Regulatory Policy

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Supporting Home Dialysis

Home dialysis is a viable treatment option for many individuals with ESRD, but individuals face a series of practical barriers that, unless addressed, will prohibit them from being able to opt into dialyzing in the home. These include the lack of a care partner, inadequate space for the home dialysis equipment and supplies, problems with housing, lack of access to nutritional food and meals, mental health issues, and lack of transportation.

KCP believes that individuals who want to choose home dialysis should be able to, and we support policies that address barriers to offer individuals that opportunity. We recognize that some individuals need support that goes beyond current Medicare reimbursement rates, and KCP encourages HHS and CMS to explore supplemental programs to better meet these individuals’ needs.

However, KCP also recognizes that home dialysis is not the right choice for all individuals and supports guardrails to ensure incentives to increase home dialysis do not override clinical appropriateness and that patient and physician voice be in the forefront in choosing a care setting. Some may fear being placed on home dialysis when it may not be the clinically appropriate option for them, and the ESRD Treatment Choices (ETC) model has increased this fear.

The Kidney Care Quality Alliance (KCQA) has developed a measure set that includes a home dialysis rate measure coupled with a retention measure that would incentivize clinicians to make sure that people who are initiated on home dialysis are supported to stay on home dialysis long-term. KCP encourages CMS to support endorsement of this measure set by the National Quality Forum (NQF) so that it can be incorporated into the ESRD quality measurement programs.