Resolving the Ruckus

Proposition 8

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Regulates Amounts Outpatient Kidney Dialysis Clinics Charge for Dialysis Treatment

initiative statute

Official Summary

Limits the charges to 115 percent of the costs for direct patient care and quality improvement costs, including training, patient education, and technology support.

Requires rebates and penalties if charges exceed the limit.

Requires annual reporting to the state regarding clinic costs, patient charges, and revenue.

Prohibits clinics from refusing to treat patients based on the source of payment for care.

Fiscal Impact: Overall annual effect on state and local governments ranging from net positive impact in the low tens of millions of dollars to net negative impact in the tens of millions of dollars.


There are 588 chronic dialysis clinics (CDCs) in CA, 50% by DaVita, 22% by Fresenius, 8% by Satellite Healthcare, 6% by US Renal Care and 14% other. Medicare pays for the majority of people on dialysis. This proposition does not affect Medicare/Medi-Cal rates, only those paid by group and individual health insurers who normally pay a higher rate that Medicare/Medi-Cal.

Proposal is that starting in 2019, the revenue of CDCs must not exceed a cap, calculated as 115% of “direct patient care services costs” and “health care quality improvement costs” - specific line items still TBD. Costs excluded from the cap calculation include things that do not touch the client, such as administrative overhead. The cap would be computed across all clinics for a particular CDC, not per clinic. The amount exceeded by the cap would need to be refunded to payers.

This measure also prohibits CDCs from refusing to provide treatment to a person based on who is paying for the treatment.