House Panel OKs Medicare Advantage Coverage for Renal Disease

July 13, 2016

Patients suffering from end-stage renal disease would have the ability to enroll in Medicare Advantage plans under a bipartisan bill (H.R 5659) approved by a House panel July 13.

Under current Medicare regulations, end-stage renal disease patients are prohibited from enrolling in Medicare Advantage.

The House Ways and Means Committee also approved H.R. 5713, known as the Sustaining Healthcare Integrity and Fair Treatment (SHIFT) Act, which would strengthen Medicare and Medicaid program integrity efforts by blocking payments to providers in certain areas where health-care fraud is prevalent. The bill would also provide 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.

H.R. 5659 was introduced July 7 by Rep. Jason Smith (R-Mo.). H.R. 5713 was introduced July 11 by Rep. Patrick Tiberi (R-Ohio).

Regulatory Relief

Currently, long-term care hospitals aren’t able to 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.

Four categories of long-term care hospitals would also be temporarily exempted from a provision in the Bipartisan Budget Act of 2013 requiring Medicare to pay the same rate for services provided in different locations including:

• long-term care hospitals that have enrolled in Medicare since Dec. 26, 2013;

• long-term care hospitals that were operating before Sept. 3, 1982, and were exempt from the prospective payment system established in the Tax Equity and Fiscal Responsibility Act of 1982;

• long-term care hospitals that primarily treat Medicare patients with severe spinal cord injuries; and

• long-term care hospitals that began operating between Sept. 3, 1982, and Sept. 30, 1995, and are part of an existing hospital.

Program Integrity

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.

Under Section 6401(a) of the Affordable Care Act, the Centers for Medicare & Medicaid Services has the authority to impose a temporary moratorium on the enrollment of new Medicare, Medicaid or CHIP providers and suppliers, including categories of providers and suppliers, if the CMS determines that it’s necessary to prevent or combat fraud, waste or abuse.

Industry Support

Kidney Care Partners Chairman Franklin Maddux said in a statement that H.R. 5659 ensures that end-stage renal disease patients will have equal access to treatment and care coordination.

Maddux said providing access to Medicare Advantage plans would also reduce program costs.

Kidney Care Partners is a national advocacy organization for kidney care.

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