healthcare Reports Data Breach Affecting Nearly 100k Patients”: Media Statement, Satellite Healthcare - In January 2023, Satellite...more

Benesch

Dialysis & Nephrology Digest - January 2023

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Federal omnibus spending bill rolls back some Medicare payment cuts scheduled for 2023, 2024 - Buried within the $1.7-trillion spending package signed by the President on Dec. 29 was partial relief for a planned 4.5% cut...more

McGuireWoods LLP

CMS Issues ESRD Prospective Payment System Final Rule for 2023

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Rule Addresses Rate Increases, Outlier, Add-On and ETC Model Payments, Oral-Only Drugs and QIP Reporting - On Oct. 31, 2022, the Centers for Medicare & Medicaid Services issued a final rule implementing an increase in...more

Benesch

Dialysis & Nephrology Digest - July 2022

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SCOTUS sides with OH-based medical plan in dispute with DaVita over dialysis reimbursements - In a 7-2 vote, the Supreme Court ruled in favor of the Marietta Memorial Hospital Employee Benefit Plan in a case that hinged...more

ArentFox Schiff

Supreme Court Holds Benefit Plan Limiting Dialysis Reimbursement Does Not Run Afoul of Medicare Secondary Payer Act

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On June 21, 2022, the Supreme Court concluded, in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641, 2022 WL 2203328 (U.S. June 21, 2022), that the terms of a benefit plan limiting...more

Kilpatrick

Supreme Court Upholds ERISA Plan Design for Dialysis Coverage

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The Supreme Court released an opinion Tuesday, June 21, 2022, holding that the Marietta Memorial Hospital Employee Health Benefit Plan (“Marietta Plan”) did not violate the Medicare Secondary Payer statute merely because it...more

Faegre Drinker Biddle & Reath LLP

Supreme Court Decides Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc.

On June 21, 2022, the Supreme Court decided Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641, holding that a group health plan that uniformly provides limited benefits for outpatient...more

Benesch

Dialysis & Nephrology Digest - December 2021

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SCOTUS to consider case alleging private plan’s ESRD coverage violates MSPA - The Supreme Court agreed to hear the case of Marietta Memorial Hospital Employee Health Benefits Plan v. DaVita, which alleges a private...more

Rivkin Radler LLP

Supreme Court to Hear DaVita’s Medicare Secondary Payer Act Case

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The U.S. Supreme Court has agreed to review the scope of the Medicare Secondary Payer Act (MSPA) as it relates to the treatment of patients with end-stage renal disease (ESRD). The case to be heard by the high court, Marietta...more

Benesch

Dialysis & Nephrology Digest - September 2021

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Industry players agree on need for quality assurance but believe CMS’ QIP program for ESRD care delivery flawed - The ESRD Quality Incentive Program (QIP) implemented by CMS provides a payment penalty of up to 2% for...more

Baker Donelson

CY 2021 ESRD PPS Final Rule Includes Policy Changes to Promote In-Home Dialysis

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The Calendar Year (CY) 2021 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule, CMS-1732-F (Final Rule) was published in the Federal Register on November 9, 2020. The Final Rule includes payment...more

Mintz - Health Care Viewpoints

CMS Announces Final Rule on ESRD Treatment Choices Model

Last week, CMS announced the finalized End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model), which will test whether incentivizing home dialysis and kidney transplantation will reduce Medicare expenditures while...more

Faegre Drinker Biddle & Reath LLP

A Compilation of Updated CMS and CDC Guidance for Dialysis Facilities in Light of COVID-19

Introduction - The Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) have announced an array of guidance to combat the spread of COVID-19 and ease provider regulatory...more

Sheppard Mullin Richter & Hampton LLP

Top 10 Provisions of CMS Proposed Rule: Medicare Advantage and Part D Programs for CY2021 and CY2022

As promised, here is a summary of some key provisions in CMS’ proposed rule relating to the Medicare Advantage and Part D programs for contract years 2021 and 2022. CMS is soliciting comments on a number of issues and we urge...more

McDermott Will & Emery

CMS Issues Medicare Advantage and Part D 2021 Proposed Rule

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The Centers for Medicare & Medicaid Services (CMS) recently released three items relating to the Medicare Advantage and Part D programs: a proposed rule, Part II of the Advance Notice and Rate Announcement for Calendar Year...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Sixth Circuit Rejects MSPA and ERISA Discrimination Claims

Seeking to control healthcare costs, many group health plans have adopted amendments that lower reimbursement rates for the treatment of end-stage renal disease ("ESRD"), which requires long-term dialysis treatment or a...more

Arnall Golden Gregory LLP

CMS Issues New Standards for End Stage Renal Disease Faculties Providing Dialysis Services to Nursing Facility Residents

On August 17, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a Memorandum to state survey agency directors regarding Medicare-approved End Stage Renal Disease (ESRD) facilities that provide dialysis...more

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