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Health Insurance Reform Implementation Continues

DPC recently sent a letter to the Department of Health and Human Services (HHS) providing comments on a new proposed rule outlining planned regulations for the new health insurance exchanges.
 
In the letter, DPC urged HHS to ensure CKD and ESRD patients have the same access to private insurance both inside and outside of the exchanges.  DPC explained the need to maintain consistent application of the Medicare Secondary Payer (MSP) law, which permits ESRD patients to keep their private health insurance coverage for 30 months before Medicare becomes the primary payer.  Ensuring this protection will mean equal treatment for kidney disease patients and has the potential to save the Medicare program billions over the next ten years.  Additionally, DPC advised HHS to ensure that ESRD patients have access to premium credits and cost-sharing subsidies to purchase private coverage through the exchanges, which will make private coverage attainable for more Americans.
 
DPC also took the opportunity to reiterate its support for including dialysis and kidney transplantation in the essential benefits package required in the new exchanges.  Additionally, DPC stated its support for the inclusion of other patient protections, including adequate provider choice, reasonable drive time requirements and regulations to avoid the possibility of dialysis coverage limits in the new exchanges.
 
>Read the full letter

ESRD Quality Incentive Program – Update

On August 30, DPC sent a letter to the Centers for Medicare and Medicaid Services (CMS) providing comments on the Proposed Rule for the Changes to the End Stage Renal Disease Prospective Payment System for CY 2012, End Stage Renal Disease Quality Incentive Program for PY 2013 and PY 2014, the most recent proposed rule suggesting changes to the ESRD Quality Incentive Program (QIP).

As a member of Kidney Care Partners (KCP), DPC stated its strong support for the comments submitted by the coalition, and used the comment letter as an opportunity to highlight a few points and emphasize several key priorities.

DPC’s main concern with the QIP continues to be the lack of timeliness of data.  In order for the QIP to be a truly useful tool for patients, the data used to evaluate the quality of care delivered must be current.

DPC is also greatly concerned with CMS’s decision to remove the lower limit hemoglobin less than 10 g/dL measure entirely from the QIP.  In the letter, DPC outlined its strong support for publicly reporting of the full range of hemoglobin levels below 10 g/dL, published both on Dialysis Facility Compare and made available in individual facilities.  DPC recommended CMS make data available from the most recent six months from the date of posting and update the data regularly, including all dialysis patients, not only those who receive ESA treatment.  At the same time, DPC urged CMS to develop appropriate anemia management measures for payment in QIP.

DPC also weighed in on several additional clinical measures, including dialysis adequacy, vascular access type, and standardized hospitalization ratio admission measure and provided comment on patient experience of care and bone mineral metabolism reporting measures. 

Additionally, DPC stressed the need to create incentives, not simply penalties, for providing quality care to dialysis patients through the QIP.  DPC strongly urged CMS to establish a means to reward those providers who deliver the highest quality of care and also recommended CMS consider new ways to incentivize innovation in ESRD care in the short term, including the possibility of a pass through payment system mimicked after a similar CMS program
 
>Read the full comment letter

 
Immunosuppressive Drug Coverage Legislation  

On August 22, DPC sent a letter to Representatives Michael C. Burgess (R- 26th TX) and Ron Kind (D- 3rd WI), thanking them for their leadership and support of The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2011. 

Currently, Medicare does not place a time limit on dialysis coverage after patients receive a kidney transplant; however, anti-rejection drugs for kidney transplant patients are only covered by Medicare for 36 months. After this 3-year period, recipients who do not already qualify for Medicare, due to age or disability, are no longer eligible for the benefit and are forced to find alternative coverage for their required daily medications. 
 
The proposed legislation will extend the current benefit beyond 36 months and will result in a net savings to Medicare, provide transplantation as an affordable option to more patients and improve patient quality of life by reducing the back and forth from transplant to dialysis. 
 
DPC anticipates the legislation will be introduced in the U.S. House of Representatives after August recess is over and a companion bill was introduced in the Senate earlier this year. DPC would again like to thank Representatives Burgess and Kind for their efforts and support on this very important issue. 

