The US Supreme Court has agreed to review federal laws that outline how employee health plans must treat patients with end-stage renal disease.
After the U.S. Court of Appeals for the Sixth Circuit ruled that the health plan of an Ohio hospital violated the Medicare Secondary Payer Act and the Employer’s Retirement Income Protection Act, the U.S. Supreme Court approved a petition to review the regulations on Friday. Classify all dialysis providers as external networks. The decision also conflicts with an earlier ruling of the U.S. Court of Appeals for the Ninth Circuit.
The dialysis provider DaVita Inc. sued the Marietta Memorial Hospital Health Plan for coverage policies in December 2018, alleging that the integrated system’s low reimbursement for dialysis differentiates these clinicians from other providers, and makes ESRD patients’ out-of-pocket expenses even greater. Gao, and eventually pushed them to join traditional medical insurance.
Dialysis When the kidneys are no longer working, they remove waste and fluid from the blood.The district court rejected DaVita’s claim, saying that because the plan provides the same benefits to all its insured persons, its coverage does not clearly discriminate Patients with end-stage renal disease Therefore, it does not violate the medical insurance secondary payer law. However, the Sixth Circuit partially overturned this decision, saying that because ESRD patients require most of the dialysis procedures, they are disproportionately affected by this policy.
Davita Recent newsletter On September 20, the dialysis provider told the Supreme Court that the case was not suitable for review by the National Supreme Court and urged officials to adopt the position of the Sixth Circuit.
“A very small number of dialysis users who do not suffer from ESRD are also adversely affected and will not change the basic equation, just as the fact that non-Jews wear yarmulks occasionally cannot obscure the reality that taxes on yarmulks will be taxed on them. Jews, “The briefing said.
In another case, the Ninth Circuit did not agree with DaVita’s argument against another employee health plan, and pointed out that ESRD patients were not the only ones using dialysis, and that the health plan’s policies did not comply with the discriminatory behavior under federal law. The required clear standards.
The COVID-19 pandemic may increase the incidence of acute kidney injury, thereby increasing the proportion of dialysis users who do not have ESRD, and the federal change that requires the Medicare Advantage health plan to recruit ESRD patients for the first time this year makes this problem more difficult than ever. Marietta said Wrote in a recent article Briefing to the Supreme Court on October 4.
“The resolution proposed by DaVita — the method of employer group health plans simply joining the Sixth Circuit — is no problem for DaVita, but it will require these plans to harm the millions of working families they protect and reduce the cost of other medical insurance. Coverage. Important medical procedures to meet the preemptive needs of dialysis providers,” Marietta’s briefing said.
The Supreme Court has not yet scheduled a debate on when to hear the case.
DaVita and Marietta Memorial Hospital Health Plan did not respond to interview requests.