Table 1.

Key elements of the Bipartisan Budget Act of 2018 that may affect kidney care

Dialysis specific
 Expands Telehealth coverage to patients on home dialysis by allowing the home to serve as an originating site (Section 50302)
 Provides continued access to Medicare Advantage Special Needs Plans for vulnerable populations, specifically designating ESRD, HIV/AIDS, and chronic and disabling mental illness as conditions that meet the definition of a severe or disabling chronic condition (Section 50311)
 Allows independent accreditation of dialysis facilities (Section 50403)
Other elements relevant to nephrology practices
 Allows prospective, voluntary assignment of Medicare fee-for-service beneficiaries to accountable care organizations (Section 50331)
 Extends the Independence at Home demonstration program (Section 50301)
 Expands Telehealth coverage for Medicare Advantage patients by permitting beneficiaries to pay the same for Telehealth consultations as they would for in-person visits and thereby, reduce cost-sharing obligations (Section 50323)
 Expands testing of the Medicare Advantage Value-Based Insurance Design test model (Section 50321)
 Changes the MACRA MIPS and Physician Fee Schedule (Section 50801)
  Reduces the effect of the cost domain from a mandatory 30% of MIPS to 10%–30%
  Eliminates Part B medications from the MIPS Cost Domain and MIPS Eligibility Determinations
  Slows implementation of performance thresholds, potentially delaying both bonuses and penalties until 2022
  Reduces the Base Physician Fee Schedule Update from 0.5% to 0.25% in 2019
 Accelerates the Reduction of the Medicare Part D “Donut Hole” Coverage Gap, potentially reducing enrollees out-of-pocket expenditures (Section 53116)
 Delays for 2 years reductions in reimbursement to disproportionate share hospitals, protecting these hospitals against potentially lower enrollment in ACA plans and less than anticipated state expansion of Medicaid coverage that would result in a corresponding higher number of uninsured and underinsured patients (Section 50204)
 Extends CHIP funding and funding for Community Health Centers (Sections 50101 and 50901)
 Allows accountable care organizations to operate beneficiary incentive programs, with incentives up to $20 (Section 50341)
  • Each element is followed by identification of the section of the Bipartisan Budget Act of 2018 in which it appears. MACRA, Medicare Access and Children’s Health Insurance Program Reauthorization Act; MIPS, Merit-Based Incentive Payment System; ACA, Affordable Care Act; CHIP, Children’s Health Insurance Program.