End Stage Renal Disease Program

Health care in the United States
Government Health Programs
Federal Employees Health Benefits Program Indian Health Service Medicaid / State Health Insurance Assistance Program (SHIP) Medicare Prescription Assistance (SPAP) Military Health System / TRICARE State Children's Health Insurance Program (CHIP) Program of All-Inclusive Care for the Elderly (PACE) Veterans Health Administration
Private health coverage
Consumer-driven health care Flexible spending account (FSA) Health Reimbursement Account Health savings account (HSA) High-deductible health plan (HDHP) Medical savings account (MSA) Private Fee-For-Service (PFFS) Health insurance in the United States Managed care (CCP) Exclusive provider organization (EPO) Health maintenance organization (HMO) Preferred provider organization (PPO) Medical underwriting
Health care reform law
Emergency Medical Treatment and Active Labor Act (1986) Health Insurance Portability and Accountability Act (1996) Medicare Prescription Drug, Improvement, and Modernization Act (2003) Patient Safety and Quality Improvement Act (2005) Health Information Technology for Economic and Clinical Health Act (2009) Patient Protection and Affordable Care Act (2010)
State level reform
Dirigo Health (Maine) Massachusetts health care reform Oregon Health Plan SustiNet (Connecticut) Vermont health care reform
Municipal health coverage
Fair Share Health Care Act (Maryland) Healthy Howard (Howard Co., Maryland) Healthy San Francisco Healthy Way LA My Health LA
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In 1972 the United States Congress passed legislation authorizing the End Stage Renal Disease Program (ESRD) under Medicare. Section 299I of Public Law 92-603, passed on October 30, 1972, extended Medicare coverage to Americans if they had stage five chronic kidney disease (CKD) and were otherwise qualified under Medicare's work history requirements. The program's launch was July 1, 1973. Previously only those over 65 could qualify for Medicare benefits. This entitlement is nearly universal, covering over 90% of all U.S. citizens with severe CKD.

Medicare's unit of payment is one composite rate per dialysis treatment. The ESRD composite rate payment system differs from most other prospective payment systems because there is a single product category to define the service Medicare is buying. Although different equipment, supplies, and labor are needed for hemodialysis and peritoneal dialysis, the current system does not differentiate payment based on dialysis method, location (home or incenter) or equipment used.

The composite rate is intended to cover all operating and capital costs that efficient providers would incur in furnishing dialysis in outpatient facilities or in beneficiaries' homes. The base composite rate as of 2006^[update] is $130 for freestanding dialysis facilities. Medicare caps its payments to facilities at an amount equal to three dialysis sessions per week. Although home dialysis may be given more frequently it is not fully reimbursed by Medicare.

An add-on payment supplements the composite rate. It represents some of the profits previously associated with payments for separately billable drugs. The Social Security Act (Section 1881(b)), as amended by Section 623 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, directed revisions to the composite rate payment system as well as payment for separately billable drugs furnished by dialysis facilities. There is an annual update to the add-on payment which is determined administratively by CMS. Congressional Record 5827 updates the drug add-on payment. For 2008^[update] the drug add-on payment to the composite payment rate increased from 14.9 percent to 15.5 percent.

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