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RPA Response to CMS Request for Information on Inappropriate Steering of Medicare and Medicaid Beneficiaries to Individual Market Plans

Creation/Revision Date: September 20, 2016

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September 20, 2016

Andrew Slavitt
Acting Administrator
Centers for Medicare and Medicaid Services
Room 445–G
Hubert H. Humphrey Building,
200 Independence Avenue, SW
Washington, DC 20201

RE: RIN 0938-ZB31; Request for Information: Inappropriate Steering of Individuals Eligible for or Receiving Medicare and Medicaid Benefits to Individual Market Plans


Dear Acting Administrator Slavitt:

The Renal Physicians Association (RPA) is the professional organization of nephrologists whose goals are to ensure optimal care under the highest standards of medical practice for patients with kidney disease and related disorders. RPA acts as the national representative for physicians engaged in the study and management of patients with kidney disease. We are writing to offer our perspective on CMS’ above-referenced Request for Information (RFI) on inappropriate steering of Medicare and Medicaid beneficiaries.

RPA strongly supports CMS’ pursuit of its broad fiduciary mission to ensure that Medicare program management and oversight issues are addressed promptly and appropriately, and we are aware that this occurs through the identification of program vulnerabilities and implementation of safeguards to eliminate fraud, waste, abuse and other inappropriate stakeholder behaviors. Further, we recognize that recent events related to insurance coverage for patients with end-stage renal disease (ESRD) may have been at least a partial catalyst for the RFI, and to the extent that inappropriate steering of kidney patients to certain insurance plans did occur (behavior that we do not believe is the norm), we commend CMS for proactively addressing this situation.

That said, RPA is concerned that rulemaking could be influenced by the information received in the RFI responses, inadvertently causing an adverse effect on charitable efforts to ensure that kidney patients have access to the qualified health plan most appropriate for them. The nation’s ESRD patient population is disproportionately low income relative to the general population, and for some individuals the financial assistance they receive from charitable non-profit organizations is the key source of support enabling them to be appropriately insured.

In kidney disease, the leading organization providing this type of assistance is the American Kidney Fund (AKF). Through its Health Insurance Premium Program (HIPP), AKF provides premium support to approximately 6,900 patients nationwide. AKF’s ability to provide this support to kidney patients occurs under the guidance of an advisory opinion provided by the HHS Office of Inspector General (OIG). In this opinion, the OIG has determined that AKF is a bona fide charitable organization and has the appropriate safeguards in place (such as a firewall between donations received and charitable grants provided to kidney patients, and a black box system to ensure that grants are made based solely on financial need) such that AKF is fully compliant with applicable law.

As noted, RPA is fully aware of CMS’ obligation to oversee the operations of the Medicare and Medicaid programs and we encourage the Agency to continue these efforts robustly and to do whatever it takes to ensure that the programs operate in an appropriate and fiscally sound manner. However, AKF is clearly offering invaluable assistance to the proportionately small number of ESRD patients it helps, and RPA’s member nephrologists recognize the importance of this aid to those ESRD patients receiving it. We therefore urge CMS to account for this reality in any potential rulemaking that may emerge from the RFI solicitation, and ensure that AKF can maintain its current operations unchanged.
As always, RPA welcomes the opportunity to work collaboratively with CMS in its efforts to improve the quality of care provided to the nation’s kidney patients, and we stand ready as a resource to CMS in its future endeavors. Any questions or comments regarding this correspondence should be directed to RPA’s Director of Public Policy, Rob Blaser, at 301-468-3515, or by email at rblaser@renalmd.org.

Sincerely,
Rebecca Schmidt DO signature
Rebecca Schmidt, DO
President