Statement from Kidney Care Partners on the Center for Medicare & Medicaid Services’ Proposed Changes to Medicare Advantage

February 7, 2020

Washington, DC — In response to the Centers for Medicare & Medicaid Services’ (CMS) announcement on proposed changes to the Medicare Advantage (MA) program, Kidney Care Partners (KCP) reiterated its strong support for action to provide Medicare beneficiaries with kidney failure – or end-stage renal disease (ESRD) — with access to MA plans. However, KCP members are concerned that the proposals in the Calendar Year 2021 and 2022 MA and Part D Proposed Rule, and the second part of the Advance Notice Call Letter, would create barriers to individuals with ESRD being able to select which Medicare benefit is best for them. KCP stands ready to assist the Administration in addressing these concerns to ensure that the intent of the Congress is implemented.

As part of the 21st Century Cures Act, Congress expanded access to MA allowing Medicare beneficiaries with ESRD to enroll in MA plans beginning next year. While the Proposed Rule and Call Letter implement this new policy that expands patient choice, some of the proposed policy discussion related to “network adequacy” could result in MA no longer being a practical option for patients who require dialysis three times a week to live.

Patients who require dialysis asked the Congress to expand access to MA plan for many reasons. For example, many MA plans offer more advanced care coordination activities, which have been shown to produce improved health outcomes for dialysis patients and reduce overall health care costs for these patients and their insurers. KCP appreciates that the Administration recognizes the importance of care coordination and supports its Sprint to Coordinated Care.

Unfortunately, the Proposed Rule and the Call Letter seek comments related to network adequacy standards that MA plans must follow. The proposed changes provide more flexibility to plans, but unfortunately also mean that individuals with ESRD will not have in-network access to the providers they need. If finalized as proposed, these policies would thwart the intention of Congress in expanding MA and ultimately eliminate patient choice.

KCP and its members are reviewing closely the proposed payment rates to ensure that the rates are adequate to cover the cost of treatment. The Medicare Fee for Service (FFS) dialysis payment rate has long been underfunded and this problem continues through the calculation of the MA payment rate. It is important that CMS address the underlying problem of the PPS FFS and make sure the MA rates are adequate so that the problem is not transferred to the FFS program as well. Given that disproportionate role that Medicare has in covering Americans with kidney disease and kidney failure, it is Medicare’s obligation to make sure that reimbursement rates support the life-saving services these patients require.

KCP remains committed to helping the Administration achieve the goals of Advancing Kidney Care in America and will continue to work constructively with CMS and Members of Congress to advance our mutual goal of improving the lives of individuals living with kidney disease, kidney failure and transplants, which includes providing dialysis patient access to MA plans.