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Medicare Dental Coverage for Transplant Candidates May be on the Way

2024-03-29T01:10:06+00:00July 5th, 2022|Categories: Article, Dental Coverage, Medicare Advantage|

The Centers for Medicare & Medicaid Services (CMS) is proposing expanded coverage of “medically necessary” dental treatment, including treatments necessary to qualify for an organ transplant. DPC and other consumer advocates have been pressing for this change for several years. Medicare currently pays for dental services in a limited number of circumstances, such as when that service is an integral part of specific treatment of a beneficiary’s primary medical condition. Some examples include reconstruction of the jaw following accidental injury, tooth extractions done in preparations for radiation treatment for cancer involving the jaw, or oral exams preceding kidney transplantation. CMS is [...]

Medicare Proposes Small Pay Increase for Dialysis Facilities

2024-03-29T01:10:06+00:00July 1st, 2022|Categories: Article, Dialysis Funding, Medicare Advantage|

On June 21, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment rates and policies under the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries for the year beginning January 1, 2023. Under the ESRD PPS for 2023, Medicare expects to pay $8.2 billion to approximately 7,800 ESRD facilities for furnishing dialysis services. The proposed 2023 ESRD PPS base rate is $264.09, which would be an increase of $6.19 to the current base rate of $257.90. CMS projects that the updates for CY 2023 would [...]

Supreme Court Erases Kidney Patients’ Insurance Protections

2024-03-29T01:10:07+00:00June 22nd, 2022|Categories: Article, Dialysis Funding, Medicare Advantage, Private Insurance Coverage, Protect Patient Care|

A U.S. Supreme Court ruling has nullified the law that protects dialysis patients from discrimination by insurers, threatening the system of financing kidney care that has stood for 40 years. The Court ruled that employer health plans may limit dialysis benefits. For four decades, employers understood the law as prohibiting limitations that only applied to dialysis. Some health benefit consultants encouraged a few small employers to disregard the law by paying no more than Medicare rates for dialysis. DaVita sued them, and one of the cases was appealed to the Supreme Court. The decision means that employers and insurers can [...]

Dialysis Patient Citizens Statement Following Supreme Court Decision in Marietta Memorial Hospital v. Davita

2024-03-29T01:10:07+00:00June 21st, 2022|Categories: Medicare Advantage, Press Release, Private Insurance Coverage, Protect Patient Care|

WASHINGTON, D.C., (June 21, 2022) -- Following the United States Supreme Court decision in the case of Marietta Memorial Hospital v. Davita, Dialysis Patient Citizens (DPC) Board of Directors President Andrew Conkling issued the following statement: “DPC is deeply disappointed by today’s Supreme Court decision,” said DPC Board President Andrew Conkling. “Congress long ago reaffirmed privately-insured patients’ right to continue on their employer-sponsored plan for 30 months. This played an important role in preserving patient choice and incentivizing insurers to detect and treat Chronic Kidney Disease. ESRD patients are among the most vulnerable Americans and face some of the largest [...]

What Patients Should Know About Value-Based Care

2024-03-29T01:10:08+00:00May 23rd, 2022|Categories: Article, Care Coordination, Improve Access to Care, Increase Quality of Care, Medicare Advantage|

DPC is a strong advocate of Value-Based Care. Value-Based Care means that your primary providers accept a single payment or budgeted amount to cover all your medical needs. For instance, if you are in a program like Comprehensive Kidney Care Contracting (or CKCC, formerly known as the ESCO program) your dialysis provider and nephrologist take responsibility for all your care—not just kidney care but other conditions, such as diabetes, and other sites of care, such as hospitals. There are currently three types of value-based care programs that kidney patients may be in: Comprehensive Kidney Care Contracting (CKCC) – you are [...]

