As the new 108th Congress begins its work this month, it will be a time of both opportunity and also a time with some risks in Washington , D.C. , for kidney patients. As always, AAKP will be paying close attention and keep you informed of breaking developments.

Perhaps the issue of most concern is the continuing federal budget deficits and their impact on federal spending. The Congressional Budget Office (CBO) predicts a $145 billion deficit for FY 2003; however CBOÕs estimates are based only on current spending levels, not “things that might happen.” For example, a private industry group, the Bond Market Association’s Treasury Borrowing Advisory Committee, is forecasting a deficit between $175 billion and $250 billion in fiscal 2003, with an eye on a potential war with Iraq and slower than expected economic growth.  Even so, the bond industry deficit forecast may be an underestimate - as the forecast does not include any additional tax relief, which may be a Republican priority in 2003-04. Because of the budget deficit, Congress will more than likely examine ways to reduce costs.  This could mean budget cuts to the Medicare ESRD Program.

Among the opportunities next year, President Bush stated, in a Nov. 7 post-election press conference, his continued commitment to enacting a Medicare prescription drug benefit in 2003. AAKP will be watching closely that any drug benefit meet the needs of both dialysis and transplant patients. There may also be an opportunity to tie increased reimbursement payments to improved dialysis facility outcome measurements. Tying Medicare payments to kidney patients’ medical outcomes has always been a top priority for AAKP.

Also in 2003, the federal government is expected to release a number of reports that may impact healthcare for kidney patients. For example, the Medicare program has several studies pending, including: a Composite Rate Bundling Study; an Annual Composite Rate Inflation Update Study; a Managed Care Demonstration Project Evaluation; and updated Conditions of Coverage. The CMS Chronic Disease Demonstration Project request for proposals is slated for spring and the Medicare Payment Advisory Commission (MedPAC) Bundling Update Report is scheduled for March.  MedPAC will also release the Dialysis Payment and Quality of Care Report - a report that studies whether the recent decline in aggregate dialysis payments relative to providers’ costs has affected quality of care - in June.

Of longstanding interest to AAKP is the release by Medicare of the updated Conditions of Coverage. The Conditions of Coverage for ESRD are the guidelines under which a provider agrees to operate in order to receive payment for services rendered. These Conditions have a significant impact on patient care and include such topics as staffing ratios, how care is provided and by whom and other issues relating to dialysis care. However, the current Conditions, first published in 1979 and updated sporadically since, are vague and AAKP hopes the new version will contain more specific guidelines. In 1997, Medicare announced that it would rewrite the Conditions and solicited advice from the renal community. During a June 2000 Senate Aging Committee hearing, a Medicare representative promised the new Conditions would be released in 2001. Last year, Medicare announced the Conditions would be released in October 2002. The new release date is sometime early this year. AAKP will continue to monitor and represent the patient voice on the importance of the new guidelines being released.

AAKP will spend January reviewing further what may be on the horizon for kidney patients both with regards to potential congressional legislation and through regulatory issues by the Centers for Medicare and Medicaid Services (CMS). Our Board of Directors will address specific issues at this month’s meeting and plan for the upcoming legislative year. We will report to you on any planned activities.

Kris Robinson is AAKP's Executive Director

Washington Report, aakpRENALIFE, Vol. 18, No. 4, January 2003

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