Sen. Charles Grassley, R-Iowa, is throwing his weight behind efforts to increase home dialysis training payments for 2015, but the renal community wants it to be “new money” injected into the ESRD Program.

A letter sent by Grassley Oct. 3 to CMS administrator Marilyn Tavenner urges the agency to make a policy change in the pending rule due out in November that updates payments to dialysis providers in the Prospective Payment System (the bundled rate). Last year, CMS agreed to raise the amount paid for home dialysis training by 50%, but made cuts elsewhere in the bundled rate. And dialysis providers and patient groups say it still isn’t enough to cover the cost of training, particularly for home hemodialysis.

“Can CMS adopt a reimbursement policy that covers the actual cost of HHD training that remains within the overall reduced ESRD budget as directed by Congress earlier this year? Such a solution would not require adding money to the ESRD budget and would ensure access and good outcomes for patients,” Grassley wrote in his letter to Tavenner.

Moving funds from within the ESRD program, however, to pay more for training will not benefit dialysis providers or patients, said Kidney Care Partners.

“We continue to believe that training rates should be more closely related to the actual cost of providing the service,” said KCP chair Edward Jones in an Aug. 29 letter to CMS commenting on the PPS proposed rule. “However, we were extremely disappointed with the decision last year to take dollars from the base rate that applies to all dialysis patients to increase payments for only a limited number of patients. While removing barriers to home dialysis is important, it cannot come at the expense of in-center patients.

“KCP does not support increasing the payment amount for the training add-on, unless CMS adds new money to the system. Any increases should not be made in a way that removes funds from the current bundled payment amount.”

CMS has acknowledged in the past that the $50.16 per-day reimbursement for training patients on home dialysis does not cover staffing costs. Grassley said the better outcomes from home dialysis would be worth the investment of higher training payments. “Home hemodialysis not only offers patients treatment flexibility, better clinical outcomes, and a better quality of life, but is also cost-effective,” Grassley said in his letter.