Kidney Care Partners Pleased CMS Implements Expansion of Medicare Advantage Program, Concerned Other Changes Could Undermine Care Access for Patients with Kidney Failure

June 22, 2020

WASHINGTON, DC – Kidney Care Partners (KCP) – the nation’s leading kidney care multi-stakeholder coalition representing patient advocates, physician organizations, health professional groups, dialysis providers, researchers, and manufacturers – sent a letter to Department of Health and Human Services (HHS) Secretary, Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma applauding CMS for implementing the statutory provisions that provide access to Medicare Advantage plans to Medicare beneficiaries who qualify for Medicare because of kidney failure.  In addition, the letter expresses concern with the recent CMS Medicare Advantage Program Final Rule that could result in these patients having less access than Congress intended.

Demonstrating rare bipartisanship, policymakers have made significant changes toward expanding the Medicare Advantage (MA) program to include beneficiaries who qualify for Medicare because of kidney failure.  In the letter, KCP states:

For many of these patients, selecting an MA plan means that they will have access to care coordination programs, transportation to appointments, expanded mental health care and dental coverage (which is essential for patients seeking to be accepted on a transplant waitlist), as well as other services.  Traditional Medicare rules do not allow such services to be provided or restrict them so that they are not as effective.  Patients recognize, as we know this Administration does, that care coordination services for patients living with chronic conditions can lead to better patient outcomes and improved quality of life.  It is important that patients, regardless of their disease status, have the ability to select the plan that will support them in meeting their health care goals.

Yet, the Final Rule implementing this new policy includes a decision to remove outpatient dialysis facilities from the list of facility specialty types to whom the network adequacy standards apply.  KCP members are concerned that this policy could likely result in a lack of choice of treatment modalities for beneficiaries needing dialysis.

The letter also noted:

Under the policies in the final rule, plans could attest to having an adequate dialysis provider network by relying upon home dialysis only (which would not be clinically appropriate as described below) or hospital-based facilities (which might not have the capacity).  By removing the minimum facility number requirement, CMS could create an opportunity for MA plans not to include any outpatient dialysis facilities…[T]he finalized policy eliminating outpatient dialysis organizations from the network adequacy requirements could limit a beneficiary’s ability to make a “genuine choice” of enrolling in an MA plan.  It is not enough to have a plan attest to having access to an outpatient dialysis facility, there must be credible enforcement mechanisms that beneficiaries can trust to protect their access to necessary care. 

Also highlighted are the unintended consequences of removing outpatient dialysis facilities from the network adequacy standards, which include potential financial and administrative barriers that could disincentivize dialysis patients from choosing MA plans by:

  • Increasing costs for home and in-center dialysis patients;
  • Reducing access to care coordination services that could promote kidney transplants;
  • Limiting access for in-center hemodialysis patients; and
  • Restricting access to those who cannot afford out-of-network rates.

Patient advocate groups have also expressed concern with the final rule after years of supporting increased choice and access to Medicare Advantage for Americans with ESRD. Lori Hartwell, Founder of the Renal Support Network, noted, “On behalf of myself and others living with chronic kidney disease, I’m disappointed CMS has failed to honor Congressional intent and instead has finalized a policy that forces patients to make a blind choice – not knowing whether or not they will be able to continue their care with the same trusted doctors and clinicians they’ve counted on for years. The kidney care community has long hoped for both newly diagnosed and existing ESRD patients to have access to coordination and care that MA offers, but that’s clearly not the case with this final rule. This rule will harm us.”

“The kidney care community believes it is important that patients, regardless of their disease status, have the ability to select the MA plan that will support them in meeting their individual health care goals, and recognizes, as the Administration does, that care coordination services can lead to better patient outcomes and improved quality of life,” concluded John P. Butler, Chair of KCP.  “Unless CMS corrects this policy so outpatient dialysis facilities are reinstated on the list of specialty providers as part of the network adequacy requirements, patients who do not see an outpatient dialysis facility as listed as being in-network may not select MA plans. As a result,  the care advantages these plans offer will remain off-limits to the very patients who could most benefit from them.”

The full letter from KCP is available here.