Blog Post

29 Sep

The 21st Century Cures Act

The 21st Century Cures Act

The 21st Century Cures Act (CURES; P.L. 114-25) will allow Medicare-eligible individuals with ESRD to enroll in Medicare Part C Medicare Advantage (MA) managed care plans, beginning in 2021.  Currently, ESRD patients are not allowed to enroll in most MA plans.  Is your dialysis facility prepared for this change?  Most dialysis facilities have a primary patient base of traditional Medicare patients.  This change from the federal government could mean a change in administrative work for your facility.  Taking action before open enrollment this fall is key in being prepared.   Here are some items to think about.


  • Do you know which Medicare Advantage Plans are offered in your facility’s geographic area?
  • Do you have a contract with the Medicare Advantage Plans with the dialysis facility’s NPI listed on the contract?
  • Is the contract current with reimbursement for current Medicare processing and payment rules? (As a rule, with the MA contracts they pay only on the dialysis treatment.  They do not reimburse separately for immunizations, add on drugs like Medicare does. This may also be a good time to update your current contracts to include AKI treatments.
  • Is your facility staffed and have trained employees to handle additional calling for drug authorizations and working on out of network prior authorizations?
  • If your patient chooses a MA plan that you are not contracted with, you will be left with a decision on treating a patient with no reimbursement while they are on their new plan or you would have to transfer the patient to an in-network facility.
  • Please remember that open enrollment for Medicare Advantage Plans starts in October 2020. Having the contracts in place prior to January 2021 gives the patients the best possible information for being able to continue care within your facility.

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