Kidney Disease Research Updates
Final Rule Posted for Medicare Kidney Disease Education Benefit
The final rule for the new Medicare Part B kidney disease education (KDE) benefit was printed in the Federal Register on November 25, 2009, as part of the 2010 Physician Fee Schedule final rule with comment period. On December 18, 2009, the Centers for Medicare & Medicaid Services (CMS) posted implementation instructions in the CMS Internet-only Manual.
The rule is effective for services furnished on or after January 1, 2010, and seeks to ensure beneficiaries are provided comprehensive information regarding their kidney disease; the management of comorbidities, including delaying the need for dialysis; prevention of uremic complications; and all therapeutic options. The rule also seeks to ensure KDE services are tailored to meet the needs of individual beneficiaries and that beneficiaries have the opportunity to actively participate in their choice of therapy.
To be covered, KDE services must be provided by a qualified person. Medicare beneficiaries who receive the services must have a referral from the physician managing their kidney condition and must be diagnosed with Stage IV chronic kidney disease (CKD). Stage IV CKD is defined as having an estimated glomerular filtration rate 15–29 ml/min/1.73 m2 using the Modification of Diet in Renal Disease (MDRD) Study formula. Qualified persons include physicians, physician assistants, nurse practitioners, and clinical nurse specialists. In addition, providers of services who are located in rural areas are included as qualified persons who can furnish KDE services.
Congress authorized the KDE Medicare benefit in the Medicare Improvements for Patients and Providers Act (MIPPA) passed on July 15, 2008. MIPPA also authorized the Secretary of the U.S. Department of Health and Human Services to establish pilot programs in three states to increase public awareness of CKD, promote screening, and provide surveillance of CKD prevalence in the population.
NIH Publication No. 10-4531