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:

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

Proposed Guardrails:

The charitable organization is directed by an independent governing body that maintains policies and procedures to ensure that:

  1. Individuals responsible for the oversight or direction of the organization’s health insurance premium and/or cost-sharing assistance program (assistance program) may not have an ownership or investment interest in, or compensation arrangement with, healthcare practitioner, provider, or supplier that has made a charitable contribution toward the organization’s assistance program or that treats patients who receive financial assistance from the program.
  2. Its patient application assessments and grant determinations are made without regard to:
    • the interests of any donor or any donor affiliate;
    • the applicant’s choice of product, provider, practitioner, supplier, or insurance option;
    • the identity of the referring person or organization, including whether the referring entity is a donor to the assistance program; or
    • the amount of contributions made by any donor whose services or products are used or may be used by the patient.
  3. The organization does not refer applicants or potential applicants to, or recommend, any specific items or services, or any providers, practitioners, suppliers of items or services, insurance plans, or QHPs.
  4. The organization operates as a tax-exempt organization under section 503(c) or 501(c)(3) of the Internal Revenue Code (IRC);
  5. The organization registers with a State agency, such as the Department of Insurance, or provides notice to such State agency that the charitable organization has a health insurance premium and/or cost-sharing assistance program;
  6. The organization awards health insurance premium and/or cost-sharing grants consistent with its charitable purpose (which may limit assistance to individuals diagnosed with a particular disease, including but not limited to cancer or end-stage renal disease), solely on the basis of financial need in accordance with criteria that are applied uniformly.