Improve Access to Care Archives - Page 13 of 16

CMS to Expand Prior Authorization of Transportation Services to Six More States

Hannah Bracamonte2024-03-29T01:50:31+00:00November 9th, 2015|Categories: State Advocacy, Transportation Services|

The Centers for Medicare and Medicaid Services (CMS) will begin expanding a prior authorization model for non-emergency ambulance transportation for dialysis patients into six states: Maryland, Delaware, the District of Columbia, North Carolina, Virginia and West Virginia. The program expansion will begin on January 1, 2016 and requires ambulance providers in those states to obtain documentation from physicians prior to beginning service. CMS plans to reach out to ambulance providers and Medicare beneficiaries about the program through educational materials. This model was originally implemented in New Jersey, Pennsylvania and South Carolina. It came in response to fraud cases found in those states, [...]

New ACO Model Focuses on ESRD Patient Care

Hannah Bracamonte2024-03-29T01:50:31+00:00October 9th, 2015|Categories: Article, Care Coordination|

The Centers for Medicare & Medicaid Services (CMS) has announced the participants for the Comprehensive ESRD Care (CEC) Model, a new accountable care organization (ACO) model designed specifically for ESRD patients. ACOs are groups of physicians and other health care providers who collectively take on responsibility for the quality and cost of care for a population of patients. In the CEC Model, dialysis facilities, nephrologists and other providers have formed ESRD Seamless Care Organizations (ESCOs) to coordinate care for ESRD beneficiaries. ESCOs will be financially accountable for quality outcomes and Medicare Part A and B spending, including all spending for dialysis [...]

ESRD Seamless Care Organizations FAQ’s

Hannah Bracamonte2024-03-29T01:50:31+00:00October 7th, 2015|Categories: Care Coordination, Other Links|

Re: Essential Health Benefits – 2017 Benchmark Plans

Hannah Bracamonte2024-03-29T01:50:32+00:00September 28th, 2015|Categories: Care Coordination, Comment Letter, Promote Financial Security|Tags: Health Insurance Exchange|

Hon. Kevin Counihan Center for Consumer and Information and Insurance Oversight Centers for Medicare and Medicaid Services Hubert H. Humphrey Building 200 Independence Ave, SW Washington, D.C. 20201 Re: Essential Health Benefits - 2017 Benchmark Plans Dear Deputy Director Counihan: Dialysis Patient Citizens, America’s largest patient-led organization representing dialysis patients, is comprised of more than 28,000 dialysis and pre-dialysis patients and their families. We seek to ensure the patient point of view is considered by policy makers. We are writing to comment on the Agency’s List of Proposed 2017 Essential Health Benefits (EHB) Benchmark Plans. States have four options for [...]

Letter to Oregon Insurance Commissioner Emphasizes Importance of Private Insurance
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Letter to Oregon Insurance Commissioner Emphasizes Importance of Private Insurance

Hannah Bracamonte2024-03-29T01:50:32+00:00September 16th, 2015|Categories: Article, Charitable Premium Assistance, Comment Letter, Improve Access to Care, Promote Financial Security, State Advocacy|Tags: Health Insurance Exchange|

Regence and Moda, two private insurance plans in Oregon, recently made changes to their 2016 plans that would negatively affect ESRD patients. Specifically, after three months of coverage, any out-of-pocket payments patients make for dialysis treatment will no longer count towards their out-of-pocket maximums. This appears to be an effort to pressure dialysis patients to drop their private coverage and enroll in Medicare. DPC’s letter to the Oregon Insurance Commissioner calls attention to this discriminatory move. Medicare plans do not include an out-of-pocket maximum amount, while most private insurance plans do. Statistics also show that patients with Medicare plans are [...]

Representative Pitts visits Reading Dialysis Center

Hannah Bracamonte2024-03-29T01:50:32+00:00September 16th, 2015|Categories: Article, Care Coordination, Dialysis Funding, Medicare Advantage, Promote Financial Security|

During the August recess, Congressman Joe Pitts took the opportunity to engage with dialysis patients in his home district. He recently visited the Reading Dialysis Center in Reading, PA where he received a tour of the facility and met with dialysis nurses and staff. As Chairman of the Energy and Commerce Health Subcommittee, he is an influential decision maker when it comes to kidney care issues. He spoke to the dialysis staff on a variety of health proposals currently in Congress including the 21st century Cures initiative. We hope Representative Pitts will continue his support of kidney care issues by co-sponsoring [...]

Biosimilar Medication Topic of House Letter to CMS

Hannah Bracamonte2024-03-29T01:50:32+00:00August 14th, 2015|Categories: Improve Access to Care, Increase Quality of Care, Promote Financial Security|

When the FDA approves a generic drug, it’s based on the chemicals contained in the original brand medication. Congress recently enacted a similar process for the approval of “biosimilars” based on the original biologic medication. The main difference is that the “biosimilar” is approved based on its development process. Biosimilars have the potential to be a cheaper alternative for expensive biologic medications such as Epogen, a drug used for anemia management. A letter sent from the House of Representatives to the Centers for Medicaid and Medicare Services (CMS) calls attention to a biosimilar reimbursement proposal in CMS’s 2016 Medicare Physician Fee Schedule proposed [...]

DPC Submits Ideas for Improving ESRD Care to Special Senate Task Force

Hannah Bracamonte2024-03-29T01:50:32+00:00July 16th, 2015|Categories: Article, Care Coordination, Medicare Advantage|

Earlier this spring, the U.S. Senate Finance Committee invited stakeholders to submit ideas to improve care for Medicare beneficiaries with chronic diseases. DPC submitted its comments on June 22 with a focus on how end-stage renal disease (ESRD) patients could benefit from increased care coordination among providers. The Senate Finance Committee oversees the Medicare program and both the current Chairman Orrin Hatch (R-UT) and top Democrat Ron Wyden (D-OR) have prioritized improving patient outcomes while lowering costs. They appointed a bipartisan task force to move forward with the best ideas for achieving these goals. DPC's comments stressed that a main barrier [...]

Chronic Kidney Disease Improvement in Research and Treatment Act Gaining Momentum

Hannah Bracamonte2024-03-29T01:50:33+00:00May 14th, 2015|Categories: Care Coordination, Dialysis Funding, Medicare Advantage, Promote Financial Security|

While only a few weeks after its introduction, the Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 1130/S. 598) is gaining new cosponsors in Congress. That said, we still have a lot of work to do to ensure this legislation is signed into law. If you want to see better care for dialysis patients, please take a few minutes to contact your Members of Congress and urge them to support this important legislation by clicking here. Representatives Tom Marino (R-PA), John Lewis (D-GA) and Peter Roskam (R-IL) introduced H.R. 1130 as the bill’s original sponsors. They are now joined [...]

Centers for Medicare and Medicaid Services Crack Down on New Jersey Ambulance Companies that Fraudulently Bill Medicare

Hannah Bracamonte2024-03-29T01:50:33+00:00May 14th, 2015|Categories: Article, State Advocacy, Transportation Services|

The Centers for Medicare and Medicaid Services (CMS) is continuing a four-month crackdown on Medicare fraud in New Jersey. CMS has accused ambulance companies of fraudulently billing Medicare for transporting patients to non-emergency dialysis, chemotherapy and wound care. CMS found that these ambulance trips in New Jersey were twice the national average (from 2002 to 2011), and that the number of trips per patient was up approximately 60%. At least 11 ambulance companies report closing in recent months. The ambulance companies in New Jersey are now required to obtain pre-authorization from Medicare to transport a given patient, and many of [...]

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