September 19, 2018
2 min read

Patient groups urge Congress to fund opioid treatment with changes to Medicare dialysis payments

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Three kidney patient organizations are urging Congress to pass legislation that would fund treatment programs for opioid addiction by using Medicare savings generated by an increase in the length of time patients on dialysis can remain on commercial insurance.

The three groups, The American Kidney Fund, Dialysis Patient Citizens and the National Kidney Foundation, said in an editorial published by The Hill on Sept. 18 that such a funding mechanism, already included in H.R. 6, the Support for Patients and Communities Act and approved by the House in June, would be a “win-win” for both patients and for Medicare.

“People with kidney failure are the only group of Americans whose access to private health coverage is time-limited because of their diagnoses. Empowering these patients and their families with more choices, while saving the government an estimated $344 million that can be used to fund opioid use disorder treatment and prevention programs, is a win-win for all involved,” wrote LaVarne A. Burton, Hrant Jamgochian, JD, LLM, and Kevin Longino. Burton is the president and CEO of the AFK; Jamgochian is the CEO of Dialysis Patient Citizens; and Longino is CEO for the NKF.

The extension of payment to health care plans is called the Medicare Secondary Payer Provision. Health care plans serve as the primary payer for kidney disease treatment costs for the first 30 months, while Medicare serves as the secondary payer. That payment responsibility reverses after 30 months of care; the House bill would extend that 30-month primary coverage for another 3 months for health plans, saving Medicare money and helping to fund the opioid treatment program. However, insurance companies say the pass-along costs for those extra 3 months would be millions of dollars more because dialysis providers charge health care plans more than Medicare.

“As an offset, extending the period before which Medicare becomes the primary payer is bad policy,” the organizations wrote in a letter to the Senate on Aug. 20. “Shifting more of the cost of ESRD services would further burden private health plans at a time when they are already facing challenges in maintaining affordable coverage.” The letter was signed by America’s Health Insurance Plans, American Benefits Council, American Federation of State, County and Municipal Employees; Blue Cross Blue Shield Association and six other organizations.

Burton, Jamgochian and Longino said in the editorial that the 3-month extension of the MSP provision “is a smart way to save money in a fair-shared manner with the Medicare program that can be used to tackle one of the most important public health crises of the day, while offering more choices for vulnerable ESRD patients. We urge Congress to act quickly to help two groups of Americans who have significant health care needs.” – by Mark E. Neumann