National Kidney Foundation Statement on CMS Interim Final Rule Medicare Program; Conditions for Coverage for End-Stage Renal Disease (ESRD) Facilities--Third Party Payment

January 12, 2017 - The National Kidney Foundation (NKF) filed final recommendations on January 11th to the Centers for Medicare & Medicaid Services (CMS) on protecting dialysis patients’ right to receive charitable third party premium assistance to help pay for the healthcare insurance option of their choice.

While the National Kidney Foundation does not provide premium assistance to help kidney patients pay for health insurance coverage, nor do we counsel patients on the type of coverage they should choose, we do not support the Federal government implementing policies which could make it more difficult for dialysis patients to receive such assistance. NKF does support protecting kidney patients from being steered to a coverage option that is not in their best healthcare and financial interest and policies requiring that patients receive comprehensive education about insurance coverage options, as well as the short-term and long-term coverage and cost implications of those options.

NKF is urging the agency to withhold implementation of the interim final rule and instead issue a proposed rule, with revised content, and at least a 30-day public comment period.  NKF offered the following recommendations to be considered for inclusion in a proposed rule:

  1. CMS, not dialysis facilities, should develop the required education in consultation with kidney patients, patient advocates, dialysis facility staff and transplant center staff.  This education should not be limited to Marketplace plans, but should be comprehensive of all insurance options available to ESRD patients.
  2. Require all dialysis facilities, not just those that contribute to third party premium assistance programs, to have an appropriately trained person on staff to educate patients on their insurance options or ensure patients receive education by a knowledgeable third party.
  3. Remove any assumption or reference to social workers being responsible for implementing the new educational requirements in the calculation of time and costs for implementing this final rule.  Many dialysis facilities employ insurance counselors and time and cost assumptions for education and counseling should be attributed to this role rather than setting up the expectation that this will become an additional responsibility for social workers.  While we recognize social workers currently provide information on insurance options to patients and help answer their questions, this new detailed level of information is an additive responsibility that should not fall on social workers and would be best provided by someone with specialized insurance training.
  4. Require dialysis facility staff functioning as insurance counselors to undergo the CMS Certified Application Counselor Program training.  The time involved in the training and the associated costs of the training should also be factored in total budget impact. Consider the same requirement of transplant centers who have staff that counsel patients on insurance.
  5. Remove the requirement that dialysis facilities contact the Marketplace issuers to obtain permission for patients receiving third party premium assistance to enroll in their plans.  Instead, require insurers who do not accept third party premium payments to alert CMS and the dialysis facilities each year.
  6. Do not remove the ability of patients to receive premium assistance to enroll in the coverage option of their choice, including Marketplace plans – patients should not have limited options because of perceived, or real, bad actors.
Kidney Disease Facts
1 in 3 American adults is at risk for kidney disease.  26 million American adults have kidney disease—and most aren’t aware of it.  Risk factors for kidney disease include diabetes, high blood pressure, family history, and age 60+.  People of African American; Hispanic; Native American, Asian; or Pacific Islander descent are at increased risk for developing the disease.  African Americans are 3 ½ times more likely, and Hispanics 1 ½ times more likely, to experience kidney failure.
The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney disease.  For more information about the NKF visit