This week begins the open enrollment period for 2016 coverage. The health insurance marketplace lists coverage options for patients who do not have an insurance plan through an employer, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or a private plan. Enrollment can be done by phone, online, through a paper application and in person. Open enrollment will run through January 31, 2016.
The Centers for Medicare & Medicaid Services (CMS) has announced the participants for the Comprehensive ESRD Care (CEC) Model, a new accountable care organization (ACO) model designed specifically for ESRD patients. ACOs are groups of physicians and other health care providers who collectively take on responsibility for the quality and cost of care for a population of patients.
DPC Policy Director Jackson Williams and Pittsburgh kidney patient Janice Nathan were among witnesses at a hearing held by Pennsylvania’s insurance commissioner on “surprise medical bills.” These are bills received from physicians who are outside of an insurer’s provider network even though they work inside facilities that are in-network.
Kidney advocates are reacting to an alarming trend in the commercial insurance industry: insurers are increasingly writing language into policy documents that attempt to exclude or limit coverage of renal care. DPC is alerting regulators at both the state and federal levels to the harm these limitations could have on patients, and asking them to enforce the numerous laws that prohibit health plans from discriminating against people with ESRD.
DPC has been hard at work on the state level fighting to ensure continued access to quality patient care, most recently in Alabama and North Carolina. In Alabama, patients fought to maintain Medicaid funding for outpatient dialysis, which the state was considering moving to local hospitals instead, in a potential effort to close the state budget shortfall. Patient advocates quickly took action and contacted their state legislators to encourage alternative revenue generating measures to close the budget gap as opposed to eliminating Medicaid funding.
While Congress was in recess during the month of August, DPC Patient Ambassadors used this opportunity to engage their legislators at home. Patient Ambassadors attended meetings with congressional staff, hosted facility tours and wrote letters to the editor in support of The Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 1130, S. 598). Facility tours and meetings took place all across the country.
During the August recess, Congressman Joe Pitts took the opportunity to engage with dialysis patients in his home district. He recently visited the Reading Dialysis Center in Reading, PA where he received a tour of the facility and met with dialysis nurses and staff. As Chairman of the Energy and Commerce Health Subcommittee, he is an influential decision maker when it comes to kidney care issues.
When the FDA approves a generic drug, it’s based on the chemicals contained in the original brand medication. Congress recently enacted a similar process for the approval of “biosimilars” based on the original biologic medication. The main difference is that the “biosimilar” is approved based on its development process. Biosimilars have the potential to be a cheaper alternative for expensive biologic medications such as Epogen, a drug used for anemia management.