National Kidney Foundation Statement on Medicare Program; Conditions for Coverage for End-Stage Renal Disease Facilities—Third Party Payment
December 13, 2016 - The National Kidney Foundation is pleased that the Centers for Medicare and Medicaid Services (CMS) has given serious consideration to how best protect dialysis patients from being steered into health insurance options that primarily benefit the provider; but may not necessarily meet healthcare and financial needs. Ensuring end stage renal disease (ESRD) patients are making informed decisions about their insurance coverage is a very important goal. However, we have concerns about the requirement which states facilities must obtain written consent from insurers that they will accept third party premium assistance. This appears to allow insurers to reject third party premium assistance for ESRD patients, even when that assistance is provided by charitable non-profit organizations. It would also give insurers a greater opportunity to discriminate against third party-premium assistance intended to help support ESRD patients in obtaining their choice of coverage.
The CMS ruling also requires additional responsibility for dialysis facilities to deliver comprehensive education to patients on insurance options in the marketplace as well as public coverage options. Patients often turn to social workers for questions about insurance; however, social workers are not trained to provide insurance counseling. If this added responsibility falls to social workers, it may further detract from the work they are trained and licensed to do—improving the health of kidney patients and connecting them to any external support services these patients may need.
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 provide factual information and tools to help patients learn about their options and make informed decisions that best serve their unique needs. For more information visit www.kidney.org
Facts about Kidney Disease
1 in 3 American adults is at risk for kidney disease. 26 million American adults have kidney disease—and nearly 90% 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 NKF visit www.kidney.org.