The American Kidney Fund (AKF) recognizes the importance of including guardrails in legislative and/or regulatory policies that both protect patient health insurance access and stabilize the insurance marketplace by requiring plans to accept charitable contributions made on behalf of patients.

AKF is confident that sensible guardrails can be developed and implemented under which third-party premium assistance programs can operate appropriately (see our proposed list below). These guardrails can meet the challenge of both maintaining a strong, stable risk pool and ensuring access for qualified patients to Marketplace plans, without discrimination.

Accordingly, if a charity meets specified guardrails (as outlined below), regulators should ensure that appropriate charitable donations are accepted by health plans by clarifying that:

  • QHPs are required to accept charitable third party premium assistance payments.
  • QHPs may not deny enrollment or terminate coverage if an enrollee accepts charitable premium assistance.

Proposed guardrails:

  1. Is operated by a bona fide 501(c)(3) charitable organization run by an independent Board of Directors;
  2. Has provided notification to or registered with a state agency such as the Department of Insurance;
  3. Has adopted uniform procedures that include an application process, independent determination of financial need by the charity’s employees, and geographic diversity;
  4. Has uniform procedures that attenuate any insurer or provider donations from determinations of assistance, including procedures prohibiting providers from limiting use of their donations to certain patients other than for financial need, and procedures prohibiting providers or insurers from having any input in the assessment or approval of patient applications;
  5. Has procedures that protect patient choice and prohibit any direction that the patient use only certain insurers or providers and provide assistance for a full range of insurance products including, but not limited to: Medicare Part B, Medigap, QHP and other commercial, Medicaid, EHGP and COBRA plans;
  6. Provides assistance to patients for cover the entire policy year (and not merely to secure temporary coverage for short-term or one-time procedures or conditions); and
  7. Complies with all other applicable federal, state and local laws and regulations.