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NRAA Advocacy Key Principles
NRAA and its members remain active advocates for the advancement of the kidney care profession and patient care year-round. With the support of the NRAA legislative counsel, Mehlman Castagnetti Rosen & Thomas, the NRAA Board of Directors has created the following key principles as the foundation for the organizations' advocacy activities, in alignment with NRAA’s core values and strategic plan.
If you have any questions regarding these Key Principles or how you can assist NRAA's advocacy efforts please reach out at
Improve Renal Care Quality and Streamline Quality Measurement Programs
Medicare should align all quality improvement efforts and establish a new quality program to modernize and improve the current one. In addition, independent providers should receive funding for quality improvement activities and hospitals should share data with facilities to improve transition and coordination of care.
Improve Care Delivery for Dialysis Patients
Coverage of chronic care management (CCM) services for beneficiaries with CKD should be expanded to include nephrologist-referred services authorized under the Physician Fee Schedule (PFS). Furthermore, alternative payment models for independent facilities that provide comprehensive and coordinated care should be developed. medicare should also work to eliminate geographic restriction requirements for patient and incentivize use of home dialysis when appropriate.
Improve Medicare Fee-For-Service Payments to Providers
Medicare should adjust the existing ESRD Prospective Payment System (PPS) to better reflect the cost of treating patients with highly complex medical needs. CMS should also require all providers to use standardized cost reports to ensure more accurate payment. Furthermore, Medicare should retain open networks and payments should adequately reimburse providers for the cost of care.
Expand Early Intervention Efforts to Delay or Prevent Onset of End-Stage Renal Disease
Kidney Disease Education (KDE) should be expanded to benefit all beneficiaries with chronic kidney disease (CKD). Furthermore, the Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare and Medicaid Services (CMS) should test alternative payment models that evaluate treatment strategies to delay and prevent the onset of end-stage renal disease (ESRD).
Improve Pediatric Care Delivery
The treatment of pediatric patients comes with a unique set of challenges. Medicare should provide additional payment to facilities for treating patients under one year old. Medicare should also adjust payment for treating young acute kidney injury (AKI) patients. Payment for facilities treating young patients should also be increased to ensure these patients complete school.
Protect Patient Access to Providers
To ensure patients can access unique facilities providing high-quality care, Medicare should implement a payment adjustment for independent facilities. CMS should implement policies that discourage "patient dumping" and "patient avoidance" practices and better account for the distinctive needs and challenges rural and low-volume facilities face.
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