[Congressional Record Volume 146, Number 106 (Tuesday, September 12, 2000)]
[Senate]
[Pages S8420-S8421]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Frist, Mr. DeWine, Mr. Bryan, and 
        Mr. Thompson):
  S. 2038. A bill to amend title XVIII of the Social Security Act to 
update the renal dialysis composite rate; to the Committee on Finance.


        the medicare renal dialysis payment fairness act of 2000

  Mr. CONRAD. Mr. President, today I am pleased to be joined by Senator 
Frist and Representatives Camp and Thurman in introducing the Medicare 
Renal Dialysis Payment Fairness Act of 2000. 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. 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, during this same time 
frame reimbursement for kidney services has not kept pace with the 
increasing demands of providing dialysis care.
  Last year, Senator Frist and I introduced legislation to ensure 
dialysis facilities could continue providing quality dialysis services 
to Medicare beneficiaries. I am happy to say that, based on these 
efforts, dialysis providers received increased Medicare reimbursement 
in fiscal years 2000 and 2001 as part of the Medicare, Medicaid, and S-
CHIP Refinement Act of 1999.
  While these efforts were a step in the right direction, a recent 
Medicare Payment Advisory Commission (MedPAC) report suggests that we 
must take further action to sustain patients' access to dialysis 
services. In particular, MedPAC recommends a 1.2 percent payment 
adjustment for Medicare-covered dialysis services in the next fiscal 
year. In addition, MedPAC recommends that the Health Care Financing 
Administration provide an annual review of the dialysis payment rate--a 
review that most other Medicare-covered services receive each year.
  I believe these recommendations represent critical adjustments that 
must be addressed this year. For this reason, I have worked with 
Senator Frist, Representative Camp and Representative Thurman to 
develop the Medicare Renal Dialysis Payment Fairness Act of 2000. This 
legislation would provide the payment rate improvements recommended by 
MedPAC and would establish an annual payment review process for 
dialysis services. This proposal would help ensure all dialysis 
providers receive reimbursement that is in line with increasing patient 
load and quality requirements. This is particularly important for our 
Nation's smaller, rural dialysis providers that on average receive 
Medicare payments to do not adequately reflect costs.
  As the Congress considers further improvements to the Medicare 
Program, I urge my colleagues to support this important effort to 
ensure patients with kidney failure continue to have access to quality 
dialysis services. I thank my colleagues for working together on this 
bipartisan and bicameral proposal.
  Mr. FRIST. Mr. President, I am pleased to join Senators Conrad, 
Thompson, Bryan, and DeWine this afternoon to introduce the Medicare 
Renal Dialysis Payment Fairness Act of 2000. This bipartisan 
legislation takes important steps to assure both the quality and 
availability of outpatient dialysis services for Medicare patients with 
end-stage renal disease (ESRD).
  Almost 30 years ago, Congress recognized the pain and suffering 
patients with end-stage renal disease face, and thus moved to provide 
coverage for dialysis treatment to this population under the Medicare 
Program. Today, approximately 300,000 patients nationwide live with 
this disease and receive services through Medicare. Presently, there 
are 3,423 dialysis facilities throughout the Nation that serve the 
Medicare population, 93 of which are in my home State of Tennessee.
  However, I fear that a lack of proper reimbursement may adversely 
impact the quality and availability of dialysis care for Medicare 
beneficiaries. As the Medicare Payment Advisory Commission (MedPAC) 
noted, the payment rate for the critical dialysis services received by 
Medicare beneficiaries was established in 1983, and had never been 
updated.
  Last year, Senator Conrad and I sought to remedy this situation by 
introducing S. 1449, the Medicare Renal

[[Page S8421]]

Dialysis Fair Payment Act of 1999, which provided an update to the 
Medicare reimbursement rate for dialysis services for Fiscal Year 2000. 
Thus, I was pleased to see the Balanced Budget Refinement Act of 1999 
(BBRA) include a provision increasing the payment rate by 1.2 percent 
for Fiscal Year 2000 and 1.2 percent for Fiscal Year 2001.
  However, the BBRA represented only the first step toward securing 
access to dialysis services for Medicare patients and ensuring they 
receive the highest quality of care. The legislation we are introducing 
today takes the necessary additional steps, as recommended by MedPAC 
this year, to assure proper reimbursement levels for dialysis services.
  Specifically, the ``Medicare Renal Dialysis Payment Fairness Act of 
2000'' provides a 1.2 percent increase in the payment rate for FY 2001, 
in addition to the 1.2 percent update included in the BBRA, providing a 
2.4 percent total increase. This follows MedPAC's analysis of dialysis 
center costs that concluded that prices paid by dialysis centers would 
rise by 2.4 percent between Fiscal Year 2000 and 2001.
  Second, the legislation ensure proper reimbursement in future years 
by requiring the Health Care Financing Administration (HCFA) to develop 
a market basket index for dialysis centers that measures input prices 
and other relevant factors and to annually review and update the 
payment rate based upon this index.
  Overall, the Medicare Renal Dialysis Payment Fairness Act of 2000 
will ensure that dialysis facilities receive the proper Medicare 
reimbursement to continue to provide high quality dialysis services to 
the ESRD population.
  I am grateful to the National Kidney Foundation, the American 
Nephrology Nurses Association, the Renal Physicians Association, the 
National Renal Administrators Association, and the Renal Leadership 
Council for their support of the Medicare Renal Dialysis Payment 
Fairness Act of 2000, and I urge my colleagues to support this critical 
measure.

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