Statement by Kidney Care Partners on Conditions for Coverage for End-Stage Renal Disease Facilities,Third Party Payment (42 CFR Part 494)
December 13, 2016
Kidney Care Partners (KCP) – the nation’s leading coalition of patient advocates, kidney disease professionals, dialysis care providers, and manufacturers – is extremely disappointed by the Centers for Medicare and Medicaid Services’ (CMS’s) failure to address a growing practice of discriminatory behavior among insurers in designing plans that prohibit a vulnerable class of individuals who require life-sustaining dialysis from receiving assistance from non-profit charitable organizations to pay their health care premiums. However, KCP was pleased to see that CMS created a more transparent process for patient education and referrals for charitable assistance in the Conditions for Coverage for End-Stage Renal Disease Facilities,Third Party Payment (42CFR Part 494).
While KCP recognizes and appreciates the need to ensure and maintain viability in the healthcare marketplace, we feel this rule simply goes too far and runs counter to the founding principles of the Affordable Care Act (ACA). Dialysis patients are among the most medically fragile in our healthcare system, and they differ from other chronically ill patients. The kidney community is deeply troubled that payers are targeting high-cost patients with pre-existing conditions to move off or away from their plans. This practice runs counter to the fundamental anti-discriminatory tenet of the ACA. Just like other Americans, those living with kidney failure have the right to select the insurance program that is right for them. A patient’s need for financial assistance should in no way disqualify him or her from participating in any health insurance plan of their choosing.
CMS should protect ESRD patients by clarifying this right and requiring issuers of plans the ACA Marketplaces to accept payments on behalf of such individuals regardless of whether they come from the individual, their family members or friends, or well-established charitable organizations. Allowing our country’s most vulnerable individuals with chronic disease conditions the ability to choose and keep their healthcare coverage is the pillar of our market-based system and therefore must be restored immediately. The failure to clarify this right will leave cherry-picking and discriminatory practices in place.
The broader kidney community has tried to work with CMS to identify issues related to third party payer and how to adequately address them in a way that preserves patient access to plans that best serve their needs. To that end, KCP remains optimistic that policymakers will come to recognize the importance of clarifying existing policy and protecting these individuals, and stands ready to work collaboratively with the new administration, the new Congress, and key stakeholders to immediately address this flawed policy.
We are concerned, however, that the requirements set forth in the rulemaking fall short of what dialysis patients want and have a right to – the ability to access commercial insurance if that plan is the one that best meets their needs. KCP is disappointed that, along with requiring greater transparency of dialysis facilities, CMS has failed to protect patients by issuing a clarification that Exchange plans must accept charitable assistance from independent 501(c)(3) charitable organizations who provide that assistance for at least a year, observe uniform procedures that separate the grant-making decisions and operations from the fundraising decisions and operations of the organization, and award premium and cost-sharing grants solely on the basis of financial need in accordance with criteria that are applied uniformly. We call on CMS to immediately provide this direction to plan issuers so that patients are not only receiving appropriate information from dialysis facilities, but are also protected from discrimination by insurance plans.