LETTER FROM ANNA ON ESRD CHOICE ACT OF 2016

FROM THE ANNA

The ESRD Choice Act of 2016

The American Nephrology Nurses Association (ANNA) is a professional nursing organization of approximately 9,000 registered nurses practicing in nephrology, transplantation, and related therapies. ANNA promotes excellence in and appreciation of nephrology nursing so we can make a

positive difference for people with kidney disease.

Every year, a significant number of Americans are diagnosed with kidney disease. More than 26 million individuals have kidney disease and more than 661,000 have kidney failure, known as end-stage renal disease (ESRD).

Three treatment options exist for those suffering from kidney disease and

ESRD: hemodialysis, peritoneal dialysis, or transplantation.

Given the limited availability of kidneys for transplantation, the majority of ESRD patients rely on dialysis care. Nearly all ESRD patients are Medicare beneficiaries. However, under current law, ESRD patients are prohibited from enrolling in Medicare Advantage (MA) plans, which offer more flexible and

integrated managed care coverage than traditional Medicare.

Moreover, MA plans include financial protections like out-of-pocket maximums, which are especially important to low-income beneficiaries

in need of ESRD care.

ESRD is the only pre-existing condition specified by the Centers for Medicare

and Medicaid Services(CMS) as a broad disqualifier for MA enrollment.

The Expanding Seniors Receiving Dialysis Choice Act of 2016 (H.R. 5659), introduced by Rep. Jason Smith (R-MO-8) on July 7, 2016, would remove the

prohibition on current ESRD patients from enrolling in MA insurance plans

for plan years beginning on or after January 1, 2020. The bill also would

streamline payments for kidney acquisition costs within Medicare.

Finally, the bill would require the Administrator of CMS to provide a report to Congress on the effects of the legislation by April 1, 2022.

There is broad group of national stakeholders that support this legislation, including patient groups, advocacy organizations, and health professional provider associations and societies. Additionally, the Medicare Payment Advisory Commission (MedPAC) supports allowing ESRD patients the choice to enroll in MA plans, having first recommended it in 2004 and again in

its March 2016 Report to Congress.

Recommendation: ANNA urges Members of Congress to cosponsor the

Expanding Seniors Receiving Dialysis Choice Act of 2016(H.R. 5659). The bill will increase access to high quality care by removing the prohibition on current ESRD patients from enrolling in MA insurance plans.

If you have questions about these issues, please contact ANNA’s Health Policy Consultant Jim Twaddell (202/230-5130, jim.twaddell@dbr.com).

Sources:

•Medicare.gov, “Who Can Join a Medicare Advantage Program?” July 2016.

https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/who-can-join-medicare-advantage-plan.html;

•National Kidney Foundation, “Fast Facts,” April 2016.

https://www.kidney.org/news/newsroom/factsheets/FastFacts

•MedPAC, “The Medicare Advantage program: Status Report,” March 2016. Pg. 363.

http://www.medpac.gov/documents/reports/chapter-12-the-medicare-advantage-program-status-report-(march-2016-report).pdf