U.S. Department of Health and Human Services

Delivery & Payment of Chronic Kidney Disease (CKD) Care

This section describes delivery and payment of chronic kidney disease care provided by the Federal government.

Centers for Medicare & Medicaid Services (CMS)

The Medicare End Stage Renal Disease Program is a national health insurance program for people with end stage renal disease (ESRD). Initially, ESRD Network areas were established to encourage self-care dialysis and kidney transplantation and to clarify reimbursement procedures in order to achieve more effective control of the costs of the renal disease program. Subsequently, the Social Security Act was amended to establish at least 17 ESRD Network areas and to revise the Network Organizations responsibilities.

Currently, 18 ESRD Network Organizations exist under contract to CMS and serve as liaisons between the federal government and the providers of ESRD services. Their work is intended to align Network activities with the Department of Health and Human Services (HHS) National Quality Strategy (NQS), the CMS Three Aims, and the CMS Quality Strategy priorities designed to produce improvements in the care of individuals with ESRD. The new approach facilitates a heightened focus on patient and family centered concerns and aims to promote better access to care.

The number and concentration of ESRD beneficiaries in each area define the Network Organizations geographically. Some Networks represent one state, and others represent multiple states. The ESRD Network Organizations' responsibilities include: the quality oversight of the care ESRD patients receive, the collection of data to administer the national Medicare ESRD program, assisting patients with grievances and access to care issues, and the provision of technical assistance to ESRD providers and patients in areas related to ESRD. In addition, the ESRD Network Coordinating Center (NCC) provides centralized coordination and support for the ESRD Network Program. The NCC's primary responsibilities include collection, maintenance and distribution of ESRD information; coordination of national activities, including training initiatives; facilitation of special projects, and administrative support services, such as the planning of meetings and summary reports for ESRD Networks and CMS' ESRD Network Program.

Contact Information
Teresa Titus- Howard
Phone: 410-786-0092
Email: Teresa.Titus-Howard@cms.hhs.gov
Web: www.esrdncc.org

Last Updated: June 1, 2014

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Department of Defense (DoD)

Eligible beneficiaries who qualify for care in the DoD Health Care System receive care for diabetes and hypertension, two leading causes of kidney failure, in their medical treatment facilities across the United States. Those who progress to kidney failure may be treated in the military treatment facilities if services are available, or covered by the Medicare ESRD program and TRICARE contract health services.

Under Federal law, if you're a TRICARE beneficiary eligible for premium-free Medicare Part A because of end-stage renal disease (ESRD), you must have Medicare Part B coverage to remain TRICARE-eligible (there are exceptions for those enrolled to US Family Health Plan, enrolled to TRICARE Reserve Select, or with an active duty sponsor).

Contact Information
James Ellzy, CDR, US Navy
Director of Clinical Quality
Phone: 703-681-0064
Email: James.ellzy@amedd.army.mil
Web: www.tricare.mil

Last Updated: March 1, 2012

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Health Resources and Services Administration (HRSA)

The primary goals of the Organ Procurement and Transplantation Network (OPTN) are to increase the effectiveness and efficiency of organ (including kidney) sharing and equity in the national system of organ allocation by establishing and maintaining policies and procedures for the field of transplantation, and to increase the supply of donated organs available for transplantation.

The OPTN efforts related to delivery of care include:

  • Facilitating the organ matching and placement process through the use of the computer system and a fully staffed Organ Center operating 24 hours a day;
  • Developing consensus based policies and procedures for organ recovery, distribution (allocation), and transportation;
  • Managing a secure Web-based computer system, which maintains the nation's organ transplant waiting list and recipient/donor organ characteristics.

HRSA supports the National Living Donor Assistance Center (NLDAC) through a cooperative agreement with the Regents of the University of Michigan and the American Society of Transplant Surgeons. The NLDAC is a national program that assists living organ donors with travel and subsistence expenses related to the donation of an organ. Since its inception in October 2007 through the end of August 2013, NLDAC facilitated 1941 living organ transplants. Overall, through this period, NLDAC received 3918 applications for financial support.

Contact Information
Robert Walsh
Director, Division of Transplantation
Phone: 301-443-6839
Email: rwalsh@hrsa.gov
Web: www.organdonor.gov

Last Updated: June 1, 2014

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Indian Health Service (IHS)

The IHS's Division of Diabetes Treatment and Prevention has published Indian Health Diabetes Best Practice: Screening for Chronic Kidney Disease (PDF, 314 KB), which outlines for IHS providers the best methods for identifying and evaluating patients with chronic kidney disease (CKD), managing and monitoring patients with CKD and diabetes, and evaluating the progression of CKD. IHS also has written best practices for health care organizations, essential elements of best practices for CKD programs, and guidance on evaluating and sustaining CKD programs.

Individuals living on reservations receive care for diabetes and hypertension, two leading causes of kidney failure, in IHS clinics across the United States. Those with progressive kidney failure are covered by the Medicare ESRD program and, if eligible, IHS contract health services.

Access additional best practice documents from the IHS CKD and Diabetes Hub .

Contact Information
About IHS:
Division of Diabetes Treatment and Prevention
Phone: 505-248-4182
Email: diabetesprogram@ihs.gov
About CKD
Andrew S. Narva, MD, FACP, FASN
Chief Clinical Consultant for Nephrology
Phone: 301-594-8864
Email: narvaa@niddk.nih.gov
Web: www.ihs.gov/MedicalPrograms/Diabetes/

Last Updated: June 1, 2014

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Veterans Affairs (VA)

The prevalence of chronic kidney disease (CKD) in the Veteran population is estimated to be 34% higher than in the general population, due to demographic differences and the existence of significant co-morbidities associated with CKD in the Veteran population—diabetes mellitus and hypertension. VA currently cares for over 600,000 Veterans with kidney disease in their 153 medical treatment facilities or 800 community based outreach clinics (CBOC's) across the United States. Those Veterans who progress to kidney failure are treated either at home or in one of the 70 VA dialysis units, or if dialysis services are not directly available, may be treated in the community under VA contracted care. Currently over 15,000 Veterans receive care directly by VA or through the community under VA contracted care. Eligible Veterans may also elect to receive dialysis care in the community using Medicare or other personal health benefits programs. Renal transplantation is also offered through the VA as a regionalized service at 5 centers.

Contact Information
VHA National Kidney Program
Email: VHANationaKidneyProgramOffice@va.gov
Web: http://www.medicalsurgical.va.gov/kidney/program.asp

Last Updated: June 1, 2014

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This information was reviewed by KICC agency representatives. It may not reflect new or future agency activities. For more information, please contact the listed representatives.