[Congressional Record Volume 145, Number 108 (Wednesday, July 28, 1999)]
[Senate]
[Page S9533]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Frist, Mr. Robb, Mr. Inouye, Mr. 
        Thompson, Mr. Murkowski, and Mr. DeWine):
  S. 1449. A bill to amend title XVIII of the Social Security Act to 
increase the payment amount for renal dialysis services furnished under 
the Medicare program; to the Committee on Finance.


            medicare renal dialysis fair payment act of 1999

 Mr. CONRAD. Mr. President, today I am pleased to join Senator 
Frist to introduce the Medicare Renal Dialysis Fair Payment Act of 
1999. This legislation takes important steps to help sustain and 
improve the quality of care for Medicare beneficiaries suffering from 
kidney-failure.
  Nationwide, more than 280,000 Americans live with end-stage renal 
disease (ESRD). In my state of North Dakota, the number of patients 
living with ESRD is relatively small, just over 600 per year. However, 
for these patients, and others across the country, access to dialysis 
treatments means the difference between life and death.
  In 1972, the Congress took important steps to ensure that elderly and 
disabled individuals with kidney-failure receive appropriate dialysis 
care. At that time, Medicare coverage was extended to include dialysis 
treatments for beneficiaries with ESRD.
  Over the last three decades, dialysis facilities have provided 
services to increasing numbers of kidney-failure patients under 
increasingly strict quality standards. However, it has come to my 
attention that reimbursement to dialysis facilities does not reflect 
the more stringent quality requirements placed upon dialysis providers.
  Since 1983, reimbursement to dialysis facilities has actually 
declined. Today, according to the Medicare Payment Advisory Commission 
(MedPAC), dialysis facilities receive on average $122 per treatment, 
compared with $138 per treatment that they received in 1983. Adjusting 
for inflation, this means that dialysis providers are only receiving 
about $42 per treatment (in 1983 dollars) to provide nursing, social 
work and dietitian care, as well as the actual dialysis treatment.
  I am concerned that a continued erosion in Medicare payments to 
dialysis facilities could jeopardize beneficiaries' access to dialysis 
services. According to MedPAC, ``without an increase in the payment 
(i.e. composite rate) the quality of dialysis services may decline. 
Therefore, an update to the composite rate is recommended.'' Further, 
MedPAC has concluded that the majority of dialysis facilities now lose 
money on Medicare reimbursement and the problem is especially acute for 
small, rural, and non-profit dialysis facilities. In my state, we 
simply cannot afford to lose rural providers--including providers of 
dialysis services.
  This legislation will ensure dialysis facilities have the resources 
to continue offering critical dialysis services to individuals with 
kidney failure. I urge my colleagues to support this important 
legislation.
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