Empowering Patient-Centered Decision-Making
Patient and physician voices should be at the forefront in care choices, but providing choices means that access to a variety of appropriate treatment modalities and coverage options should be offered as widely as possible. Policy barriers that discourage patients from using certain forms of coverage and treatment modalities––including home dialysis––should be eliminated or revised. Individuals with ESRD must maintain their choice of care and coverage, while payors should continue to provide appropriate payments for treatment.
Empowered care choices begin with education, and individuals must also have access to clear, easy-to-understand information that can help them decide on the best care option for them. Effective educational intervention is central to informed patient decision making, effective management of co-morbidities and uremic complications, and enhanced patient involvement in health care. KCP supports expanding the Medicare annual wellness benefit to include kidney disease screening and increase access to the Medicare Kidney Disease Education Benefit.
KCP asks the Administration to ensure that insurance plans do not discriminate against individuals on dialysis and that patients can continue to have a choice in coverage — whether Medicare, private insurance, group health insurance, or any other option — that best meets the needs of the patient and his/her family. KCP opposes any efforts to force individuals on dialysis out of their private insurance and onto Medicare, as these policies rob individuals of autonomy over their care and directly conflicts with Congressional intent in the Medicare Secondary Payer Act.
Low-income individuals are under attack by insurers’ attempts to decrease charitable premium assistance (CPA), which plays a key role in allowing individuals with ESRD to determine the best insurance coverage option for themselves and families. Furthermore, Medigap coverage and Medicare Advantage should also be available to individuals living with kidney disease, if they wish. KCP supports Congressional action to guarantee access to Medigap for ESRD beneficiaries under 65 and allowing ESRD patients to have earlier access to Medicare Advantage plans and keep access to their preferred specialist.
Comment Letters & Resources:
- Amicus Brief of Kidney Care Partners to U.S. Supreme Court in Marietta v. Davita
- Letter to CMS on the End-Stage Renal Disease Treatment Choices (ETC) Model Proposed Rule (August 26, 2021)
- Letter to CMS Requesting Additional Guidance Regarding the implementation of the ESRD Treatment Choices (ETC) Model (February 23, 2021)
- Comments on the Advance Notice of Methodological Changes for Calendar Year (CY) 2022 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies – Part II (November 25, 2020)
- Comments on the CY 2021 Proposed Rule for Revisions to Payment under the Physician Fee Schedule (September 30, 2020)
- Letter to CMS on the Medicare Advantage Program Final Rule (June 17, 2020)
- Letter to CMS on the Proposed Specialty Care Models To Improve Quality of Care and Reduce Expenditures and the ESRD Treatment Choices (ETC) model (September 15, 2019)