Has the Medicare Secondary Payer (MSP) provision been a good feature of the dialysis entitlement? What would the provision of dialysis in the US look like with no MSP? This is a relevant question at a time when all manner healthcare reform is on the table.
Cahaba Government Benefit Administrators (Cahaba GBA) who is a Medicare contractor for the Centers for Medicare and Medicaid Services (CMS) has some background about the MSP provision that I had not see before. It feeds my inner dialysis wonk. From their General Information for Providers page:
End-Stage Renal Disease
Medicare Secondary Payer Manual (CMS Pub. 100-5, Ch.2 §20)
End-stage renal disease (ESRD) [Medicare secondary payer] is part of [Omnibus Budget Reconciliation Act] (OBRA) legislation enacted in 1981 which provides for the coordination of benefits between Medicare and group health insurance plans for individuals entitled to Medicare solely on the basis of ESRD. If an individual is entitled to Medicare because of ESRD and is covered by a Group Health Plan (GHP), the GHP insurance is primary for the first thirty months. The GHP is primary regardless of the number of employees in the group, and regardless of employment status.
Note: Prior to March 1, 1996, the coordination period was eighteen months. The Balanced Budget Act (BBA) of 1997 extended the eighteen-month period to thirty months for beneficiaries whose coordination period began on or after March 1, 1996.
The coordination period begins when the beneficiary could have enrolled in Medicare, even if he/she did not enroll at the time (i.e., the date self-course of dialysis began, on the date of the transplant, three months after dialysis starts, even though the beneficiary may not have enrolled in Medicare).
ESRD Beneficiaries and OBRA 93
The Omnibus Budget Reconciliation Act of 1993 (OBRA 1993) resulted in changes in the coordination period for ESRD beneficiaries with "dual entitlement." Dual entitlement means the beneficiary is eligible for Medicare because of ESRD and age or disability. Before OBRA 93, Medicare became the primary payer for an ESRD beneficiary at the time his/her "dual entitlement" began. Effective August 10, 1993, OBRA 93 allows Medicare to remain the secondary payer for all end stage renal disease (ESRD) beneficiaries, regardless of other Medicare entitlements, during the first thirty months of ESRD Medicare Coverage. At the end of the thirty months, Medicare becomes and remains the primary payer as long as the beneficiary still has ESRD. If the beneficiary's condition changes and he or she loses ESRD entitlement, other MSP laws may apply. (A beneficiary may lose ESRD entitlement if he or she receives a kidney transplant and the transplant is successful for thirty-six months.)
There is a disagreement regarding the wisdom of extending the MSP to 42 months. This extension was included in the CHAMP act the the House passed this summer (but the language didn't survive conference). Some say extending the MSP period is a bad idea (aakp); some that it is good idea (KCP); and some say it's a good idea only if Congress will use the money saved CMS by extending MSP to fix other elements of the program (this has been my position). One assumption in all this is that a 30 month MSP is a given. Maybe. Maybe not.
There is a lot of talk about healthcare this political year. Every candidate for office will have positions and plans. Some of these plans imply an end to MSP. I want to know how these plans stack up, looking from the sharp end of the needle.