New rule ensuring equal access for ESRD patients receives DPC praise

Dialysis Patient Citizens (DPC), the nation's largest patient-led organization representing dialysis patients, applauded the Administration for taking steps to solidify a key provision that will ensure end stage renal disease (ESRD) patients have equal access to private coverage as Affordable Care Act reforms are implemented.

In a rule released yesterday by the Department of Health and Human Services, the Administration clarified that a provision known as Medicare Secondary Payer (MSP) will apply to small group plans sold in the new health insurance exchanges, ensuring equal access for ESRD patients who chose to purchase insurance through an exchange.

"Yesterday's announcement marks a major win for ESRD patients across the country who wish to take advantage of the reforms the Affordable Care Act promised to all Americans," said Hrant Jamgochian, Executive Director of Dialysis Patient Citizens.  "By clarifying that MSP will apply equally both inside and outside of the exchanges, the Administration is ensuring equitable treatment for some of America's most vulnerable patients, while upholding the longstanding partnership between private plans and Medicare that so many ESRD patients rely on."

Under current law, MSP allows individuals with group health plan coverage who are diagnosed with kidney failure to maintain their private coverage for 30 months before enrollment in Medicare.  The rule released today clarifies that individuals who enroll in small group plans within the new health exchanges and are diagnosed with kidney failure will be granted the same right to maintain private coverage for up to 30 months as people with group health coverage purchased outside of the exchanges.  For many patients, this 30 month period is crucial as it minimizes interruptions in care during the critical transition to dialysis or a transplant, and allows these Americans and their families to continue utilizing their preferred provider networks, doctors and pharmacy plans.

Last week, dozens of patient advocates came to Washington, DC from across the country to advocate for this and other issues important to the kidney community in honor of World Kidney Day.  Advocates held more than 100 meetings with their Senators and Representatives to discuss MSP, extending Medicare coverage of immunosuppressive drugs for kidney transplant patients, and ensuring adequate resources and oversight to properly include oral medications in the new Medicare ESRD bundle payment system.