Congress and the White House are faced with decisions on the federal debt limit and the resolution of Fiscal Year 2013 spending, while at the same time considering the FY 2014 budget. These responsibilities have set the tone for the year. NKF is balancing its efforts between protecting federal programs that benefit kidney patients and building support for new opportunities and needs.
- Protecting federal funding for kidney programs and activities.
The pressure of annual budget deficits and more importantly the federal debt and borrowing cap (debt limit) present a unique challenge for virtually all federal programs. Traditionally, discretionary programs (which include most Health and Human Services programs other than Medicare and Medicaid) are the first target for spending cuts. Long term cuts in discretionary spending, including defense, were agreed to in August 2011 as part of legislation to increase the debt ceiling. In addition, the "Sequestration" issue that has been at the forefront the past several months refers to additional mandated savings of at least an additional $1.2 trillion over 10 years beginning in Fiscal Year (FY) 2013. Sequestration took effect April 1, 2013 and substantially cut mandatory spending including a 2 percent across the board cut in Medicare payments to providers. As a result of this constrained budget environment, NKF has been working with our congressional supporters to ensure kidney patients' care under Medicare is not compromised.
Congressional deliberations on FY 2014 funding has not begun, but following meetings we have had with Members of the House and Senate Appropriations Committees this year, we are cautiously optimistic Congress will provide continued support for the CDC's chronic kidney disease (CKD) program. In November, the Centers for Disease Control and Prevention (CDC) launched a link on its web site containing valuable information on CKD prevalence. Another area threatened by budget concerns is research supported by the National Institute of Diabetes and Digestive Diseases (NIDDK). We will continue to explore funding opportunities for kidney initiatives under these and other agencies including the Department of Veterans Affairs and the Department of Defense medical research program.
- Advocating for policy initiatives to improve access to transplantation.
Legislation to eliminate the current 36 month post-transplant limit of Medicare coverage of immunosuppressive drugs for kidney transplant recipients has been a cornerstone of our public policy efforts for many years, and NKF is recognized in the kidney and transplant communities as one of the leaders on this initiative. The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013 (bill numbers S. 323 and H.R. 1428) was introduced in March and we continue to work closely with the bills' sponsors in the House and Senate on new strategies in 2013 to pass it into law.
- Assuring that the Affordable Care Act meets the needs of people with Chronic Kidney Disease.
Health Insurance Exchanges created by the Affordable Care Act (ACA) will open for enrollment this fall and are effective January 1, 2014. NKF 's activities will include ensuring (a) that insurance exchanges provide for early identification and treatment of CKD, (b) adequate payment is made for all modalities of kidney replacement therapy, including transplantation and home dialysis, through insurance available from an Exchange, and (c) support is available from the new Prevention and Public Health Fund for wellness programs focused on CKD. We will also ensure that kidney patients under the expanded Medicaid have similar protections. Examples of our efforts include submitting comments to federal agencies in response to proposed rulemakings and meetings with federal agency staff.
- Advocating for quality care in implementation of the dialysis provisions in the Medicare Improvements for Patients and Providers Act (MIPPA) and the Medicare Conditions for Coverage for ESRD Facilities.
Regulations to implement the MIPPA Quality Incentive Program and the Clinical Performance Measures connected with the Conditions for Coverage are crucial to protect dialysis patients in a bundled reimbursement system. Similarly, adequacy of reimbursement for dialysis services is essential to ensure access to care tailored to the individual needs of Medicare beneficiaries with ESRD. Legislation passed at the end of 2012 required a portion of the bundled reimbursement to be cut. NKF is working with community partners, Congressional supporters, and staff at the Centers for Medicare and Medicaid Services (CMS) to ensure cuts are implemented in a way that does not harm patients' access to quality dialysis care.
- Facilitate patient access to all modalities of dialysis therapy, including the home dialysis options of peritoneal dialysis and home hemodialysis.
This has been a traditional NKF public policy priority. In March 2012, we were afforded a new opportunity to potentially increase access to home therapy by participating in the Home Dialysis Summit. NKF President Dr. Beth Piraino was a featured panelist at the Summit. While there is increased awareness among policy makers in Congress and among members of the health media on the potential benefits of home therapy, these modalities remain significantly underutilized with only about 10 percent of dialysis patients undergoing home treatment. The Home Dialysis Alliance was created following the 2012 Summit to build support for the various recommendations among Congress, federal health agencies, academia and clinical centers, and others. NKF is a member of the Alliance Steering Committee and will work with the Alliance to reduce barriers to patient access to home modalities.