Table 2.

Key legislation affecting payment for the US ESRD Program

Year	Public Law	Title	Major Provisions
1972	92–603	Social Security Act of 1972	Medicare coverage of patients with ESRD <65 yr of age after a 3-mo waiting period
1978	95–292	ESRD Program Amendments of 1978	Elimination of the 3-mo waiting period for home dialysis or transplantation
1981	97–35	Omnibus Reconciliation Act	Establishment of single prospective rate to cover all services and supplies for dialysis (composite rate); excluded certain laboratory tests and drugs that were separately billable; MSP for 12 mo after the patient qualifies for Medicare if that patient has employer group health insurance
1986	99–509	Omnibus Reconciliation Act	Mandatory $0.50 withhold per treatment to fund ESRD Networks
1991			MSP increased to 18 mo
2003	108–173	MMA	Statutorily mandated increases in composite rate to adjust for inflation; separately billable drugs reimbursed at average sales price plus 6% (rather than average wholesale cost); composite rate add on to replace drug margins; MSP increased to 30 mo; case-mix adjustment for age and body size
2008	110–275	MIPPA	Established bundled reimbursement to include composite rate items and services, injectable drugs and their oral equivalents, and laboratory tests to begin in 2011; oral-only ESRD drugs to be included in the bundle in 2014; new case-mix adjusters; elimination of higher payment for hospital-based providers; Quality Incentive Program to begin in 2012
2012	112–240	ATRA	Mandated rebasing of dialysis reimbursement to reflect lower use of drugs; oral-only ESRD drugs to be included in the bundle in 2016
2014	113–93	PAMA	Spreads out and reduces rebasing reimbursement cut; oral-only drugs to be included in the bundle in 2024

MMA, Medicare Modernization Act; MIPPA, Medicare Improvements for Patients and Providers Act; American Taxpayer Relief Act; PAMA, Protecting Access to Medicare Act of 2014; MSP, Medicare to be secondary payer.