Elevating Dialysis Patient Voices Bolsters State Advocacy Victories

2024-03-29T01:10:08+00:00April 27th, 2022|Categories: Access to Transplant, Article, Medicaid, Medicare Advantage, Medigap Coverage|

As many 2022 state legislative sessions are winding down or have recently wrapped-up, it is a good time to update DPC members on state legislation important to dialysis patients. The participation of our Patient Ambassadors in DPC’s advocacy efforts has been really beneficial in educating legislators to help them make more-informed decisions on legislation that impacts End Stage Renal Disease (ESRD) patients. Improving access to affordable Medicare Supplemental Insurance (a.k.a., Medigap) plans is a top priority for DPC, and legislation was introduced in multiple states: Arizona, Kentucky, Louisiana, Nebraska, Maryland, New Jersey, Rhode Island, Vermont, and Wisconsin. Arizona, Kentucky, Nebraska, and [...]

DPC’s Letter to Daniel Tsai, Deputy Administrator and Director of CMCS

2024-03-29T01:10:08+00:00April 21st, 2022|Categories: Medicaid, Medicare Advantage, Medigap Coverage|

Daniel Tsai, Deputy Administrator, and Director Center for Medicaid and CHIP Services Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD  21244 Re:       Eligibility Redeterminations for Enrollees with Chronic Health Conditions Dear Mr. Tsai: When the Public Health Emergency ends and states resume making Medicaid eligibility redeterminations, up to 15 million enrollees are expected to lose their coverage. We are concerned that as many as one-quarter of those individuals may be receiving treatment for  chronic diseases, and that treatment might be interrupted by a lapse in insurance coverage. We are asking that CMS and the states make a special [...]

DPC Urges Medicare Officials to Take Action on Dialysis Workforce Shortages

2024-03-29T01:10:09+00:00March 7th, 2022|Categories: Article, Comment Letter, Improve Access to Care, Increase Quality of Care, Medicare Advantage|

DPC has written to top Medicare officials asking that they develop policy options to address the current labor shortage. The letter notes that the lengthy rulemaking process used to update payments to healthcare providers is ill-suited to react to urgent changes in the labor market. Fourteen years ago, the prestigious Institute of Medicine warned that as Americans aged, there would be fewer workers to take care of more elderly and disabled individuals. DPC’s letter urges officials to take another look at the report, which recommended “wage pass through” components of provider payments to address rising wages and delegating more responsibilities to [...]

Final ESCO Evaluation Documents Care Coordination Success Story

2024-03-29T01:10:09+00:00March 2nd, 2022|Categories: Article, Increase Quality of Care, Medicare Advantage, Protect Patient Care|

Medicare’s Comprehensive ESRD Care Model was designed to identify, test, and evaluate new ways to improve care for End-Stage Renal Disease (ESRD) patients. It established ESRD Seamless Care Organizations (ESCOs) that brought dialysis clinics and nephrologists together to coordinate patients’ kidney- and non-kidney care. This demonstration project ended last year and was replaced by a similar one this year. The Medicare Innovation Center has released the final evaluation report for the ESCOs. Overall, the ESCOs showed modest but statistically significant results over the five performance years, reducing Medicare expenditures. The number of hospitalizations decreased 3% and the percent of beneficiaries with [...]

2022’s State Advocacy Kick-Off

2024-03-29T01:10:09+00:00February 17th, 2022|Categories: Access to Transplant, Article, Medicare Advantage, Medigap Coverage, Promote Financial Security, State Advocacy, Transplant Donor Protection|

It’s been a busy start in 2022 for DPC’s state advocacy efforts. While many states are holding shorter legislative sessions due to the upcoming primary elections, bills impacting dialysis patients are being introduced and moving quickly through the legislative process. Legislation to expanded Medigap access has already been introduced in Arizona, Kentucky, Nebraska, Maryland, New Jersey, Rhode Island, and Vermont. Improving access to Medicare supplementary (Medigap) plans is a top policy priority for DPC, and we are pleased that multiple states are considering how they can help, particularly in states that have limited or no access to Medigap for the under [...]

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