W&M Passes Bills To Let Kidney-Failure Patients Enroll In MA; Help LTCHs

July 13, 2016

The House Ways & Means Committee on Wednesday (July 13) passed two Medicare bills: one that lets kidney-failure patients enroll in Medicare Advantage, and another that again delays the so-called 25 percent rule for long-term care hospitals and that narrowly exempts four types of LTCHs from site-neutral pay measures.

Kidney patient advocates praised the committee for passing H.R. 5659. End-stage renal failure patients are not allowed to enroll in Medicare Advantage, but many of those patients want MA plans because they coordinate benefits, and it’s common for kidney-failure patients to have other chronic conditions that benefit from care coordination.

“A majority of ESRD patients are living with multiple chronic conditions and medical challenges, making care coordination a priority for ensuring a positive patient outcome,” Franklin Maddux, chair of Kidney Care Partner, said. “Data show that patients with kidney failure experience fewer disease-related complications and fewer hospital days when care is coordinated,” he added.

The committee also passed H.R. 5713, which includes several provisions related to long-term care hospitals.The bill would delay for nine months a rule that cuts pay to LTCHs that receive at least 25 percent of their patients from a single acute-care hospital. The bill would instead subject LTCHs to a 50 percent patient threshold. Congress has repeatedly delayed the 25 percent rule for a decade, according to health subcommittee Chair Pat Tiberi (R-OH), who wrote that portion of the bill. The bill would apply the 50 percent threshold from October through next June.

The bill includes several other measures friendly to LTCHs. It would exclude four types of LTCHs from site-neutral pay rules that were part of the Bipartisan Budget Act of 2013. Those groups include: LTCHs that came into the Medicare program after Dec. 26, 2013; LTCHs that existed before Sept. 3, 1982, and were exempt from the prospective payment system established in the Tax Equity and Fiscal Responsibility Act of 1982; LTCHs that primarily treats Medicare patients who have severe spinal cord injuries (there are two such facilities in the country); LTCHs started between Sept. 3, 1982, and Sept. 30, 1995, that are small LTCHs within another existing hospital.

The also includes measures aimed at curbing fraud, waste and abuse in Medicare, Medicaid and the Children’s Health Insurance Program.

Click here to see the original article on the Inside Health Policy website.