Supreme Court Allows Health Plans to Limit Dialysis Benefits
September 14, 2022, Report#: LSB10819
By Jennifer A. Staman, Legislative Attorney
"This past term, the Supreme Court issued a variety of impactful decisions in the health care arena, including some that affect coverage and reimbursement for health care services under federal programs, such as Medicare and Medicaid. Among these decisions is Marietta Memorial Hospital Employee Benefit Plan v. DaVita, a case about the intersection of Medicare and employment-based health benefits for patients with end-stage renal disease (ESRD). In DaVita, the Court held that an employer-sponsored health plan could limit benefits for kidney dialysis services without running afoul of the Medicare Secondary Payer (MSP) statute, a provision designed to reduce Medicare spending by moving health care costs from the Medicare program to private payment sources. This Legal Sidebar provides background on the MSP statute, discusses the Court’s decision in DaVita, and concludes with selected legal considerations for Congress."
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