CMS-1651-P, Prospective Payment System and QIP
Andrew Slavitt, Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, D.C. 20201 Re: CMS-1651-P: End-Stage Renal Disease Prospective Payment System, Quality Incentive Program Dear Mr. Slavitt: Dialysis Patient Citizens (DPC) appreciates the opportunity to provide the Centers for Medicare and Medicaid Services (CMS) with comments on the proposed payment rule for the Medicare End Stage Renal Disease (ESRD) program. As America’s largest patient-led organization representing dialysis patients, DPC’s membership consists of more than 28,000 dialysis and pre-dialysis patients and their families. We seek to ensure [...]
DPC Responds to CMS’ Request for Information
If anyone doesn’t know why the public is fed-up with our government, all they need to do is look at yesterday’s RFI on third party payment, which can best be summarized as “politics as usual” and big insurance dictating its own agenda. The former CMS Administrator – who is now the nation’s leading lobbyist for the insurance industry – appears to be getting the Agency to prioritize her new employer’s desires over the needs of the nation’s most vulnerable patients. To put even more pressure on the Obama Administration, Aetna just threatened to pull out of even more health insurance exchanges if it doesn’t get [...]
Did Payment Reform Affect Patient Modality Choice?
One of the main policy goals of Dialysis Patient Citizens is to Improve Access to Care. This tenet includes improving patient access to all dialysis modalities: home hemodialysis, peritoneal dialysis, in-center hemodialysis and transplantation. Through our annual membership survey, we’ve uncovered various barriers for patients who would like to receive home hemodialysis. Many patients are unable to receive treatments in their home because of a lack of a caregiver, which is a requirement to receive treatment. However, DPC has also uncovered that the type of insurance a patient has may affect the likelihood of whether they are informed of home dialysis [...]
ESRD Choice Act Moves out of Committee with Unanimous Support
Dialysis Patient Citizens (DPC) hailed the introduction of H.R. 5659 as the latest in a series of milestones toward opening Medicare Advantage (MA) enrollment to end-stage renal disease (ESRD) patients. With bi-partisan introduction by Reps. Jason Smith (R-MO), John Lewis (D-GA), Gus Bilirakis (R-FL), Kurt Schrader (D-OR) and Tom Marino (R-PA), this legislation is a momentous step forward to providing dialysis patients increased access to insurance. “As a dialysis patient of 5 years, I am fortunate to have secondary insurance to cover what Medicare does not, however I know many patients in my facility don’t have that luxury. Providing dialysis patients access [...]
DPC Complaint to OFM re: Washington State Insurance Plans
Re: Violations of the Medicare Secondary Payer Statute, 42 U.S.C. § 1395y(b), by Washington State Health Insurance Plans Dear Ms. Parker and Ms. Dotzel: We write to bring to your attention the fact that at least three group insurers in the state of Washington are offering large plans with provisions that violate the explicit terms of the Medicare Secondary Payer Statute. These violations not only potentially subject the insurers to statutory civil monetary penalties, but render these insurers’ plans nonconforming under applicable regulations. As America's largest patient-led organization representing 29,000 dialysis patients and family members, Dialysis Patient Citizens (DPC) strives to [...]
CMS Proposes Payment Updates for ESRD and New Policies for Quality Incentive Program (QIP)
Each year, the Centers for Medicare & Medicaid Services (CMS) issue proposed rules to update payment rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services for the following year. On June 24, 2016, CMS proposed updates to the PPS as well as new quality measures for 2017. Notably, CMS proposed an increase to the base rate paid to dialysis facilities of $0.65 in addition to proposing increasing the home and self-dialysis training payment. In regards to quality measures, CMS proposes the inclusion of a new “Safety Measure Domain” category for 2019, which would provide data on dialysis-events including [...]
New Legislation Introduced to Improve Dialysis Patient Care
The Dialysis PATIENT Act (Patient Access To Integrated care, Empowerment, Nephrologists, and Treatment), S. 3090, recently introduced by Senators Heller (R-NV) and Nelson (D-FL). It follows introduction of the House version (H.R. 5506) the previous week by Reps. Young (R-IN), Blumenauer (D-OR), McMorris Rodgers (R-WA) and Cardenas (D-CA). The Dialysis PATIENT Act would permit dialysis organizations to accept capitated payments to cover all of an ESRD patient's Medicare expenditures in return for coordinating care for their renal disease and other comorbidities. The program would be voluntary for patients and provide access to an expanded clinical team that would “quarterback” their care. [...]
DPC Complaint to Department of Labor re: Insurance Plan Discrimination
The Honorable Phyllis C. Borzi Assistant Secretary Employee Benefits Security Administration United States Department of Labor 200 Constitution Ave NW Washington, DC 20210 Re: Violations of Part 7 of the Employee Retirement Income Security Act Relating to Health Plans’ Treatment of End-Stage Renal Disease Dear Assistant Secretary Borzi: On behalf of the 29,000 dialysis patients and family members that we serve, Dialysis Patient Citizens (DPC) asks that the Employee Benefits Security Administration (EBSA) investigate activities some group health plans have undertaken that we believe discriminate against individuals with kidney failure in violation of Part 7 of the Employee Retirement Income Security [...]
Dialysis Patient Citizens Applauds Introduction of Dialysis PATIENT Demonstration Bills
Bipartisan, bicameral legislation mandating a new Medicare demonstration of integrated care for ESRD patients will help spread best practices for treating this population, says beneficiary advocacy group Dialysis Patient Citizens (DPC). “As an in-center hemodialysis patient of 41 years, I am well aware of the multiple health issues that a large percentage of my fellow patients have to cope with on a daily basis. Coordinating their care among health providers would lead to better outcomes for patients and reward providers for optimal care with fewer dollars spent overall,” said Jack Reynolds, DPC’s president and a dialysis patient from Carlisle, Iowa. A [...]