Restore Protections for Dialysis Patients

Summary#

This bill, the "Restore Protections for Dialysis Patients Act," would change part of the Social Security Act (section 1862(b)(1)(C)). It would make clear that group health plans may not treat people with end stage renal disease (ESRD) or the need for renal dialysis differently from other enrollees. The bill says plans may not apply benefit limits or other rules that would disparately affect people with ESRD or shift primary responsibility for dialysis care to Medicare. The bill also says a plan is still allowed to choose which dialysis providers are in its network. The Secretary must enforce these rules consistent with existing nonconformance rules in 42 C.F.R. part 411.

What it means for you#

• If you have ESRD or need dialysis: private group health plans could not apply benefit rules that single out dialysis patients or make Medicare the default primary payer for dialysis care. You would still be covered subject to the plan's normal benefit rules that do not single out dialysis.
• If you have or run a group health plan or employer plan: you must not impose benefits or limits that treat dialysis patients worse than other enrollees. You may still decide which dialysis providers to include in your network.

Expenses#

No publicly available information.

Proponents' View#

As stated in the bill, the sponsors aim to "restore the MSPA's protections for ESRD patients," stop private plans from shifting primary payment responsibility to Medicare, and clarify that singling out dialysis for disfavored treatment is an inappropriate differentiation. The bill text also notes it does not require plans to include particular dialysis providers in their networks.

Opponents' View#

No publicly available information.