Benefits Byte

September 258, 2022

Council Warns of Adverse Consequences to Proposed Dialysis Coverage Legislation

In letters to the U.S. Senate and House of Representatives on September 15, the American Benefits Council expressed strong concerns with proposed legislation that would effectively allow dialysis providers to collect higher reimbursements from employer plan sponsors through a vague and unnecessary benefit mandate and parity requirement.

The Restore Protections for Dialysis Patients Act (RPDPS, S. 4750/H.R. 8594) is a response to the U.S. Supreme Court decision in Marietta Memorial v. DaVita Inc., in which the high court ruled that a group health plan that provides limited benefits for outpatient dialysis—but does so uniformly for all plan participants— does not violate the Medicare Secondary Payer statute (which dictates when another entity has the responsibility to pay for a service before Medicare does).

In the Council’s view, rather than simply “restoring” protections for individuals with ESRD, the legislation effectively imposes a mandate that group health plans cover dialysis services with no limits relative to other chronic medical conditions that are covered by the plan.

The Council’s letter details these concerns, explaining that “While the legislation may increase profits for dialysis providers … it will ultimately harm employees through higher premiums and hamper employer efforts to make health care more affordable for working families.” We also note that the legislation is “unworkable” since the parity requirements are unclear on how to determine a sufficient level of reimbursement or coverage.

The RPDPS has not yet been scheduled for consideration in committee or on the floor of the Senate or House. However, the measures have bipartisan support and could be added to other must-pass legislation before the end of the year.

For more information, contact Ilyse Schuman, senior vice president, health policy.