Legislation aimed at health plans that push patients to Medicare gets more co-sponsors
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Key takeaways:
- A bill that would prevent health plans from limiting payments for dialysis care in an effort to push patients onto Medicare now has over 30 co-sponsors.
- Advocates say patients end up paying more under Medicare.
A bill in the U.S. House of Representatives that would slow efforts by commercial health plans from moving patients with end-stage kidney disease to Medicare now has 30 co-sponsors, according to a press release.
The Restore Protections for Dialysis Patients Act (H.R. 6860) was introduced last December by Reps Mike Kelly, R-Pa.; Yvette D. Clarke, D-NY; Neal Dunn, MD, R-Fla.; Danny Davis, D-Ill.; John Joyce, R-Pa., and Raul Ruiz, D-Calif. in response to a U.S. Supreme Court ruling in June 2022 in favor of Marietta Memorial Hospital Health Plan that made payments for dialysis care to DaVita Inc. for its employees below Medicare rates, pushing beneficiaries with ESKD to Medicare in an effort to make it the primary payer.
DaVita Inc. had sued the health plan, claiming the payment model was in violation of the Medicare Secondary Payer Act (MSPA), which requires commercial health plans to serve as the primary payer for kidney care services for the first 30 months if a patient is already in a commercial health plan when they start dialysis or receive a kidney transplant. After that 30-month period, Medicare then becomes the primary payer.
After a lower court ruled in favor of DaVita, the dialysis provider lost the case in a 7-2 vote before the Supreme Court.
That decision “undermined the intended protections of the [MSPA] and enabled insurers to shift individuals with end-stage renal disease (ESRD) from their employer-sponsored plans and onto Medicare,” Kidney Care Partners said in a press release. “This shift in payer coverage not only leads to increased out-of-pocket expenses and loss of both individual and family benefits but also places undue strain on the sustainability of the Medicare program.”
If passed, H.R. 6860 would restore the 30-month coordination period for patients before a commercial health plan can move patients to Medicare.
“This legislation is critical for Americans living with end-stage renal disease and who rely on dialysis,” Kelly said in a press release. “Patients deserve to know their benefits will be in place when they need them. This legislation will improve both patient care and patient outcomes.”
"Nearly 40 million Americans live with kidney disease, and the millions more at risk deserve our support in their fight against kidney disease — from prevention through post-transplant living," Clarke said in the release. "Unfortunately, far too many patients affected with the disease, which disproportionately impacts communities of color, have complex health care needs that create incentives for plans to discourage enrollment .... [This] bipartisan bill ... seeks to ensure people on dialysis receive the care they need."
“People with ESRD are more likely to be low-income and from historically marginalized communities, making premature loss of health coverage and related cost increases particularly devastating,” LaVarne Burton, president and CEO of the American Kidney Fund, said in a press release about the bill. “Thankfully, the Restore Protections for Dialysis Patients Act will ensure that people with kidney failure won’t be singled out based on their disease or forced to pay higher costs.”
References:
Kelly, colleagues introduce Restore Protections for Dialysis Patients Act. https://kelly.house.gov/media/press-releases/kelly-colleagues-introduce-restore-protections-dialysis-patients-act. Published Dec. 20, 2023. Accessed June 12, 2024.
Kidney Care Partners commend 30+ cosponsors of the Restore Protections for Dialysis Patients Act, calls for further congressional action. https://kidneycarepartners.org/press/kidney-care-partners-commends-30-cosponsors-of-the-restore-protections-for-dialysis-patients-act-calls-for-further-congressional-action/. Posted May 23, 2024. Accessed June 12, 2024.
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