PREVENT ESRD Act

This legislation, known as the PREVENT ESRD Act, aims to address the significant impact of kidney disease on Americans and the Medicare program by preventing or delaying its progression to End-Stage Renal Disease (ESRD). It highlights that kidney disease affects millions, often undiagnosed, and accounts for billions in healthcare spending, with Medicare bearing a substantial portion for ESRD treatment. The bill proposes a voluntary payment model to encourage health plans to invest in early intervention and care.

To achieve this, the Secretary of Health and Human Services is directed to implement a 10-year Multipayer Kidney Care Medicare Savings Demonstration Program by January 1, 2027. This program will involve various eligible plans, including commercial, Medicaid, and Medicare Advantage plans, which will voluntarily participate to increase access to specified kidney care services for qualifying enrollees. Participating plans must develop screening plans, submit comprehensive data on kidney disease progression, and cover all specified services with the lowest possible cost-sharing, including cost-free screening for all enrollees.

The specified kidney care services encompass a range of interventions, including screening measures like urinalysis and genetic testing, FDA-approved drugs for slowing kidney function decline, nutrition services, disease management support, and kidney health consultations. These services can also be furnished via telehealth when medically appropriate. Plans must not apply utilization management to drugs and biologicals more restrictively than FDA-approved labeling.

A core incentive of the program is the opportunity for participating plans to receive shared savings payments. If a plan's progression rates to the next stage of chronic kidney disease or ESRD are below a risk-adjusted benchmark, they can receive 25 percent of the Medicare savings generated. The Secretary may also provide optional advance investment payments to help plans improve care quality and uptake of specified services, which would be deducted from any shared savings.

Before the program's implementation, the Secretary must host a listening session to gather expert input on policy solutions for improving kidney disease screening, diagnosis, and treatment. The Secretary is also mandated to continuously monitor and evaluate the program's effectiveness in delaying ESRD and reducing Medicare expenditures, submitting reports to Congress. Funding for administration and shared savings will be drawn from the Federal Hospital Insurance and Supplementary Medical Insurance Trust Funds.