Washington, DC - U.S. Rep. Terri Sewell (D-AL) and Rep. Jason Smith (R-MO) led a bipartisan group of 42 Members of Congress in a letter urging the Centers for Medicare and Medicaid Services (CMS) to ensure that the end-stage renal disease (ESRD) patients who will be enrolling in Medicare Advantage (MA) plans in 2021 have access to a sufficient number of providers and locations to access their dialysis care. The bipartisan letter was written in response to CMS’s decision to remove outpatient dialysis facilities from time and distance standards in Medicare Advantage (MA).  

Read the full letter to CMS Administrator Seema Verma.

“As representative of a congressional district with one of the highest rates of dialysis patients in the country, I am deeply concerned about the consequences of CMS’s decision to remove outpatient dialysis facilities from time and distance standards in Medicare Advantage, especially in the COVID-19 pandemic,” said Rep. Terri Sewell. “It is incumbent on CMS to carefully monitor network adequacy and patient access, as well as maintain the current standards for ESRD patients who transition to Medicare Advantage. Network adequacy protections are critical to ensure that dialysis patients, who are among the most medically fragile patients, have unfettered access to adequate coverage of the dialysis care they depend on.”

“The elimination of the time and distance standards would result in increased travel time for ESRD patients in rural areas and undermine the intent of the ESRD Choice Act.” said Rep. Smith. “It is vital that ESRD patients enrolling in Medicare Advantage have access to an outpatient dialysis facility near their home and I look forward to working with CMS to ensure ESRD patients enrolling in Medicare Advantage have the protections they deserve.”

Due to the removal of network adequacy protections for outpatient dialysis care by CMS, the 2021 transition that allows all ESRD patients to enroll in MA will not meet its full potential to improve outcomes, and dialysis patients who enroll in MA will be at greater risk due to weakened network adequacy protections. Specifically, ESRD patients could have increased travel time to covered dialysis facilities, which has been shown to negatively impact patients’ quality of life, adherence to treatment, and overall health outcomes.

Data shows that African American, Hispanic, and low-income patients are disproportionately impacted by ESRD. These populations already face significant disparities in care access and outcomes. Moreover, ESRD is a key risk factor for COVID-19 morbidity and mortality. At a time when ESRD patients are particularly vulnerable to increased public exposure and changes in their care routine, patients should be able to access the most clinically appropriate facility-based care close to home.