<!Rnngre.Ss Nf Tqe Llnite~ §Fates

<!rnngre.ss nf tqe llnite~ §fates D!Jasf1ington, ilQt 20515 August 1, 201 3 Honorable Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1 850 Dear Administrator Tavenner: We write to express our concerns about the Centers for Medicru·e & Medicaid Services (CMS) recently proposed rule on the End-Stage Renal Disease (ESRD) Prospective Payment System. The new bundled payment system for dialysis has been a remarkable success in payment ref01m. However, as written, the new proposed rule would have a devastating impact on Medicare beneficiaries who desperately depend on dialysis treatments just to stay alive. The proposed cut in payn1 ents in the pending rule constitute a 12% or a $30 reduction of what would otherwise be $246 prospecti ve payment for dialysis. A cut of this magnitude to an industry that, according to the Medicare Payment Advisory Commission, has just 3-4% Medicare margins, could result in closure of dialysis facilities and a reversal of many recent gains that have been made in improving quality of care and mortality for dialysis pati ents. It is our concern that CMS has not considered its fu ll statutory obligations in developing this proposal; it is c1itical to take analyze the costs of providing dialysis care. As you are aware, CMS has an obligati on to link the payment rate to facility costs or other economic and equitable factors. As you move toward finalizing the rule, we hope that the Agency will consider the full impact of the proposed changes in order to ensure that the fi nal payment amount is not less than the cost of providing care. Again, the new bundled payment system for dialysis shows the great strides we have made, ar1d can make again. We should not let the next rule negatively impact beneficiaries who rely on these critical services. Thrulk you fo r your considerati on of our comments. Sincerely, Diane Black ew1s Member of Congress 2'of Congress. Ben Ray ~ Member of Congress PRINTED ON RECYCLED PAPER Member of Congress Member of Congress me Langevin ember of Congress ~ j(;k{. (!{r~ ~I ~ Blake Farenthold Bill Posey Member of Congress Member of Congress ~, I~ Glenn Thompson Erik Paulsen Member of Congress Member of Congress Leonard Lance Member of Congress ~~~~b . ~· &~ Cathy McMorris Rodgers Frederica Wilson Member of Congress Mem of Congress Vern Buchanan Corrine Brown Member of Congress Member of Congress ~//j, ~ ~~Mike Rogers -- Eleanor Holmes Norton Member of Congress Member of Congress Ileana Ros-Lehtinen ~LRichard Neal ~ Mem erof ~J s Member of Congress . IY(~~·---- ess10ns Member of Congress John Tierney Member of Congress Mem er of Congress Keith Ellison Member of Congress ~Member of Congress 4!tre~P) Chris Smith Member of Congress Member of Congress ~ ~ Michael Fitzpatrick Steve Cohen Member of Congress Member of Congress Scott Peters Member of Congress Adam :ff CJJ. ~ ~~;c ~ ~ Member of Congress Member of Cong ess ~J.~ ]:*~~ Linda Sanchez Member of Congress Steve Peace Lyn estmoreland Member of Congress Member of Congress :Jhrls Q. !!1~ Doris Matsui Member of Congress < §? ~~d~ Member of Co gress Member of Congress ruce Braley Adam Smith Member of Congress Member of Congress Member of Congress Charles Rangel Member of Congress D~ Member of Congress ~ Member of Congress c· Yr'~ Phil Roe Member of Congress Karen Bass Member of Congress 7~~ ~a is Member of Congress Tom Cotton Member of Congress ~~mber of Congress!7 RtneeEiilTiers M~p~ Member of Congress Member of Congress AlanClbn~ Grayson Member of Congr{) Member of Congress ~~ Member of Congr s Member of Congress Tulsi Gabbard Member of Congress uke Messer Member of Congress eth Etsy Ted Yoho ber of Congress M~-~ David Valadao Member of Congress - Devin nes ~mber of Congress Member of Congress J D.Zley~ Stev~r~ Member of Congress Member of Congress Vicky Hartz &4~ Member~ of ongress Member of Congress Ly Jenkins 7J::7~VJJM 17il;~lt!r Daniel Web;tef Morgan Griffith Member of Congress Markwayne u m Member of Congress Chris Collins Member of Congress e~ StePhel1(eeFil1Ch ~ &e ic~:J:f~~ Member of Congress Member of Congress Jaime Herrera Beutler Bill Cassidy Member of Congress Member of Congress _.......Sean Duf Member~ of Congress Member of Congress !-::! ~ Member of Congress Member of Congress (i[M~ Chellie Pingree Member of Congress Trey Gow Ami Bera lll'.l.JbEd Perlmutter Member of Congress Member of Congress Al(4t;Jtl Clfl(tt: 1tiMichael~ Capuano ~ Matt Cartwright Member of Congress Member of Congress ...----I ~ ~-- - Member of Congress Charles Boustany Member of Co e Garcia ember of Congress Member of Congress lTIReed ~op - ~ 1€Member of Congress Member of Congress -:b:Lnas&d~ uMember of Congress Member of Congress b~a Christ sen 1/Member of Congress %~ Judy Chu Member of Congress Member of Congress c~ rvP s ~ _\) rrOJJL Carol Shea-Porter Member of Congress Member of Congress GJi:zd::zd o:fi/ Member of Congress ~w J. 7/(r~ race Napolitano ~J~~'M·jL Jember of Congress Member of Congress /Jd/ fi:vhns Van/4. Hollen~ Member of Congress Rick Crawford i\tChaelHOilda~~ Member of Congress .J.I~/jl~ \1'ardlil Rtutkbum )..tc:rnhcr (lr c·.,.,iSfc~ Mike Tho . p~ ~ Mcmht:r{l ~.fd{/~iiA Culkocn I hmuhu~u Member of Con ~l'c.ss Mcmher \ll'( 'uu.gl't:s:-: 4 M~)tt~ Ccdri~.: I ~ ichnmml f\·tcmbc1 oft'o ng.~·e:ss ~=~ Pc1c Ol•o" Member ofConll't" -~SS?~ Brnd SciUicldcr Mcmbtl' of Congn:ss ~dan K1ldec l.t'fdu...; Mcmbl:r oi" Congress Mike Coffman Member of Congress ~~· ~ Robert Lana Andre carson Member of Congress Member of Congress Charlie Dent Member of Congress ~~ ,;;;;;. ofCongr ss Bob te hen f . Lyncl Member ofCongress 1J&LeM~J._ ~~.r Michael T. McCaul ~ mb<r of Congress Member of Congress \(. ~~. 4~ Gus BJilrakis Member of Congress Member of Congress ~dy e£#~ ember of Congress .

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