The ESRD Network program began in 1977 when the Department of Health and Human Services (formerly Department of Health, Education and Welfare) published the final regulations establishing 32 National Coordinating Councils to administer the newly funded program.
With only 40,000 dialysis patients receiving care in 600 facilities, the Networks’ responsibilities focused on organizational activities, health planning tasks, and medical review activities.
The Medicare End Stage Renal Disease (ESRD) Program, a national health insurance program for people with end stage renal disease, was established in 1972 with the passage of Section 299I of Public Law 92-603. The formation of ESRD Network Organizations was authorized in 1978 by Public Law 95-292 which amended Title XVIII of the Social Security Act by adding section 1881. Thirty-two ESRD Network areas were initially established. H.R. 8423 was designed to encourage self-care dialysis and kidney transplantation and clarify reimbursement procedures in order to achieve more effective control of the costs of the renal disease program. In 1986, the Omnibus Budget Reconciliation Act of 1986 (P.L. 99-509) amended section 1881c of the Social Security Act to establish at least 17 ESRD Network areas and to revise the Network Organizations responsibilities.
Today, eighteen (18) ESRD Network Organizations exist under contract to CMS and serve as liaisons between the federal government and the providers of ESRD services. The number and concentration of ESRD beneficiaries in each area define the Network Organizations geographically. Some Networks represent one state, and others represent multiple states. The ESRD Network Organizations’ responsibilities include: the quality oversight of the care ESRD patients receive, the collection of data to administer the national Medicare ESRD program, and the provision of technical assistance to ESRD providers and patients in areas related to ESRD.
The ESRD National Coordinating Center (NCC) was established in September 2002 and is now contracted under Centers for Medicare & Medicaid Services (CMS) with the ESRD Network of NY. The NCC supports activities of the ESRD Networks as required by Section 1881 of the Social Security Act; the CMS Quality Improvement Program (HCQIP) and other directives related to monitoring, improving and maintaining the quality of care received by ESRD patients. The NCC represents an innovative approach to initiate projects of interest to the Medicare ESRD Program.
The NCC provides centralized coordination and support for the ESRD Network Program as described in the Statement of Work (SOW). The NCC’s primary responsibilities include collection, maintenance and distribution of ESRD information; coordination of national activities including training initiatives; facilitation of special projects, and administrative support services such as meeting planning and summary reports for the ESRD Networks.
By December 31, 1987, the ESRD program encompassed 98,432 patients and 1,701 facilities administering renal replacement therapy. At this time, Congress consolidated the 32 Networks into 18, redistributing and increasing their geographical areas as well as their program responsibilities. Funding mechanisms changed when Congress mandated that $ 0.50 from the composite rate payment from each dialysis treatment be withheld and allocated to fund the ESRD Network program. In 1988 CMS began formal contracting with the ESRD Networks to meet their legislative responsibilities. These contracts placed greater emphasis on quality improvement activities and standardized approaches to quality assessment and data analysis; health-planning functions were reduced.
In 2002, the ESRD program encompassed 299,591 patients and 4,443 providers. The Networks now operate on a three-year Statement of Work (SOW) cycle. The 2003 – 2006 SOW was implemented in July 2003. At the time of the contract renewal, CMS provided an updated ESRD Network Organization Manual that provided background and articulated responsibilities of the Networks as well as modifications to some requirements of the ESRD Network program. This manual further describes contract responsibilities.
As specified in the Statement of Work, each Network is responsible for conducting activities in the following areas:
- Quality Improvement
- Community Information and Resources
- Information Management
- Special Studies
CMS contracts require each Network to have an Executive Director, a Director of Quality Improvement, and a Director of Data Management as well as other necessary staff to fulfill the contract obligations. The role of the Executive Director is to coordinate the activities of the Network. The Director of Quality Improvement coordinates quality-related requirements and creates and implements quality improvement projects. The role of the Director of Data Management is the accurate recording and transmission of data between the facilities, the Network, and CMS.
In addition to these staff members, Networks employ other individuals to accomplish contract responsibilities. Though these positions vary from Network to Network, additional staff in the areas of quality improvement, data, and patient services are essential for the coordination of the many Network activities.