Federal Judge Blocks CMS Rule Change on Premium Assistance for Kidney Patients

The Centers for Medicare and Medicaid Services (CMS) rule change has been blocked by federal judge on Wednesday that would have barred sufferers with end-stage renal disease (ESRD) from getting charitable assistance to pay for private health coverage. 

CMS had reconsidered to add steps for kidney sufferers who seek premium assistance after a major number of them ended up on the Affordable Care Act (ACA) exchanges, raising charges for health plans that participate. The ESRD’s cost, which needs patients to be on dialysis, is so high that most sufferers are automatically eligible for Medicare. Major nationwide dialysis centers had developed foundations to pay premiums for these patients with the advent of ACA, permitting them to charge health policies up to $200,000 a year each patient. Medicare, by contrast, pays over $100,000 a year.
Judge Amos L. Mazzant III, sitting in the United States (US) District in Eastern Texas, released a preliminary injunction on the CMS interim final rule, genuinely set to take effect on the day of January 13, 2017. The order bars HHS from executing the rule. He was in favor with the complaint from Dialysis Patient Citizens (DPC) as well as key providers involving Davita that the CMS rule singled out ESRD patients, while those with other expensive conditions had no special rules for seeking assistance to fund private coverage. Mazzant discovered that HHS had “failed to review the advantages of private qualified health plans and neglected the disadvantages of the rule.” Centers for Medicare and Medicaid Services (CMS) didn’t technically bar ESRD patients from getting assistance with premiums, but it needed complete disclosure of assistance to facilities and to insurers, many of whom won’t cover enrollees if a third party pays for coverage. Rather than the high charges for insurers, CMS mentioned testimony from social workers that third-party help for insurance coverage mostly ended once a patient got a kidney transplant, and that sufferers were then left to figure out how to cover aftercare.
The decision was acknowledged by the DPC in a statement. The group said, “The court went beyond invalidating the rule on procedural grounds and questioned the policy itself.” The statement quoted the opinion, claiming, “Congress has long identified the significance of dialysis treatment for ESRD patients and has afforded sufferers the chance to elect coverage that best suits their requirements.” The gaps were cited by the court that the CMS rule didn’t deal, like what happens to ESRD sufferers not eligible for Medicare, and what happens to family members, since Medicare will merely cover the kidney failure patient, not the remaining ones. The court also found that CMS rushed the rule into effect without precise notice and comment.
In its own statement, Davita said, kidney failure sufferers remain at risk and compelled the Trump administration to resolve the matter for good.