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Title
Notice of Interim Final Rule (IFR) Third Party Payment and Information on Implementation Plan
Memo #
17-16-ESRD
Posting Date
2016-12-16
Fiscal Year
2017
Summary
• 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.
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