>Read the full letter here



Dialysis as an Essential Benefit

In August, DPC submitted a letter urging the Institute of Medicine (IOM) to include both dialysis and transplantation in the essential benefits package it recommends the Department of Health and Human Services (HHS) adopt for the new health insurance exchanges. 

When defining essential benefits for the health exchange plans, we find it difficult to imagine the exclusion of dialysis and transplantation, as both are absolutely essential to the survival of an ESRD patient.  In fact, these life-preserving treatments allow hundreds of thousands of Americans to live high quality and fulfilling lives.  Mandating dialysis as an essential benefit will enable thousands of Americans to take advantage of new coverage opportunities the exchanges create.   

>Read the full comment
 

Association Health Plans

As part of DPC’s on-going efforts to ensure dialysis patients are protected in the new state-based health insurance exchanges, we recently joined a coalition of consumer groups who are also working to retain the consumer protections in Association Health Plans.

In June, DPC joined several consumer groups at a meeting with the White House and the Departments of Labor, Treasury and Health.  DPC wanted to ensure that the Affordable Care Act would not roll back critical consumer protections currently in place in Association Health Plans.  Most important from DPC’s perspective is the retention of “essential benefits” protections in these plans, such as dialysis and transplantation.  The meeting was a productive one, with officials from the Administration thanking us for bringing the issue to their attention and pledging their commitment to ensure our concerns are incorporated into future rules implementing the health reform law. 

In conjunction with the meeting, DPC and the consumer coalition also sent a joint letter to Department of Health and Human Services (HHS) Secretary Kathleen Sebelius outlining our concerns and urging increased consumer protections. 

>Read the full letter

Accountable Care Organizations
In April, the Centers for Medicare and Medicaid Services released the Proposed Rule for the Medicare Shared Savings Program: Accountable Care Organizations (ACOs). ACOs are a model of integrated care formulated to improve quality and reduce costs in the health care system. The Affordable Care Act (ACA) requires the Secretary of Health and Human Services to establish a new ACO program for Medicare beneficiaries by January 1, 2012 and the recently released Proposed Rule begins this process. DPC submitted comments to CMS to ensure the patient’s point of view is heard as this important issue moves forward.

In the letter, DPC stated its support for the movement to increase integration in our health care system because of the potentially positive impact on dialysis patients and the tremendous opportunity for care coordination in Medicare. We appreciate the emphasis CMS placed on ensuring patient choice and we are strong supporters of CMS’ commitment to reward high-quality providers. At the same time, we want to ensure that this commitment extends to providers treating kidney patients and we are especially concerned that the Proposed Rule is currently structured in such a way that will exclude those with high cost chronic conditions like kidney disease from experiencing the benefits of this effort.

>Read the Full Comment Letter

>Read the DPC Policy on Coordinated Care

Health Insurance Reform Implementation
DPC recently submitted a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) urging CIIO to consider the complex needs of people with kidney failure who are on dialysis when designing the regulatory framework for the insurance exchanges. As health insurance reform implementation moves forward, DPC is committed to increasing awareness about the unique vulnerabilities of this beneficiary population and ensuring that important protections for dialysis patients and families are included.  

In the letter, DPC highlighted the need for dialysis services to be considered an essential health benefit in the new exchanges, reflecting today’s standard of coverage. We urged that the Affordable Care Act (ACA) not be interpreted in any way that would prevent dialysis patients from receiving premium credits and cost-sharing subsidies in the exchanges and that exchange plans include an adequate choice of providers. We also requested parity between coverage inside and outside of the exchanges, meaning consistent application of the Medicare Secondary Payer (MSP) law, which would allow patients to keep the health plans of their choice for the statutory 30-month period before Medicare becomes their primary payer.
>Read the Full Comment Letter

Transition to the New Medicare Bundled Payment System
Thank you for your great advocacy! On Friday April 1, the Centers for Medicare and Medicaid Services (CMS) announced their proposal to fix the transition adjustment rate to dialysis providers’ reimbursement under the new Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS also known as the Bundle).

