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
- Department of Defense
- Health Resources and Services Administration
- Indian Health Service
- Veterans Affairs
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.
Last Updated: June 1, 2014
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).
Last Updated: March 1, 2012
Health Resources and Services Administration (HRSA)
HRSA supports the Reimbursement of Travel and Subsistence Expenses toward the Living Organ Donation Program, which provides financial assistance for people who wish to be living organ donors who might not otherwise be able to donate. HRSA administers the program through a cooperative agreement with the Regents of the University of Michigan, which partnered with American Society of Transplant Surgeons in establishing the National Living Donor Assistance Center (NLDAC). The NLDAC provides reimbursement for donation-related travel, lodging, and miscellaneous expenses related to donors’ evaluation, surgery, and follow-up visit(s) to those who wish to be living organ donors, with priority given to individuals not otherwise able to afford those costs.
Last Updated: May 26, 2016
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.
Division of Diabetes Treatment and Prevention
Last Updated: June 1, 2014
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.
VHA National Kidney Program
Last Updated: June 1, 2014
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.