Key Provision in 21st Century Cures Act Allows Access, Choice of Medicare Advantage Plans for Individuals with Kidney Failure

December 13, 2016

Kidney Care Community Lauds Provision As Significant Win for Nation’s Medicare Beneficiaries with Kidney Failure

Washington, DC – President Obama signed the landmark 21st Century Cures Act today, following a bipartisan wave of support in the House and Senate, which contains a provision allowing Medicare beneficiaries with kidney failure, or end-stage renal disease (ESRD), access to Medicare Advantage (MA) plans.  Prior to passage of the Cures Act, the law as written prohibited Medicare patients with ESRD from enrolling in Medicare Advantage plans, a choice afforded to all other Medicare beneficiaries.   The Cures Act eliminates this discriminatory prohibition.

End-stage renal disease is an irreversible failure of kidney function that is fatal without kidney transplantation or dialysis treatments. Because of the limited number of kidneys available for transplantation, most ESRD patients undergo dialysis, typically three times per week. More than 80 percent of dialysis patients rely on Medicare’s ESRD benefit to pay for their care.

“ESRD is a complex medical condition, and most patients are living with multiple medical problems, relying on multiple medications,” said Dr. Franklin W. Maddux, Chair of Kidney Care Partners. “Allowing this patient population the choice to enroll in a Medicare Advantage (MA) plan will provide a patient driven path to care coordination, which has been shown to produce improved health outcomes.”

In addition to the highly coordinated care available through MA plans, enrollees experience lower out-of-pocket health care costs. Because many Medicare ESRD beneficiaries are under the age of 65, in most states these beneficiaries do not have the option of purchasing a Medigap policy to help defray co-payment obligations and cost sharing, which can be significant. Many MA plans offer reduced cost sharing, which would be an invaluable benefit for ESRD beneficiaries.

Since 2000, the Medicare Payment Advisory Commission has recommended that Congress remove the prohibition against ESRD beneficiary access to MA. Yet, the prohibition has remained in place.

The specific language contained in the Cures Act for ESRD beneficiaries stemmed from the bipartisan ESRD Choice Act, which passed with unanimous support in the House, for which the broader kidney community were strong advocates.

“We want to thank Representatives Jason Smith, John Lewis, Gus Bilirakis, Kurt Schrader, and Tom Marino for their early sponsorship of the Choice Act – the foundation for the ESRD MA language contained in the Cures Act.  We’d also like to acknowledge Fred Upton for his continued perseverance in passing 21st Century Cures.” said Dr. Maddux.  “On the senate side, our community recognizes Senators Crapo, Cardin and Nelson for their leadership of this same policy that was included in their legislation, the Chronic Kidney Disease Improvement in Research and Treatment Act of 2015. Last, Senator Alexander deserves recognition for his leadership on helping pass Cures.”

“KCP believes the care coordination offered through Medicare Advantage plans provides a crucial option for individuals with kidney failure. We appreciate the years of work that have gone into Cures and thank our bipartisan Members of Congress for including language that will increase treatment and plan options for those suffering with advanced kidney disease,” added Dr. Maddux.