On December 13, 2016, the Centers for Medicare & Medicaid Services (CMS) released an interim final rule (IFR) entitled the Medicare Program; Conditions for Coverage for End-Stage Renal Disease Facilities-Third Party Payment. The IFR would have required approval from insurers before ESRD patients could use charitable assistance to pay their premiums—which would have allowed insurers to deny health care coverage to low-income ESRD patients. The rule was to become effective January 14, 2017.
CMS said this would create a more transparent process to ensure that dialysis patients had the information they needed to understand their coverage options, which can include Medicare, Medicaid, COBRA, employer group health plans, and qualified health plans (QHPs) purchased on the ACA insurance Marketplace (Exchange).
On January 25, 2017, Judge Amos Mazzant III, a federal judge for the United States District Court for the Eastern District of Texas, entered a preliminary injunction preventing CMS from implementing or enforcing the IFR. We were pleased to note Judge Mazzant’s understanding of the possible impact of the IFR on ESRD patients: “Not all ESRD [end-stage renal disease] patients qualify for Medicare, and Medicare does not cover family members. Further, many health care providers do not accept Medicare. Therefore, some ESRD patients and their families could lose access to their health care providers or even lose insurance coverage altogether.”