Advance CKD and Kidney Failure

For employees with advanced CKD, employers can ensure that individuals have access to high quality, effective dialysis. Home dialysis is associated with improved outcomes and lower costs. 

Employers should ensure that benefits policies cover:  

• Minimum of 13 treatments per month for in-center dialysis.
• Access to education that describes all treatment modalities.
• Equal coverage or incentivization of home dialysis.   
• Coverage of paid care partner to support home dialysis.
• Offering additional paid time, temporary desk work, or other modifications to support physical health needs.  
• Ensure adequate short-term disability coverage. 
   

Transplant is the most effective treatment for kidney failure. Unfortunately, many people who are eligible for kidney transplant encounter barriers in their access to this treatment. 

Support for multiple listing: 

Employer plans should provide coverage for full transplant evaluation at more than one transplant center (called “multi-listing” or “multiple listing”). Multi-listing enhances patient autonomy and enables individuals to access a wider range of available organs as well as programs with willingness to take on candidates with higher medical complexity. Multiple listing can significantly reduce waiting times, improve matching opportunities, and ultimately save lives. This approach not only benefits patients but also promotes healthy competition and excellence among transplant programs.

Provide simultaneous evaluation for living donors: 

A significant delay in care can result when a patient has multiple potential living donors and one donor is not allowed to start the evaluation process until a decision is rendered on another donor, a process which can take significant time (months to a year in many cases). By allowing for simultaneous donor evaluations, programs can streamline the evaluation process, reduce wait times, and facilitate quicker access to transplantation for recipients. Given that the average recipient may have four donors evaluated, this change has the potential to dramatically increase the efficiency of living donation.

Allow transplant approval outside of payor networks, when appropriate: 

Employer plan approval of transplant procedures performed outside of payers' networks and Centers of Excellence (COEs) when warranted by patient circumstances. Situations including patient hardship, geographic barriers, challenges in accessing care, and unique clinical co-morbidities or the need for emergent care for critically ill patients often necessitate flexibility in the standard approval process. By enabling exceptions under these circumstances, this will ensure that all patients receive equitable access to transplantation, regardless of their geographic location or financial constraints.

Extend sick leave and/or paid time off to accommodate transplant evaluation process: 

Evaluations for transplant can be time-consuming endeavors. Additional sick and/or paid time off to cover visits and travel time for evaluation appointments may increase the likelihood of prospective recipients completing the process.

Extend sick leave and/or paid time off to accommodate pre-donation evaluation process: 

There can be considerable variability in the time required to get evaluation for living donation. Factors like where the donor lives, where they are donating, the transplant center evaluation process (typically ranging from 1-3 days plus travel time) contribute to this variability. Some employers with unlimited PTO cover this easily, others may need to consider additional days or offering a PTO bank or balance sharing to facilitate this process.

Consider reimbursement of travel, lodging, or dependent care costs related to living donation: 

There are other programs such as the National Living Donor Assistance Program, the National Kidney Registry, and others that provide this support pending donor eligibility. Employers can help fill these gaps to offset the financial barriers that sometimes limit transplant.