Rob Blaser

and aid the transplantation of medically complex kidneys. We'll keep digging into this massive legislation and will keep the kidney community apprised as appropriate. (4/end)

and several organ donation/transplantation provisions that would, among other things, support the adoption of real-time organ tracking during transit, (3)

extension of the Geographic Practice Cost Indices (GPCI) floor of 1.0 for rural areas, a 3.1% alternate payment model (APM) bonus for qualifying participants for performance year 2026, (2)

Folks, I know a lot of people already know about this but the FY2026 appropriations bill included a health package with key provisions for nephrology. Among these provisions was a two-year extension of current telehealth flexibilities (until December 31, 2027 (1)

Rest assured that RPA is tracking developments and will keep the nephrology community updated on what happens. (3/end)

The initial announcement is intriguing but the real proof-is-in-the-pudding details won't be known until the Agency releases a request for application (RFA) that includes enrollment, implementation, operational, and other details. (2)

Good morning people. I know many folks have heard about the new CMS/CMMI ACCESS Payment Model (link below) that seeks to leverage digital and technological assets to help manage and delay the onset of chronic disease. (1)
www.cms.gov/priorities/i...

The other extender package items (GPCI floor and low volume hospital payments, for example) will be handled similarly. RPA will keep on top of this and keep the nephrology/kidney policy community advised in as real-time a manner as possible. Take care and be kind to others. (2/end).

I realize folks have probably heard this elsewhere, but it looks like the shutdown will likely end very soon, if not tonight then tomorrow. The good health policy news is that the telehealth flexibilities will be extended until January 30 and made retroactive back to October 1. (1)

More to come, Happy Halloween. (8/end).

Recall that this is the first year of the two-conversion factor system mandated by MACRA that gives a higher bonus for qualifying APM participants and a lower increase for non-qualifying Medicare Part B providers. (7)

"Similarly, the final CY 2026 nonqualifying APM conversion factor of $33.40 represents a projected increase of $1.05 (+3.26%) from the current conversion factor of $32.35.” (6)

Regarding the conversion factor, this too is unchanged from what was proposed; per the CMS press release on the rule, “the final CY 2026 qualifying APM conversion factor of $33.57 represents a projected increase of $1.22 (+3.77%) from the current conversion factor of $32.35. (5)

Accordingly, changes to the dialysis code family and to E&M codes are as proposed in July, healthy increases for outpatient E&M services/corresponding cuts to I/P E&M codes. One change made to the efficiency adjustment proposal is to exempt new codes from the adjustment. (4)

Thus, the -9.4% hit for (for example) CPT code 90935 (inpatient dialysis) and the +9.0 increase for 90960 (adult monthly dialysis) are still as proposed. (3)

So, nephrology is still slated to have a projected impact of +1%, and the inpatient/outpatient dichotomy is in July, as the methodological changes for the work RVUs (via the efficiency adjustment) and the practice expense RVUs (via changes to indirect PEs) are still in place. (2)

Folks, the final rule for the 2026 Medicare Fee Schedule was released tonight, and it appears to have been finalized almost exactly as it was proposed. (1)

The MLN post ended up being correct, CMS issued a clarification last night that aligned with the MLN post and thus the vast majority of claims will be paid as scheduled.

Great question. There was much communication (confusion?) yesterday that all payments were paused per a CMS announcement, but the original Medicare Learning Network (MLN) post said it only claims for expiring provisions were being held, like those for telehealth. (1)

Very kind Charlotte, thank you. Great seeing you and I hope you had an uneventful trip home.

@rpanephrology leaders strategizing about RPA’s Capitol Hill Day tomorrow. Over drinks.

So, given the good chance that a Medicare extenders package happens before say year's end, the flexibilities should be extended then. Stay tuned. (4/end)

Whether that lasts for days/weeks/months no one knows, but practices should be adjusting their schedules accordingly. The positive news IMO is that everyone on the Hill seems to agree that the telehealth flexibilities should be extended if not made permanent. (3)

While I was pretty bullish that this would get resolved prior to 9/30 earlier this year, now it looks pretty likely that there will be a lapse in the flexibilities with an almost certain government shutdown. (2)

Folks, there is a lot of chatter among nephrology practices about whether the telehealth flexibilities and thus the ability to provide services via those means will end on September 30. (1)

Charlotte, the chances of it getting resolved by September 30 are slim to nonexistent. My guess is the flexibilities will be extended by years’ end but when that happens, who knows?

NEPHROLOGY NURSES, YOU ROCK!!! Happy Nephrology Nurses Week to all of the heroes out there providing great care to persons with kidney disease, can't wait to spend time with our friends at the American Nephrology Nurses Association next week. Thanks for everything y'all do!

You know that scene in an action movie when the bad guy runs through the kitchen of a restaurant and pulls down all the pots and pans behind him to slow down his pursuers? We're in that part of the Trump presidency.

Folks, there was a error in my MFS post this A.M., the 'all others' CF increase for 2026 will be about $3.30, not $3.62. The 2nd figure ($3.62) was from the CMS Newsroom press release on the rule, but that's no excuse, I should have double checked the math. Sorry about that.

Comments on the proposed rule are due on September 12. (12/end).