Kidney Care Advocates Praise Biden For Pulling Third-Party Payer Rule

As published in Inside Health Policy on February 2, 2021 available at

The Biden administration recently withdrew an unreleased draft rule on end-stage renal disease conditions of coverage that was expected to address the controversial issue of whether insurers must accept premium payments from third-party charities -- a move quickly applauded by kidney care advocates, although the rule could resurface.

Insurers who had been urging HHS to prohibit payments from any entity that could financially benefit from third-party support did not comment on queries on the draft rule, which was withdrawn Jan. 25. The White House affirmed the rule was pulled as part of the new administration’s regulatory freeze and said federal agencies will confer with their new leaders to determine the fate of each frozen rule.

At issue is insurers’ long-time complaints that the American Kidney Fund, which receives contributions from large dialysis firms, is using its charitable premium assistance program to steer patients who would otherwise be eligible for Medicare or Medicaid into private coverage, which reimburses at higher rates. AKF denies the charges and has repeatedly noted it has run its charitable program for more than 20 years with permission by the HHS Office of Inspector General. And while Medicare covers ESRD patients, AKF and other kidney stakeholders argue that patients should be able to maintain their private coverage if they wish.
Still, in late December 2016, the Obama administration issued a last-minute interim final rule that required dialysis clinics to inform patients about all payment options and to essentially get permission from issuers before helping the patients with their premiums.

But shortly after it was released, dialysis firms and kidney advocates sued the Obama administration over procedural violations and a Texas court vacated the rule and sent it back to HHS. The rule showed up on the regulatory agenda for several years, but nothing happened until it appeared as a draft rule in June 2019. HHS held several meetings on the rule, including one with AKF, which recommended parameters for requiring issuers to accept payments including those provided by: the Ryan White Program, city and state agencies, and third-party entities, so long as they certify they keep fundraising and operations separate, cover premiums for an entire year, make decisions on financial assistance without regard to patients' insurance and ensure no conflicts of interest.

The proposed rule never left White House review; it was withdrawn by the Biden administration on Jan. 25.

LaVarne Burton, president and CEO of AKF, said the rule would have affected AKF’s ability to help thousands of low-income and predominantly minority dialysis and transplant patients with their premiums, and she applauded the administration for withdrawing it. “Without our assistance, many of the dialysis and transplant patients we help would go without life-saving health care,” Burton said. AKF operates the charitable premium assistance program under strict firewalls and safeguards, she says.

“We are grateful to the Biden Administration for withdrawing a regulation that would have limited AKF’s ability to ensure that the people we assist are able to choose the health insurance that works best for them,” Burton adds. Kidney Care Partners, another group of patient advocates and dialysis stakeholders, said low-income kidney patients under age 65 who rely on charitable help have been “under attack” by large insurers trying to end that assistance. Policymakers must protect their right to keep the coverage that best meets their needs, the group said. -- Amy Lotven (

As published in Inside Health Policy on February 2, 2021 available at

Posted: | Author: AKF staff

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