The CMS has issued an interim final rule Monday that attempts to stop providers and organizations from steering patients eligible for Medicaid or Medicare into private insurance as a way to receive higher reimbursement rates.
The rule issued Monday requires dialysis centers that help patients pay private insurance premiums either directly or through charities to clarify what plans in their region pay for and how that compares to Medicare or Medicaid.
The notices must inform patients that some plans may not cover all costs typically covered by Medicare, such as necessary medical expenses for living donors.
“We believe these individual market premium payments are particularly prone to abuse because they are so closely tied to the type of coverage an individual selects,” the agency says in the rule.
The notices also must detail the exact subsidy amount for private insurance and how much the dialysis center's reimbursement differs from private insurers to other payers.
Dialysis facilities must also reach out to a plan to ensure that they will accept insurance subsidies from a third party and will do so for a full calendar year to ensure continuity of care. The rule, which affects 6,064 dialysis centers throughout the country, goes into effect on Jan. 14, 2017.
The CMS estimates it will cost these facilities nearly $700 million in administrative costs to comply with the rule between 2017 and 2026.
Earlier this year, UnitedHealth Group alleged it was charged more by dialysis treatment chain American Renal Associates by steering Medicare- and Medicaid-eligible patients to the insurers' plans and then helping the patients pay for the premiums through a charity, the American Kidney Fund.
The rule's comment period ends Jan. 14, 2017.
