Notice of Interim Final Rule (IFR) Third Party Payment and Information on
• Publication: The Centers for Medicare & Medicaid Services (CMS) has published an IFR on third party payment requirements
in the Federal Register on December 14, 2016. This rule implements new requirements for Medicare-certified dialysis facilities
that make financial contributions to patients in order to support enrollment in individual market health plans either directly
or indirectly through a parent organization or third party.
• The IFR establishes new standards under the End Stage Renal Disease (ESRD) Conditions for Coverage (CfC) 42 CFR 494.70 Patient
Rights (c) Standard: Right to be informed of health insurance options and 42 CFR 494.180 Governance (k) Standard: Disclosure
of financial assistance to insurers.
• The requirements of the IFR apply to any dialysis facility offering financial contributions in the form of premium assistance
to support enrollment in individual market health plans. The requirements will be effective 30 days from the date of publication
with the exception of one portion of 42 CFR 494.180(k) which may be delayed to July 1, 2017 if there is a potential for a
coverage gap for the beneficiary.
• A survey tool has been developed to assess compliance with the new standards pending completion of Interpretive Guidance.