Federal Register - July 9, 2021
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Source: Federal Register
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Federal Register / Vol. 86, No. 129 / Friday, July 9, 2021 / Proposed Rules
waitlist, we analyzed data from the United Network for Organ Sharing UNOS.305. The UNOS data suggest that the number of new patients added to the kidney transplant waitlist steadily decreased between the weeks of March 15, 2020 through May 10, 2020, when between 16 to 81 percent of patients listed on the weekly kidney transplant waitlist became inactive due to COVID
19 precautions. During July through December 2020, the number of new patients added to the kidney transplant waitlist increased to near pre-pandemic levels with an average of less than 3
percent of patients listed as inactive due to COVID19. Anomalous dips in the number of new patients added to the kidney transplant waitlist were observed during the weeks of November 22, 2020 and December 27, 2020, which correspond with federal holidays in addition to a period that Americans were asked to social distance to slow the spread of COVID19. Continuing into the first quarter of 2021, new additions
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305 UNOS. 2021. COVID19 and Solid Organ Transplants. Transplant and Waitlist Data Visualizations. https unos.org/covid/.
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to the kidney transplant waitlist remained at approximately prepandemic rates. Therefore, we assume that the number of new patients added to the waitlist will not decrease as a result of the pandemic and the linear 2-percentage point growth rate for the transplant waitlist calculated using years 2017 through 2019 CCSQ data remains a reasonable assumption for baseline growth going forward. In the proposed rule, we also included a 1
percent increase to the standard error to account for a new variation assumption to address how year-over-year changes could fluctuate at the ESRD facility or Managing Clinician level, which was potentially exacerbated by the exclusion criteria that is, residents of a nursing facility, receiving dialysis in a skilled nursing facility, dialysis for AKI only applied to the updated model data source used for estimates in this proposed rule.
No changes were proposed to the payment structure for the HDPA
calculation described in the final rule 512.350. As such, the HDPA was calculated using the home dialysis and home dialysis-related payments
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adjusted by decreasing amounts 3, 2, and 1 percent during each of the first 3 years of the Model.
The kidney disease patient education services utilization and cost data were identified by codes G0420 and G0421, to capture face-to-face individual and group training sessions for chronic kidney disease beneficiaries on treatment modalities. The home dialysis training costs for incident beneficiaries on home dialysis for Continuous Ambulatory Peritoneal Dialysis CAPD
or Continuous Cycler-Assisted Peritoneal Dialysis CCPD were defined using CPT codes 90989 and 90993 for complete and incomplete training sessions, respectively.
Data from CY 2019 were used to project baseline expenditures that is, expenditures before the proposed changes were applied and the traditional FFS payment system billing patterns were assumed to continue under current law.
3 Medicare EstimatePrimary Specification, Assume Proposed Benchmark Updates BILLING CODE 412001P
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