American Kidney Fund Policy Priorities
The American Kidney Fund advocates for policies that improve the quality of care for individuals with both chronic kidney disease and end stage renal disease (ESRD). Below are our policy priorities for this year.
1. Implementation of Affordable Care Act
Essential Health Benefits - In 2012, CMS released a Proposed Rule to set standards for essential health benefits – a set of items and services that health plans will be required to offer beginning in January 2014. In the rule, CMS outlined an approach that would give each State the flexibility to define its essential health benefits package through the selection of an existing benchmark plan, rather than prescribe a specific list of items and services that all health plans must provide.
POSITION: AKF understands the need for state flexibility but maintains the position that states should clarify coverage of end stage renal disease (ESRD) as an essential health benefit within the qualified health plans.
Health Insurance Exchanges - Health Insurance Exchanges are new organizations mandated by the Affordable Care Act that will be set up to create a more organized and competitive market for buying health insurance. They will offer a choice of different health plans, certifying plans that participate and providing information to help consumers better understand their options. Beginning in 2014, Exchanges will serve primarily individuals buying insurance on their own and small businesses with up to 100 employees. States have been given the option to run their own marketplaces, partner with the federal government to set up and manage the marketplaces, or allow the federal government to run the program. As of February 15, 2013, the deadline for states to express their intent, it appeared as though 26 states opted for a federally run program, 7 states opted for a partnership, and the remaining 17 states will run their own exchanges.
POSITION: AKF supports the creation of Health Insurance Exchanges. As matter of equity and access, as the Health Exchanges are developed, AKF will advocate to ensure that plans do not discriminate against patients with ESRD and that ESRD patients have access to the same benefits and subsidies available to others.
2. Budget: Protecting Access to the Medicare ESRD Program
The American Taxpayer Relief Act delayed the implementation of automatic cuts to Medicare, including its ESRD program, that were scheduled to take effect in January 2013. These cuts are part of sequestration – a series of federal budget cuts that were enacted as a result of the failed Super Committee negotiations of 2011. These cuts are now scheduled to take effect at the beginning of March, and the Medicare ESRD program could see a reduction of up to two percent. The Medicare ESRD program has faced a series of significant payment reforms since 2011 including: a new bundled payment system that came with a 2 percent reduction in provider reimbursements; a new Quality Incentive Program (QIP) that further reduced payments to certain facilities; and a low projected payment update to the ESRD bundled payment system.
POSITION: AKF and the kidney care community have and will continue to strongly advocate against these and any further cuts that may threaten kidney patients’ access to quality care.
3. Extension of Medicare Secondary Payer (MSP)
Kidney failure is the only chronic disease that automatically qualifies an individual for Medicare, regardless of age. Dialysis patients have the option to continue with their employer group health plans (EGHPs) as a primary payer for the first 30 months after their diagnosis. After that period, patients must use Medicare as their primary insurance, even if the EGHP offers better coverage, and Medicare becomes the secondary payer. Other Medicare patients already have the option of continuing their private insurance as primary for as long as they choose. For many patients, private health insurance coverage provides a more extensive benefit package and lower out-of-pocket costs.
POSITION: As a matter of equity, ESRD patients should be given the option of continuing private coverage beyond 30 months if they choose. AKF will support proposals to retain and extend private coverage for ESRD patients for an additional 12 months. In the context of reducing the federal debt, AKF believes that extending MSP could provide cost savings to the government by delaying enrollment into Medicare.
4. Lifetime Immunosuppressive Drug Coverage
A kidney transplant is often the treatment option associated with the best outcomes for patients. Patients who receive a kidney transplant must take immunosuppressive drugs for the life of their kidney transplant. However, Medicare will only pay for these anti-rejection drugs for the first 36 months after a patient receives their transplant. These medications average $17,000 per year. Patients who are unable to pay for the medications are often forced to discontinue their use, resulting in kidney rejection and a return to Medicare-covered dialysis treatments at an annual cost of nearly $71,000 per patient.
POSITION: AKF urges Congress to fund the vital lifetime coverage for immunosuppressive drugs.
5. Ensure Patient Protections in ESRD Quality Incentive Program (QIP)
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) created a Quality Incentive Program (QIP) for Medicare’s end stage renal disease (ESRD) program, which took effect in January 2012. The QIP, now entering its second payment year, establishes a payment reduction program for dialysis facilities based on performance standards on specific measures of dialysis care.
POSITION: AKF supports the establishment of the ESRD QIP and will continue to monitor the implementation of QIP and consideration of future measures. Specifically, AKF remains concerned about the lack of a clear minimum standard of anemia management in the QIP, and will continue to work with CMS to establish a clinically relevant lower hemoglobin measure to protect patients.
6. Funding for NIH Research
The growing epidemic of kidney disease in American highlights the importance of robust medical research to continue to improve care and outcomes for over 31 million people living with this disease. The National Institute of Health (NIH) has been funding research, providing new pathways for treating and preventing kidney disease. Under the sequester, several thousand researchers could lose their jobs. In addition, up to 12,000 scientists and students will be impacted.
POSITION: As Congress addresses issues surrounding budget reconciliation and deficit reduction, AKF urges a thoughtful, balanced approach, taking into account the importance of NIH and the impact that federal investments in biomedical research have on improving and saving lives, as well as reducing health costs.