Medicare

Pursuant to a congressional request, GAO reviewed the transition of a Medicare contractor's end-stage renal disease patients to different sources of dialysis to determine: (1) the appropriate circumstances to authorize Medicare payments for an aide under the end stage renal disease program when patients dialyze at home; and (2) potential increased indirect costs for transportation and day care.

GAO found that: (1) the contractor ceased providing aides to its home patients after the Omnibus Budget Reconciliation Act of 1989 limited payments to suppliers of dialysis equipment and supplies for dialysis treatment; (2) if Medicare authorized paid aides for home dialysis patients, it would need to establish criteria that would limit the availability of paid aides; (3) the Health Care Financing Administration (HCFA) could require that the beneficiary be homebound or bedridden to qualify for a paid home dialysis aide; and (4) other eligibility criteria included limited daily living activities or serious medical conditions that would be exacerbated by travel to a dialysis facility.