American Kidney Fund urges Centers for Medicare and Medicaid Services to issue rule protecting vulnerable patients from discriminatory practices by health insurers


CMS’ silence on third-party payment issue allows insurers to put in place practices that jeopardize patients’ access to life-sustaining care

WASHINGTON (March 3, 2016)—The American Kidney Fund (AKF) urges the Centers for Medicare and Medicaid Services (CMS) to issue clear regulations that would require insurance companies to accept third-party premium payments from charitable nonprofit organizations like AKF whose programs fall within reasonable “guardrails.” Such regulations would ensure that low-income individuals with chronic illnesses including kidney failure are able to afford health insurance, and at the same time would protect insurance risk pools.

In the 2017 Notice of Benefit and Payment Parameters (NBPP), issued earlier this week, CMS stated that it would address nonprofit third-party payments in future rulemaking.

“We have been urging CMS to clarify its regulations around nonprofit third-party payments for almost two years,” said LaVarne A. Burton, AKF president and CEO. “CMS’ existing guidance is open to a wide range of interpretations—and insurance companies are taking advantage of these ambiguities to refuse charitable premium payments on behalf of their low-income policyholders. Some insurance companies are going so far as to threaten to terminate the coverage of anyone who receives such charitable help.”

A group of patient-advocates from eight states—including North Carolina, Illinois and Texas, where insurers are targeting patients with kidney failure—joined AKF on Capitol Hill Tuesday for a Congressional briefing and meetings with their Representatives and Senators on the issue. The advocates asked legislators to contact acting CMS Administrator Andy Slavitt to urge him to address this issue with a greater sense of urgency.

“We need CMS to recognize the seriousness of the third-party payment issue, and through rulemaking, protect the vulnerable patients who depend on assistance from the nation’s health nonprofits,” Burton added.

The existing CMS guidance requires insurance companies to accept third-party payments only from certain entities: government programs, Indian tribal organizations, and the Ryan White HIV/AIDS program.

In Monday’s NBPP, CMS referred back to a 2014 FAQ document it issued, which states that third-party payments from private foundations are not prohibited, so long as the payer covers an individual for the full year and only takes into account an individual’s financial need, not their health status. Although AKF meets these criteria, insurance companies have cited the criteria as justification to refuse AKF’s payments.

“The existing FAQ is not sufficient,” said Burton. “It does not address the unique and longstanding role of our nation’s health nonprofits in providing assistance to patients.”

AKF’s Health Insurance Premium Program was established almost 20 years ago under favorable guidance from the U.S. Department of Health and Human Services Office of Inspector General. AKF helps close to 80,000 U.S. kidney failure patients maintain their health coverage by paying health insurance premiums when patients cannot afford to pay. Of the patients AKF assists, 6,400 are enrolled in Marketplace plans; the rest are enrolled in Medicare Part B, Medigap, COBRA, employer group health and other commercial plans. AKF makes most payments directly to insurance carriers, a third-party payment process that ensures no patient will lose coverage due to late or non-payment. AKF assists patients for the full year and has no involvement in patients’ choice of insurance plans or healthcare providers; patients apply to AKF for help when they already have insurance they cannot afford.

Insurers in at least 34 states have begun to reject third-party payments from AKF and many other health nonprofits. Some carriers are requiring individuals to sign an attestation that a nonprofit is not helping them to pay for their coverage—and if they receive charitable assistance, refusing to issue them coverage or threatening to terminate their coverage.

“We have proposed to CMS a number of guardrails that would ensure nonprofit premium payments are made in a way that protects the integrity of the insurance marketplace,” Burton said. “We look forward to continued discussion with CMS on this topic to ensure a final rule emerges in a timely manner to protect the patients we serve.”

About the American Kidney Fund

As the nation’s leading nonprofit working on behalf of the 31 million Americans with kidney disease, the American Kidney Fund is dedicated to ensuring that every kidney patient has access to health care, and that every person at risk for kidney disease is empowered to prevent it. AKF fulfills its mission by providing a complete spectrum of programs and services: prevention outreach, top-rated health educational resources, and direct financial assistance enabling kidney patients to access lifesaving medical care, including dialysis and transplantation.

AKF helps 1 out of every 5 U.S. dialysis patients with treatment-related expenses. More than 93,000 patients in all 50 states received AKF grants last year. AKF invests in clinical research to improve outcomes for kidney patients, and fights tirelessly on Capitol Hill for legislation and policies supporting the issues that are important to kidney patients. To address the enormous public health threat of kidney disease, AKF provides public and professional health education materials and courses, the Kidney Action Day® community outreach program, a Kidney Health Educator program, and a toll-free health information HelpLine (866.300.2900). AKF’s new grassroots fundraising platform, KIDNEYNATION, unites Americans who are raising funds to support the organization’s mission.

AKF spends 97 cents of every donated dollar on programs and services. AKF holds the highest ratings from the nation’s charity watchdog groups, including Charity Navigator, which includes AKF on its “top 10” list of nonprofits with the longest track records of outstanding stewardship of the donated dollar.

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