A new CMS regulation that would potentially curtail third party payments for insurance for dialysis patients has been delayed by a U.S. District Court judge in Texas.
Fresenius Medical Care, Davita, U.S. Renal Care, along with Dialysis Patient Citizens, filed a lawsuit to block the CMS rule on Jan. 6, 2017. Issued as an interim rule in August 2016, the regulation was set to go into effect Jan. 13, 2017. The judge’s temporary restraining order delaying the rule may stay in place for up to 14 days post-issuance.
In its lawsuit, the groups stated that the rule was pushed through without the proper notice or comment period that usually occurs before a new rule is adopted.
The U.S. District Court judge agreed, stating the organizations likely showed that the Department of Health and Human Services (HHS) implemented the final rule without time for thorough review and comment.
In a statement about the temporary restraining order, Fresenius Medical Care said: “We are pleased that the court has issued a temporary restraining order preventing this improperly issued regulation from going into effect. Today’s ruling will help ensure that Americans with kidney failure have the same right as every other American to receive charitable assistance to pay their health insurance premiums. We look forward to working with the new administration on regulations that protect the sustainability of the Medicare program while protecting the ability of Americans to select the health coverage of their choosing, free from discrimination based on their health status or disability.”
The rule grew out of a CMS investigation of reports that dialysis companies were paying for private insurance in order to boost their reimbursements. It requires dialysis companies to fully disclose to a patient their insurance options, how the providers would benefit from a patient’s receiving private coverage, and would require insurance company approval of coverage for the patient.
In a Jan. 11, 2017, letter to CMS commenting on the rule, the American Society of Nephrology (ASN) urged the agency to take more time and gather more input from stakeholders before finalizing the rule.
“The ASN firmly agrees with CMS that payment of premiums and cost-sharing by third party entities should only be used to promote the best interests of the beneficiary,” ASN stated in its comment letter. “For many patients in the vulnerable dialysis population, third party assistance currently helps them achieve their goals, be it to work part time, gain access to transplant, or afford medications, and the society is concerned that the proposals in this [rule] would inadvertently jeopardize some individuals’ access to care.”