The American Kidney Fund said that it has created new safeguards to protect patients’ autonomy and informed choice when they turn to AKF’s Health Insurance Premium Program (HIPP) for help affording insurance coverage.

AKF said it currently educates grant recipients about the HIPP program with a program guidelines document and a quarterly patient newsletter. The enhanced safeguards announced today—a Provider Code of Conduct, a Patient Bill of Rights, and enhanced educational materials—are directed at dialysis providers as well as patients. They clarify the rights and responsibilities of each party to ensure that patients have made an informed choice when selecting health insurance coverage and applying for HIPP grant assistance from AKF.

In August, the Centers for Medicare & Medicaid Services issued a request for information seeking public comment on concerns that some health care companies, including dialysis providers, may be steering people eligible for, or receiving, Medicare or Medicaid benefits into Affordable Care Act-compliant individual market plans to of obtain higher reimbursement rates.

“We are concerned about reports that some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients’ needs,” said CMS Acting Administrator Andy Slavitt. “These actions can limit benefits for those who need them, potentially result in greater costs to patients, and ultimately increase the cost of Marketplace coverage for everyone.

United Healthcare, the largest insurer in the country, filed a lawsuit against American Renal Associates on July 1, charging that the country’s fifth largest provider convinced Medicaid patients to switch to more lucrative commercial insurance plans that paid the provider thousands of dollars more. American Renal Associates has said the lawsuit is without merit and has filed a request to dismiss it.

A statement from AKF said the organization sees the recent attention as an opportunity to further its role as a patient educator and advocate.

“We adamantly oppose any provider efforts to improperly steer patients to private insurance plans, and we equally oppose insurer efforts to steer kidney patients into Medicare or Medicaid plans that may not adequately meet their needs,” Burton said. “In addressing anecdotal reports of provider steering, the Obama Administration must not close off access to the Marketplace for low-income ESRD patients who need charitable help.”

AKF said that, for some patients, a Marketplace plan may provide better coverage at lower out-of-pocket expense. For example, many do not require insurance carriers to offer Medigap insurance to ESRD patients under 65. These patients are therefore exposed to a 20% out-of-pocket Medicare cost burden with no annual cap; for these patients, a Marketplace plan may have lower out-of-pocket annual costs than Medicare.

Changes to AKF’s HIPP program

Beginning in 2017, grant applicants will need to demonstrate to AKF why a Marketplace plan is a better option for them personally than Medicare or Medicaid. This mandatory step in the grant approval process will ensure that each patient has carefully evaluated his or her insurance options and has made an informed decision. AKF met with CMS on October 24 and presented the new steps that they are undertaking.

The following additional safeguards will become effective in 2017:

  • A Provider Code of Conduct that each referring dialysis provider must sign, The Code of requiring dialysis providers to keep the best interests of the patient in mind when referring patients to AKF for assistance. It requires providers to give patients comprehensive, accurate, and impartial information enabling them to make informed decisions about their health insurance coverage. Such comprehensive information will include financial and coverage-related implications associated with the choice of a particular coverage option.
  • A Patient Bill of Rights that outlines for patients their rights and responsibilities regarding thei receipt of HIPP grant assistance. This document explains patients’ freedom to independently choose their health care coverage and providers, to make changes in provider or coverage, to register online to track their AKF grant status, and to report to AKF any concerns about the program, including whether there are concerns that patients’ rights under HIPP have been violated.
  • AKF is developing new educational materials to provide patients with objective information about their insurance options.