The agency requested information Aug. 18 about some dialysis facilities allegedly steering Medicare- and Medicaid-eligible patients toward individual market coverage to incur higher reimbursements. CMS said evidence it received about some dialysis facilities — like encouraging all patients to sign up for individual market plans and not providing information about downsides associated with individual market coverage — was sufficient to issue the interim rule Dec. 12.
“This arrangement has large financial benefits for providers, since individual market reimbursement rates for dialysis treatment are as much as four times higher than Medicare and Medicaid’s, adding up to a difference of $100,000 to $200,000 or more per patient per year. This easily dwarfs the several thousand dollar cost of providing premium assistance,” according to CMS’ statement.
The interim final rule with comment will require Medicare-certified dialysis facilities to tell patients about the risks associated with different coverage options, provide cost summaries of various health coverage options for patients, improve transparency regarding third-party payments to insurers and protect patients from coverage disruption. CMS said some patient consequences associated with choosing individual market plans over Medicare or Medicaid are transplant interference, increased out-of-pocket costs and coverage disruption.
In response to CMS’ interim final rule, the American Kidney Fund said, “CMS’ stated goal in issuing the [rule] is to create a more transparent process for patient education and referral to nonprofits for charitable assistance for health insurance premiums. We wholeheartedly support that goal — but in reality, the [rule] effectively removes kidney patients from the insurance decision-making process. It leaves to insurers the decision of whether to provide ACA coverage to low-income kidney patients who need charitable assistance to afford premiums.”
The interim final rule with comment period will take effect 30 days after being published in the federal register.
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