Health officials both here in New Hampshire and across the country have been hard at work for months to protect patients from the spread of COVID-19.
From the moment Gov. Chris Sununu declared a state of emergency in March, the focus has been on keeping people safe and ensuring they can access the care they need, especially those with a higher risk of contracting COVID-19 and suffering severe health problems as a result.
However, a recent move by the Centers for Medicare and Medicaid Services (CMS) will jeopardize the ability of New Hampshire patients with end-stage renal disease (ESRD) to access care plans that work best for them.
Earlier this year, CMS made a change to the network adequacy rules, which dictate how the Medicare Advantage plan networks offered through private insurance companies handle dialysis clinics.
These network adequacy rules are designed to help make sure that each company allows patients appropriate access to the treatments offered by their Medicare Advantage plan networks.
Traditionally, dialysis clinics that were included in these networks were governed by standards called “time and distance limits,” which outlined specifically how long or how far a network could make a patient travel to the nearest clinic.
With the new rule, however, that system was turned on its head. Now, instead of time and distance limits, dialysis clinics will be included in networks based on rules that draw from general treatment patterns in a given community.
This is a major problem for ESRD patients for several reasons.
Most importantly, this decision is sure to limit access to necessary treatments for ESRD patients who elect to enroll in a Medicare Advantage plan.
Many need multiple, hours-long dialysis treatments in-center each week, but even those who can do dialysis at home still have to be able to go to their clinics for regular check-ups.
With this new rule, insurance companies can simply cut back on the number of clinics in their networks to save money, leaving patients without a clinic within a reasonable distance of where they live despite needing to go so frequently.
Of course, because of this, many ESRD patients will elect not to enroll in a Medicare Advantage plan at all in order to keep their doctor. Instead, they will need to stay on traditional Medicare, which usually includes fewer treatments that dialysis and ESRD patients need at a higher cost out-of-pocket.
This action by CMS also completely undermines what had been a landmark achievement for the ESRD community.
In 2016, at the end of a long advocacy effort from ESRD patients, Congress passed the 21st Century Cures Act, which included a measure allowing thousands of ESRD patients who had not been eligible for Medicare Advantage to finally be able to enroll. The first open enrollment period was scheduled to happen in October.
Instead, that victory has been quickly and unceremoniously undone by CMS’ decision, and patients are already fighting back. Dialysis Patient Citizens, a leading ESRD patient advocacy organization, has already filed suit against CMS to see to it that this decision is overturned.
This reaction is to be expected, given how hard patients fought for that access.
When President Trump ran for office in 2016, he claimed he would fix our broken healthcare system and protect the most vulnerable patients. Now, officials in his administration are doing the opposite for the ESRD patients who are already unsure of how they will face the weeks and months ahead, given the continued spread of COVID-19.
Whether it is this administration or an incoming Biden administration, the change cannot be allowed to stand.
The right thing for the administration to do is to overturn this decision. By doing so, it can show patients that it really is up to the task of ensuring patients can receive the care they need.
As things stand, ESRD patients across New Hampshire will be forced to wait a bit longer to reap the benefits of the hard-fought win that the 21st Century Cures Act represented.
