Policy and Politics News

Editor's note: This is part 1 of a two part series.

The Centers for Medicare & Medicaid Services has finalized a rule that sets emergency preparedness requirements for health care providers participating in Medicare and Medicaid, the agency announced Sept. 8.

It really shouldn’t come as any surprise that dialysis companies are partial to billing commercial health plans for dialysis services. It’s survival, they say, and Medicare has always looked the other way because it helps to reduce what the ESRD program consumes each year––about 8% of the budget.

The Centers for Medicare & Medicaid Services has issued a request for information seeking public comment on concerns that some health care companies, including dialysis providers, and provider-affiliated organizations may be steering people eligible for, or receiving, Medicare and/or Medicaid benefits into Affordable Care Act-compliant individual market plans, including Health Insurance Marketplace plans, for the purpose of obtaining higher reimbursement rates.

Attorneys representing American Renal Associates Holdings have filed a request in a U.S. District Court in Southern Florida to dismiss a lawsuit filed by United Healthcare over charges of pushing dialysis patients into UHC plans in order to collect higher payments.

The Centers for Medicare & Medicaid Services’ Innovation Center re-opened the application process earlier this summer for the Comprehensive ESRD Care (CEC) demonstration. The move was an effort to encourage smaller dialysis providers to join the five-year project aimed at testing the effectiveness of integrated care for end-stage renal disease. The deadline for applications was July 15; the agency will announce any new accepted participants next month, with a January 2017 launch.

The Star Rating System for dialysis clinics has been under fire since it was introduced in January 2014. But despite this scrutiny and expert panel review, questions about the system’s value remain. A four-star facility in New England was recently slapped with a $5,000 fine for numerous core survey deficiencies (the star system doesn’t include such criteria). Two dialysis units affiliated with a prominent academic medical center, whose nephrology program was recently ranked #8 in the country by U.S. News & World Report, have both garnered just one star, two years running.

Total health care spending growth is expected to average 5.8% annually over 2015-2025, according to a report from the Centers for Medicare & Medicaid Services’ Office of the Actuary (OACT), published July 13 by Health Affairs and authored. Projected national health spending growth remains lower than the average over previous two decades before 2008 (nearly 8%).

From 2000–2015, twenty-five states passed legislation to join the Nurse Licensure Compact (NLC, or Compact). The Compact license allows nurses (RNs and LPNs) whose primary state of residence is a compact state to practice in all other compact states whether that be physically, electronically or telephonically. For nurses who live in the current compact states, licenses automatically become multi-state licenses, as long as the nurse is in good standing. In addition to the requirements of their home states, nurses are subject to the nurse practice act and regulations in the state of practice, i.e., the state where the patient is located at the time nursing service is rendered.

Editor's note: This article was originally published by Kaiser Health News and NPR.