Dialysis Patients Get OK in House to Enroll in Medicare Plans

September 22, 2016

Published by Bloomberg BNA

People suffering from end-stage renal disease would be allowed to enroll in Medicare Advantage plans under one of three health-care related bills passed by the House Sept. 21.

Included in the three bills are provisions lifting Medicare regulations that prohibit end-stage renal disease (ESRD) patients from enrolling in Medicare Advantage and strengthening Medicare and Medicaid program integrity efforts by blocking payments to providers in certain areas where health-care fraud is prevalent.

One bill would delay Centers for Medicare & Medicaid Services enforcement of a requirement that physicians at critical access hospitals provide direct supervision over outpatient therapeutic services.

Managed Care Access in 2020

The Expanding Seniors Receiving Dialysis Choice Act (H.R. 5659), introduced in July by Rep. Jason Smith (R-Mo.), would allow more seniors to access Medicare managed care plans starting in 2020.

Medicare Advantage plans offer better integrated care and financial protections for patients who suffer from chronic diseases that affect the kidneys, Smith said on the House floor Sept. 20.

“This bill expands access to high quality, affordable options for ESRD patients,” Smith said.

The bill was approved unanimously.

The bill wouldn’t increase federal spending largely because Medicare currently pays Medicare Advantage plans an amount equal to the statewide average cost of treating ESRD patients, according to the CBO. This means that Medicare pays about the same for ESRD treatments regardless whether the patient is in Medicare Advantage.

The head of Kidney Care Partners, a coalition of patient advocates and dialysis providers, said he expects the bill to eventually reduce Medicare costs by making dialysis patients healthier.

“Research shows that patients with kidney failure experience fewer complications and spend fewer days in the hospital when their care is coordinated,” Frank Maddux, chairman of Kidney Care Partners, said in a statement.

The bill now goes to the Senate for consideration.

Fraud-Fighting Measures

The Sustaining Healthcare Integrity and Fair Treatment (SHIFT) Act (H.R. 5713) would strengthen Medicare and Medicaid fraud-fighting efforts and provide some regulatory relief to long-term care hospitals by making it easier for them to qualify for Medicare reimbursement for patients transferred from acute-care hospitals.

These changes would increase Medicare spending by $25 million between 2017 and 2021, according to the Congressional Budget Office.

The bill was approved 420-3.

The bill was introduced July 11 by Rep. Pat Tiberi (R-Ohio).

There is no Senate version, so the upper chamber of Congress would need to adopt its own bill before the SHIFT Act could reach the president’s desk.

Currently, long-term care hospitals cannot receive full reimbursement if more than 25 percent of their annual Medicare patient population comes from only one acute-care hospital. The SHIFT Act would temporarily increase the Medicare patient population threshold to 50 percent for nine months, from Oct. 1 through June 30, 2017.

The program integrity provisions in the SHIFT Act would allow the health and human services secretary to block Medicare, Medicaid and Children’s Health Insurance Program reimbursement payments to newly enrolled providers and suppliers operating in geographic areas under temporary enrollment moratoriums.


The Continuing Access to Hospitals Act of 2016 (H.R. 5613), introduced by Rep. Lynn Jenkins (R-Kan.), would delay until 2017 enforcement of a CMS rule that physicians in critical access hospitals must provide direct, not general, supervision over most outpatient therapeutic services.

A CMS requirement originally established in 2014 requires physicians in small, rural hospitals deemed critical access hospitals to be directly responsible for outpatient services, meaning the services can’t be delivered by a nurse or other health-care provider in order to qualify for Medicare reimbursement.

Lawmakers have passed legislation to postpone enforcement of the requirement every year since it was first enacted.

Sponsors of the bill and hospital groups, notably the American Hospital Association, have complained that this requirement is unfair since many small, rural hospital face a shortage of physicians.

“These facilities simply lack the resources to fulfill this burdensome mandate,” Jenkins said on the House floor Sept. 20.

The bill was approved unanimously.

The Senate has yet to approve its version of the CAH Act (S. 3129).

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at

For More Information

The Expanding Seniors Receiving Dialysis’ Choice Act is at

The Sustaining Healthcare Integrity and Fair Treatment (SHIFT) Act is at

The Continuing Access to Hospitals Act is at

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