The Chronic Kidney Disease Improvement in Research and Treatment Act of 2021 (H.R. 4065/S. 1971) is designed to make improvements in care for people living with kidney failure. The bill would lead to an increase in kidney disease awareness and education and expand on kidney disease preventative services. H.R. 4065/S. 1971 would also guarantee Medigap access to all Medicare beneficiaries on dialysis who are under the age of 65.
Medigap is Medicare secondary insurance that can cover coinsurance or deductibles. Because of the high out-of-pocket costs associated with dialysis, Medigap coverage is vital for Medicare beneficiaries who are on dialysis. Currently, twenty states do not require Medigap for Medicare beneficiaries under 65 who are on dialysis. The bill was introduced in the House by Representatives Terri Sewell (D-AL) and Vern Buchanan (R-FL), and in the Senate by Senators Ben Cardin (D-MD) and Roy Blunt (R-MO).
Here are the top four provisions you should know about in H.R. 4065/S. 1971:
- The expansion of the Medicare Annual Wellness Benefit to include kidney screenings. Too often, people with kidney disease are unaware they have it. Fortunately, screenings at annual check-ups help you keep track of your kidney function and apply early interventions if needed. With this bill, Medicare beneficiaries would now have access to these screenings.
- An increase in access to the under-utilized Medicare Kidney Disease Education (KDE) benefit, which currently covers up to 6 sessions of kidney education services for beneficiaries with stage 4 kidney disease. With H.R. 4065/S. 1971, the KDE services at dialysis facilities would be covered. The bill will also allow nurse practitioners, physician assistants and other health care providers to refer KDE services, in addition to doctor referrals that are currently covered. Finally, under this expansion, Medicare beneficiaries with stage 5 kidney disease (kidney failure), but who are not yet on dialysis, would also have access to KDE benefits.
- Requirements for the Department of Health and Human Services to submit a report to Congress no later than 18 months after enactment on national kidney transplantation rates and to study the progression and treatment of kidney disease in communities of color. The transplantation report is vital for understanding state-by-state organ donation rates and revealing barriers to increasing living organ donor transplants. Likewise, the study of kidney disease in communities of color — since people of color are disproportionately impacted by kidney failure — is an essential step in ensuring equitable treatment for all.
- An increase in your choice of health insurance coverage. Right now, insurers in 20 states are not required to offer Medigap to people with kidney failure who are under age 65. There are 100,000 people on dialysis under 65 in those 20 states. H.R. 4065/S. 1971 ensures Medigap access to all Medicare beneficiaries with kidney failure, regardless of their age.
This bill also safeguards access to Medicare Advantage (MA) plans for people on dialysis. As of 2021, people with kidney failure are now eligible to enroll in an MA plan. However, in its latest rule, the Centers for Medicare & Medicaid Services did not include dialysis facilities in MA Network Adequacy standards. These standards generally set the number of all types of health care providers who must be in a geographic location to ensure there are enough providers in an MA plan's network. Excluding dialysis providers from these standards, people who need dialysis treatments may have a hard time finding a center near them.
H.R. 4065/S. 1971 also increases the Medicare Secondary Payor (MSP) payer rule from 30 months to 42 months. The MSP is the federal rule that states people on dialysis should stay on their current, private insurance (i.e. employer-sponsored insurance or an individual plan) before moving to Medicare as their primary insurance. This is especially important if you are hoping to receive a kidney transplant, since you must have full insurance coverage to be considered eligible for the organ transplant waiting list.