NKF Response to Requests for Information on the ESRD Payment System

NKF wants CMS to require every patient to get a proper check to see whether home dialysis could work for them, along with a real plan to address any problems standing in the way—like needing more training, equipment, or support.

We want Medicare to pay for things like:

• Training family members or caregivers to help
• Extra support and check-ins early on
• Help delivering supplies
• Short-term or long-term hands-on assistance when patients need it

NKF wants Medicare to pay for temporary, staff-assisted home dialysis assistance for patients just starting out, coming home from the hospital, or dealing with a caregiver who is overwhelmed or unavailable. We also want longer-term help available for patients with ongoing challenges. 

For patients who choose to focus on comfort rather than aggressive treatment, NKF wants CMS to define "palliative dialysis" based on what the patient wants, like their goals, comfort, and quality of life, instead of rigid rules about treatment type or how long they're expected to live. This care should include a clear plan that the patient and their care team agree on together.

Right now, payment rules can make it hard to offer home dialysis on a flexible schedule, like short daily sessions or overnight treatments several times a week. NKF wants CMS to think about a new payment approach that supports these flexible schedules, as long as it still lets doctors prescribe what's right for each patient and doesn't encourage cutting corners.

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NKF wants kidney care to work better for each person. That means making home dialysis easier to access, providing support when patients and caregivers need it, and making sure dialysis plans can reflect a person’s goals, comfort, and quality of life.