Judge tells CMS to hold off on sub­si­dized pay rule for dial­y­sis

Modern Healthcare - - REGIONAL NEWS - —Maria Castel­lucci

A District Court judge in Texas or­dered the CMS to hold off on a fi­nal rule re­quir­ing dial­y­sis cen­ters that help pa­tients pay pri­vate in­sur­ance pre­mi­ums to dis­close what plans in their re­gion pay for and how that com­pares to Med­i­caid and Medi­care.

The CMS is­sued the rule in an at­tempt to stop providers from steer­ing pa­tients el­i­gi­ble for Med­i­caid or Medi­care into pri­vate in­sur­ance as a way to re­ceive higher re­im­burse­ment rates.

The rule was set to go into ef­fect Jan. 14, but U.S. District Court Judge Amos Maz­zant is­sued a tem­po­rary re­strain­ing or­der on it un­til he made a de­ci­sion. His or­der placed a stay on the CMS rule.

Dial­y­sis providers DaVita and U.S. Re­nal Care sued the CMS last month, say­ing the rule would al­low in­sur­ers to deny cov­er­age to dial­y­sis pa­tients be­cause of their con­di­tions.

Maz­zant ruled that the CMS vi­o­lated the Ad­min­is­tra­tive Pro­ce­dures Act when it is­sued the in­terim rule, fail­ing to pro­vide ap­pro­pri­ate no­tice of the rule or enough time to com­ment.

The rule re­quires dial­y­sis providers to reach out to plans to en­sure they will ac­cept in­sur­ance sub­si­dies from a char­i­ta­ble or­ga­ni­za­tion and will do so for a full cal­en­dar year to en­sure con­ti­nu­ity of care.

A CMS spokesman de­clined a re­quest for com­ment.

Maz­zant also called the rule “ar­bi­trary and capri­cious.” He con­cluded that the CMS failed to con­sider how the rule could po­ten­tially cause pri­vate in­sur­ers to deny in­sur­ance cov­er­age to Medi­care-el­i­gi­ble dial­y­sis pa­tients.

In a state­ment, DaVita said it was pleased with the court’s de­ci­sion and urged the CMS to elim­i­nate the rule. The CMS es­ti­mates it will cost these fa­cil­i­ties nearly $700 mil­lion in ad­min­is­tra­tive costs to com­ply with the rule be­tween 2017 and 2026.

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