Medicare Coverage for End-Stage Renal Disease Patients211
The network administrative organization of each renal disease network area will be responsible for developing criteria and standards relating to the quality and appropriateness of patient care;212 implementing a procedure for evaluating and resolving patient grievances;213 submitting an annual report to the Secretary which shall include data on the network’s performance in meeting its goals, including the comparative performance of facilities and providers with respect to the identification and placement of suitable candidates in self-care settings and transplantation and encouraging participation in vocational rehabilitation programs;214 and collecting, validating, and analyzing such data as are necessary to prepare these reports215 for all facilities and providers of renal disease services located within its network area.216 The Secretary will establish a national end stage renal disease registry to assemble and analyze the data reported by network organizations217 that will permit an identification of the economic impact, cost-effectiveness and medical efficacy of alternative modalities of treatment;218 and the determination of patient mortality and morbidity rates, trends in such rates, and other indices of quality of care.219
Each provider or facility must meet or exceed a total performance score with respect to performance measures established by the Secretary, 220 which include measures of patient satisfaction.221 The Secretary will make public the information regarding performance222 after giving the facility the opportunity to review the information.223 The Secretary will provide certificates that indicate the total performance score to providers of services and renal dialysis facilities;224 each facility receiving a certificate shall prominently display the certificate at the facility.225 The Secretary will establish a list of providers of services that indicates the total performance score and the performance score for individual measures that will be posted on CMS’ website.226
Footnotes
- 211. Social Security Act § 1881, 42 U.S.C. 1395rr.
- 212. Social Security Act § 1881(c)(2)(B), 42 U.S.C. 1395rr(c)(2)(B).
- 213. Social Security Act § 1881(c)(2)(D), 42 U.S.C. 1395rr(c)(2)(D).
- 214. Social Security Act § 1881(c)(2)(H), 42 U.S.C. 1395rr(c)(2)(H).
- 215. Social Security Act § 1881(c)(2)(F), 42 U.S.C. 1395rr(c)(2)(F).
- 216. Social Security Act § 1881(c)(1)(A)(i)(II), 42 U.S.C. 1395rr(c)(1)(A)(i)(II).
- 217. Social Security Act § 1881(c)(7), 42 U.S.C. 1395rr(c)(7).
- 218. Social Security Act § 1881(c)(7)(B), 42 U.S.C. 1395rr(c)(7)(B).
- 219. Social Security Act § 1881(c)(7)(D), 42 U.S.C. 1395rr(c)(7)(D).
- 220. Social Security Act § 1881(h)(1)(B), 42 U.S.C. 1395rr(h)(1)(B).
- 221. Social Security Act § 1881(h)(2)(A)(ii), 42 U.S.C. 1395rr(h)(2)(A)(ii).
- 222. Social Security Act § 1881(h)(6)(A), 42 U.S.C. 1395rr(h)(6)(A).
- 223. Social Security Act § 1881(h)(6)(B), 42 U.S.C. 1395rr(h)(6)(B).
- 224. Social Security Act §1881(h)(6)(C)(i), 42 U.S.C. 1395rr(h)(6)(C)(i).
- 225. Social Security Act § 1881(h)(6)(C)(ii), 42 U.S.C. 1395rr(h)(6)(C)(ii).
- 226. Social Security Act §1881(h)(6)(D), 42 U.S.C. 1395rr(h)(6)(D).
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