After raising concerns through two Centers for Medicare & Medicaid Services’ open door forums that the 500-patient minimum to qualify for the new Comprehensive ESRD Care initiative was too high, small providers won a victory on May 3 when the agency agreed to lower the threshold.

CMS may have made the decision to also help spark more interest among smaller dialysis providers who were contemplating participation in the renal-specific Accountable Care Organization demonstration. The deadline for letters of intent had already been extended once – to May 15 – in an effort by CMS to attract more applicants.

In the original language that was published on Feb. 4 outlining the details of the renal ACO, CMS required that applicants have a minimum of 500 matched beneficiaries to be eligible for participation. CMS said the number was selected to ensure a statistically accurate shared savings payment calculation, but agreed to the change after reviewing feedback and suggestions from organizations.

Due to this change, the minimum savings rate in the payment track for non-Large Dialysis Organizations that have between 350 to 499 matched beneficiaries in performance years 1 and 2 will change from 4% to 4.75% in order to maintain the same level of accuracy in calculating shared savings or losses.