As many of you are already aware, on Sept. 15, the Centers for Medicare & Medicaid Services issued the proposed rule for perhaps the most significant change in renal dialysis reimbursement since the introduction of the composite rate in 1983.
Before I delve into the details and expected impact of the proposed rule, I would like to briefly explain what a proposed rule is and how it affects the dialysis provider.
In our federal legislative process, the general flow of events is that a bill is introduced in Congress, sent to committee and debated to death, modified, amended and sometimes ultimately passed by both the House of Representatives and the Senate. After the president signs it, the law is on the books, but it may not take effect until some future date, in the case of the new ESRD bundle, implementation occurs as of Jan. 1, 2011. In the case of Medicare, the details of implementing the law are not so much a question of law but a question of regulations and rules. From my point of view, congressional legislation details the “what” with respect to Medicare payment, and the rules set forth the “how.”
Once legislation is enacted, we have virtually no say in what major changes are going to be mandated by the legislation itself. If we did want to have input and impact, this had to be done prior to passing the finalized legislation, primarily by influencing our local congressional representatives and senior members of the party in power; in this case, not the Democratic party but the Republican party, which was in power when the ESRD bundle legislation, Medicare Improvements for Patients and Providers Act (MIPPA) was passed on July 15, 2008.
