Preserving Low-Income Dialysis Patient Access to Health Care: American Kidney Fund Announces Enhanced Safeguards for its Health Insurance Premium Program

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Enhancements designed to ensure patients’ informed choice of health insurance plan and prevent inappropriate use of program

In addressing anecdotal reports of provider steering, the Obama Administration must not close off access to the Marketplace for low-income ESRD patients who need charitable help.

The American Kidney Fund (AKF), the nation’s leading charitable organization working on behalf of Americans with kidney disease, today announced a series of measures to protect patients’ autonomy and informed choice when they turn to AKF’s Health Insurance Premium Program (HIPP) for help affording insurance coverage.

AKF currently educates grant recipients about the HIPP program through a number of channels, including a HIPP program guidelines document and a quarterly patient newsletter. The enhanced safeguards announced today—a Provider Code of Conduct, a Patient Bill of Rights, and enhanced educational materials—are directed at providers as well as patients. They clarify the rights and responsibilities of each party to ensure that patients have made an informed choice when selecting health insurance coverage and applying for HIPP grant assistance from AKF.

“For nearly 20 years, AKF’s HIPP program has made it possible for low-income patients dialysis patients to access health insurance coverage even if they need charitable assistance to afford it,” said LaVarne A. Burton, AKF president and CEO. “Our grants have always been issued solely on financial need, without regard to a patient’s insurer or provider, and we have adjusted the program as the health care landscape has evolved over two decades. With the ever-increasing complexity and new health insurance options available in the Marketplace, we are taking additional steps to be sure that patients are well informed and best able to navigate the available choices to select the health plan that best meets their medical and financial needs.”

In August, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information about health care providers allegedly steering patients to qualified health plans in the exchange, also known as Marketplace plans. CMS cited dialysis providers in particular. Amid the anecdotal allegations, AKF sees an opportunity to further its role as a patient educator and advocate.

“We adamantly oppose any provider efforts to improperly steer patients to private insurance plans, and we equally oppose insurer efforts to steer kidney patients into Medicare or Medicaid plans that may not adequately meet their needs,” Burton said. “In addressing anecdotal reports of provider steering, the Obama Administration must not close off access to the Marketplace for low-income ESRD patients who need charitable help.”

While most ESRD patients can become eligible for Medicare regardless of age, for some patients, a Marketplace plan may provide better coverage at lower out-of-pocket expense. Each patient’s situation is unique, and patients need to carefully evaluate their choices. As one example, about half the states do not require insurance carriers to offer Medigap insurance to ESRD patients under 65. These patients are therefore exposed to a 20 percent out-of-pocket Medicare cost burden with no annual cap; for these patients, a Marketplace plan may have lower out-of-pocket annual costs than would Medicare.

Beginning in 2017, grant applicants will need to demonstrate to AKF why a Marketplace plan is a better option for them personally than Medicare or Medicaid. This mandatory step in the grant approval process will ensure that each patient has carefully evaluated his or her insurance options and has made an informed decision.

The additional safeguards announced today, effective beginning in 2017, are:

  • A Provider Code of Conduct that each referring dialysis provider must sign. The Code of Conduct requires dialysis providers to keep the best interests of the patient in mind when referring patients to AKF for assistance, and requires providers to give patients comprehensive, accurate, and impartial information enabling them to make informed decisions about their health insurance coverage. Such comprehensive information will include financial and coverage-related implications associated with the choice of a particular coverage option.
  • A Patient Bill of Rights that outlines for patients their rights and responsibilities regarding their receipt of HIPP grant assistance. This document explains patients’ freedom to independently choose their health care coverage and providers, to make changes in provider or coverage, to register online to track their AKF grant status, and to report to AKF any concerns about the program, including whether there are concerns that patients’ rights under HIPP have been violated.
  • The choice of health insurance can be very complicated for patients with kidney failure, and the options available to them are more limited than those available to Medicare recipients who are over 65 years of age. Medicare requires that all dialysis facilities have sufficient social services staff to meet dialysis patient needs, and AKF is committed to working with providers and with CMS to ensure that dialysis social workers and other dialysis center employees can continue their very important role in educating patients about insurance choice. In this regard, AKF will continue to work in conjunction with patients as well as the kidney care community to develop further solutions to protect patient rights and choices. Additionally, AKF is developing new educational materials to provide patients with objective information about their insurance options.

“We have consistently taken a comprehensive approach to ensuring the integrity of our work, including carrying out the HIPP program in compliance with the federal Advisory Opinion under which the program operates,” Burton said, referring to U.S. Department of Health and Human Services Advisory Opinion 97-01, issued in response to an AKF request in 1997. “The steps we are now taking go well beyond what we are required to do under the Opinion, and will add significant safeguards to ensure HIPP remains a critical part of the nation’s safety net for low-income dialysis patients for decades to come.”

AKF’s HIPP program has provided financial assistance to financially eligible end-stage renal disease (ESRD) patients for nearly 20 years, helping patients afford Medicare Part B, Medigap, employer group health, COBRA and commercial plans. With the advent of the Affordable Care Act, AKF HIPP grants have also provided premium payments for Marketplace plans. About 6,400 of the 80,000 patients who receive premium assistance under HIPP are in Marketplace plans.

For nearly three years, AKF has been providing information to CMS about insurance carriers nationwide that are attempting to steer dialysis patients away from their plans by refusing to accept charitable premium payments, and more recently, insurance carriers that are refusing to insure people who receive charitable assistance. AKF has long urged CMS to promulgate a rule that requires insurers to accept premium payments behalf of low-income patients from independent, publicly supported charitable organizations that meet certain objective criteria.

“Our position has long been that with the proper guardrails in place, nonprofits like AKF can play a critical role in making the promise of the Affordable Care Act come true for chronically ill people who otherwise would not be able to afford Marketplace coverage,” Burton said. “As we take important steps to strengthen our program against improper provider actions, we look forward to continuing to work with CMS to ensure that low-income ESRD patients may continue to receive charitable grant assistance allowing them to afford health coverage. On Monday, we met with CMS and presented the new steps that we are undertaking.”

About the American Kidney Fund
As the nation’s leading nonprofit working on behalf of the 31 million Americans with kidney disease, the American Kidney Fund is dedicated to ensuring that every kidney patient has access to health care, and that every person at risk for kidney disease is empowered to prevent it. AKF provides a complete spectrum of programs and services: prevention outreach, top-rated health educational resources, and direct financial assistance enabling 1 in 5 U.S. dialysis patients to access lifesaving medical care, including dialysis and transplantation.

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Alice Andors
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American Kidney Fund
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