This section describes delivery and payment of chronic kidney disease care provided by the Federal government.
The Medicare End Stage Renal Disease Program is a national health insurance program for people with end stage renal disease (ESRD). Initially, ESRD Network areas were established to encourage self-care dialysis and kidney transplantation and to clarify reimbursement procedures in order to achieve more effective control of the costs of the renal disease program. Subsequently, the Social Security Act was amended to establish at least 17 ESRD Network areas and to revise the Network Organizations responsibilities.
Currently, 18 ESRD Network Organizations exist under contract to CMS and serve as liaisons between the federal government and the providers of ESRD services. The number and concentration of ESRD beneficiaries in each area define the Network Organizations geographically. Some Networks represent one state, and others represent multiple states. The ESRD Network Organizations' responsibilities include: the quality oversight of the care ESRD patients receive, the collection of data to administer the national Medicare ESRD program, and the provision of technical assistance to ESRD providers and patients in areas related to ESRD. In addition, the ESRD Network Coordinating Center (NCC) provides centralized coordination and support for the ESRD Network Program. The NCC's primary responsibilities include collection, maintenance and distribution of ESRD information; coordination of national activities, including training initiatives; facilitation of special projects, and administrative support services, such as the planning of meetings and summary reports for ESRD Networks and CMS' ESRD Network Program.
Eligible beneficiaries who qualify for care in the DoD Health Care System receive care for diabetes and hypertension, two leading causes of kidney failure, in their medical treatment facilities across the United States. Those who progress to kidney failure may be treated in the military treatment facilities if services are available, or covered by the Medicare ESRD program and TRICARE contract health services.
Under Federal law, if you're a TRICARE beneficiary eligible for premium-free Medicare Part A because of end-stage renal disease (ESRD), you must have Medicare Part B coverage to remain TRICARE-eligible (there are exceptions for those enrolled to US Family Health Plan, enrolled to TRICARE Reserve Select, or with an active duty sponsor).
The primary goals of the OPTN are to increase the effectiveness and efficiency of organ sharing and equity in the national system of organ allocation by establishing and maintaining policies and procedures for the field of transplantation, and to increase the supply of donated organs available for transplantation.
The OPTN efforts related to delivery of care include:
As of December 31, 2010, there were 110,000 candidates on the waitlist, of which 87,760 (79.6%) were waiting for a kidney transplant.
The IHS's Division of Diabetes Treatment and Prevention has published Indian Health Diabetes Best Practices: Chronic Kidney Disease and Diabetes, which outlines for IHS providers the best methods for identifying and evaluating patients with chronic kidney disease (CKD), managing and monitoring patients with CKD and diabetes, and evaluating the progression of CKD. IHS also has written best practices for health care organizations, essential elements of best practices for CKD programs, and guidance on evaluating and sustaining CKD programs.
Individuals living on reservations receive care for diabetes and hypertension, two leading causes of kidney failure, in IHS clinics across the United States. Those with progressive kidney failure are covered by the Medicare ESRD program and, if eligible, IHS contract health services.
The prevalence of CKD in the veteran population is estimated to be 34% higher than in the general population, due to demographic differences and the existence of significant co-morbidities associated with CKD in the veteran population - diabetes mellitus and hypertension. The Veteran's Administration (VA) currently cares for over 200,000 veterans with moderate to severe kidney disease in their 153 medical treatment facilities or 800 community based outreach clinics (CBOC's) across the United States. Those veterans who progress to kidney failure are treated either at home or in one of the 60+ VA dialysis units, or if dialysis services are not directly available, may be treated in the community under VA contracted care. Currently over 12,000 veterans receive this benefit. Eligible veterans may also elect to receive dialysis care in the community using Medicare or other personal health benefits programs. Renal transplantation is also offered through the VA as a regionalized service.
This information was reviewed by KICC agency representatives. It may not reflect new or future agency activities. For more information, please contact the listed representatives.
Page last updated: June 6, 2012