Explanation of H.R. 4143 - Dialysis Patient Access Act

Explanation of H.R. 4143 - Dialysis Patient Access Act

H.R. 4143, the Dialysis Patient Access Act, establishes a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease. This program aims to improve patient care by testing alternative care delivery models and payment methodologies for eligible beneficiaries.

The key provisions of the bill include:

Establishment of a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease.
Creation of ESRD Integrated Care Organizations to deliver care under Medicare fee-for-service program.
Definition of eligible participating providers and partners, determining eligible beneficiaries, and establishing care delivery models.
Requirement for Organizations to cover all benefits under Medicare Parts A and B, excluding kidney acquisition costs.
Payment mechanism involving monthly capitated payments adjusted for health status risk.
Exclusive exclusion of kidney acquisition costs from MA benchmark calculations for Organizations.
Waiver authority for Secretary to waive certain program requirements for implementation.
Extension of guaranteed issue rights under Medigap policies for participants in the demonstration program.

The bill also emphasizes protecting beneficiary rights, ensuring continuity of care, and setting quality performance standards for participating Organizations. It specifies processes for reassessment, expansion, and termination of contracts based on performance measures.

Rep. David Valadao

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