Kidney centers causing coverage nightmares, feds say

For a kidney dialysis center, getting a government plan enrollee into a private plan can add $200,000 in revenue per year, officials say. (Photo: iStock)
For a kidney dialysis center, getting a government plan enrollee into a private plan can add $200,000 in revenue per year, officials say. (Photo: iStock)

Kidney dialysis centers might be keeping some patients from getting desperately needed kidney transplants by pushing them into ordinary individual major medical coverage.

Officials at the Centers for Medicare & Medicaid Services (CMS) include that allegation in an explanation of its reasons for adding new disclosure requirements for kidney dialysis patients who are getting help from the facilities with arranging and paying for the health coverage.

Related: Feds ask insurers about enrollee steering

CMS has established an emergency regulation that requires facilities to tell patients about the possible effects, including costs and transplant implications, of switching plans. The regulation requires the facilities to tell ACA exchange plan issuers when they are helping consumers pay the premiums.

An exchange plan issuer can choose whether to accept third-party payments, CMS says.

The regulations take effect on Jan. 13, 2017.

Kidney dialysis helps people with severe kidney failure survive. CMS officials estimate that 6,737 U.S. dialysis facilities serve about 495,000 people with severe kidney failure.

Medicare covers dialysis for patients who need it and have no other coverage. But the ACA now requires issuers of private medical coverage to offer coverage for all people, including those with kidney failure, for the same standard rates. Some patients qualify for Medicaid coverage instead, and some prefer private exchange plan coverage to Medicare coverage.

CMS officials say that about 99.3 percent of dialysis patients visit Medicare-certified facilities.

CMS officials also estimate that Medicaid pays an average of $78,000 per year per dialysis patient; Medicare, $91,000; and commercial plans, $312,000.

Dialysis facilities have an obvious incentive to push patients to enroll in commercial plans, but patients who switch may end up with extra out-of-pocket costs, or with disruptions in coverage that may interfere with their ability to get kidney transplants, officials say.

CMS ACA risk-adjustment program reports seem to show that the number of individual health insureds getting dialysis doubled between 2014 and 2015, officials say.

Related:

5 Senate Finance chronic-care proposal basics

ACA rationing: 5 ways insurers can limit care access in this brave new world

Are you following us on Facebook?

Leave a Reply