Published by Inside Health Policy 

HHS Secretary Alex Azar met with kidney disease advocates on Wednesday (June 13) to discuss a potential shift in reimbursement policy, which providers have said doesn’t currently cover the cost of providing kidney care in Medicare.

Kidney Care Partners, which includes providers, those providing charitable assistance, patients and drug makers, also met with lawmakers on Capitol Hill Wednesday. Kidney care advocates asked legislators to cosponsor the Chronic Kidney Disease Improvement in Research and Treatment Act. They also urged lawmakers to press CMS to withdraw an interim final rule that requires dialysis facilities get issuer approval before agreeing to accept a patient getting charitable assistance for premium payments; and to make it easier for beneficiaries with end-stage renal disease to access Medigap and Medicare Advantage coverage.

“With Kidney Care Partners, Secretary Azar shared the Trump Administration’s interest in continuing to improve the quality of kidney-disease care provided in the United States, including through payment model advances, reductions in regulatory burden, and new pathways for reimbursement that may support innovation,” an HHS release said.

HHS did not provide any additional information on what new pathways or pay model advances might look like, and at press time had not returned a request for comment.

Allen Nissenson, chair of Kidney Care Partners, said other important areas discussed include ways to improve patient access, and to prioritize resources for research and innovations in care delivery models, medical and device innovations and modalities like home dialysis.

“Secretary Azar has paid more attention to our nation’s kidney disease epidemic than any Secretary in recent history, and we enjoyed our discussions of how the Administration could be helpful to continually improve kidney care in America,” Nissenson told Inside Health Policy in a statement.

Kidney Care Partners in their meetings on Capitol Hill urged lawmakers to cosponsor the Chronic Kidney Disease Improvement in Research and Treatment Act, which the group says “will set the stage for the future of kidney care.”

The legislation would make sure all individuals with ESRD can enroll in Medigap coverage and would provide earlier access to Medicare Advantage plans by moving up by a year, from 2021 to 2020, the effective date of a provision from the 21st Century Cures Act that allows ESRD beneficiaries to access MA coverage. It also would provide better access to nephrologists and non-physician practitioners in urban and rural under-served areas, according to Kidney Care Partners. Plus, the legislation would increase research into different areas of kidney care and rework Medicare dialysis reimbursement.

The House bill also contains a provision, not included in the Senate version, that would allow those covered by private health insurance to keep their plan for an additional 12 months.

The kidney group also asked lawmakers to press CMS to withdraw a rule that said patients must be educated about all insurance options. The agency required dialysis facilities to get issuer approval before agreeing to accept a patient getting charitable assistance for premium payments. Under current guidelines, issuers are required to accept payments from only certain groups, including Ryan White HIV/AIDs program, and city, state and Tribal organizations. Some stakeholders have pushed CMS to explicitly require plans accept all third-party pay, while others, namely issuers, want the agency to restrict the practice.

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