The rule revises the initial rate of 3.1% down to a rate of 0% effective April 1 through December 31, 2011. This means that no further cuts will be made to dialysis care and those cuts that were implemented after April 1 will be returned to dialysis providers.  DPC sent a big thank you to CMS for the adjustment.
>Read the Full Comment Letter

>Read More

On February 2, 2011 American Kidney Fund, Dialysis Patient Citizens, National Kidney Foundation and Renal Support Network sent a joint letter to Congress requesting a fix to the calculation of the transition adjuster that will be applied to the new bundled payment system in 2011.
>Patient Letter on Transition

National Coverage Determination for ESA
Recently, the Centers for Medicare and Medicaid Services (CMS) announced its decision to not create a National Coverage Determination (NCD) for the use of erythropoiesis stimulating agents (ESAs) to manage anemia in patients who have chronic kidney disease (CKD).  DPC submitted a letter in support of this decision, which falls very much in-line with our goal to ensure flexibility in the physician and patient decision making relationship.
>Read the Full Comment Letter

Quality Incentive Program for the ESRD Bundle
To aid in implementation of the new ESRD bundled payment system, Congress and the Centers for Medicare and Medicaid Services (CMS) have taken to develop a Quality Incentive Program (QIP) that seeks to align payment incentives with patient outcomes. We believe that the quality measures included in this program should above all be patient-centered, reflective of health outcomes for all dialysis patients regardless of the treatment modality they choose (i.e. in-center hemodialysis, home hemodialysis and peritoneal dialysis) and target levels that will ensure patients don’t just meet adequate standards, but can live high quality lives.  DPC submitted comments to the National Quality Forum (NQF) to ensure the patient perspective is considered when determining future quality measures for the program.
>Read the Full Comment Letter

Get to know your Lawmakers
As a result of the federal, state and local elections held in November 2010, there are a number of new lawmakers in place that could potentially be strong supporters of dialysis care and kidney disease education initiatives this year.  DPC encourages you to get to know who your lawmakers are and reach out to them to introduce yourself as one of their constituents. The best way to do this is by writing a brief letter (only about a page long) explaining that you are a dialysis patient in their area, describing DPC and our mission, and presenting what some of our key issues are in working to improve all dialysis patients’ quality of life.  You can click here to send e-mails directly to your Federal and State lawmakers about issues that could impact your care.

DPC provides guidance to the U.S. Department of Health and Human Services on initiative to Improve the Quality of Life and health of Individuals Living with Multiple Chronic Conditions
DPC commends HHS Secretary Kathleen Sebelius for working to improve the quality of life and the health of individuals who are living with chronic diseases. DPC submitted a letter to the Secretary thanking her for the agency’s attention to this issue and provided our input on the workgroup’s initial plan. 

DPC’s work with the Partnership to Fight Chronic Disease (PFCD)
To ensure the needs of patients with chronic kidney disease are better served and their voices heard more prominently, DPC works with the Partnership to Fight Chronic Disease. Recently, we have accompanied many other members of PFCD in signing on to letters to federal lawmakers about policies that can help Americans better prevent and manage chronic disease.
Read PFCDs comments on prevention and chronic disease care:

• National Health Care Quality Strategy and Plan
• Comments supporting the Framework for Comprehensive Health Reform
• Prevention Strategy Letter

What can you do to help ensure quality access to kidney care for all patients?

• DPC and the kidney care community will work with the 112th Congress to ensure that the provisions passed last year are implemented and to ensure that the dialysis patients’ voice is heard on important issues facing the community. Please take a minute to email your Members of Congress and ask them to support kidney care and dialysis patients. Email Congress
• Many kidney care reforms will take place at the state level of government, so it's important to start educating your state legislators about kidney disease. Email your state legislators
• Learn about Public Policy issues that impact kidney care.

Advocacy Archives
As the new Congress convenes new legislation will need to be introduced to accomplish our advocacy priorities. Click here for a list of issues and legislation DPC advocated for in past Congressional Sessions.
 

> Who Represents Me? > Educating Your Members of Congress About Dialysis   > Invite a Politician to Visit Your Dialysis Center