CMS proposed raising the calendar year (CY) 2019 End Stage Rental Disease (ESRD) prospective payment system (PPS) rate to $232.37, an increase of $3.45. The agency also proposed removing four reporting measures from the quality incentive program (QIP) and restructuring the QIP’s domains and measure weights in future payment years (PYs), changing the bidding and pricing methodologies under the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program (CBP), and allowing beneficiaries to receive DMEPOS items from any willing supplier beginning January 1, 2019 until the agency awards new contracts under the CBP. The Proposed rule will publish in the Federal Register July 19, 2018.
ESRD PPS. The proposed base rate increase reflects a reduced market basket increate and the application of the wage index budget-neutrality adjustment factor. The bundled market basket is rebased to reflect cost data from 2016, which will result in an increase in the labor-related share as data reflects an increase in compensation and a relative decrease in other costs, such as drug costs. The wage index floor will be increased from 0.4 to 0.5. As of January 1, 2019, all new renal dialysis drugs and biologics would be eligible for the Transitional Drug Add-On Payment Adjustment (TDAPA) until the TDAPA period ends, regardless of whether the drugs fall under a functional category.
QIP. The ESRD QIP reduces payments to ESRD facilities that do not meet or exceed a minimum total performance score (TPS) and publish those results publicly by up to two percent. CMS proposed changes the following changes for PY 2021:
- removing the reporting measures for healthcare personnel influenza vaccination, pain assessment and follow-up, anemia management, and serum phosphorus;
- restructuring domains and measure weights to score facilities in the quality domains of patient and family engagement, care coordination, clinical care, and safety; and
- expanding National Healthcare Safety Network (NHSN) validation to 150 facilities.
The following changes were proposed for PY 2022:
- expanding NHSN validation to 300 facilities;
- adopting measures for percentage of prevalent patients waitlisted and medication reconciliation for patients receiving care at dialysis facilities.
The agency also proposed adopting one measure for PY 2024: standardized first kidney transplant waitlist ratio for incident dialysis patients.
DMEPOS CBP. The DMEPOS CBPs operate throughout the country to facilitate the furnishing of competitively priced items and services. The 21st Century Cures Act (P.L. 114-255) required HHS to adjust fee schedule amounts under the CBP after taking into account stakeholder input and the highest bid by a winning supplier in each bidding area, with a comparison of various factors such as costs to suppliers, volume of items and services, and number of suppliers. CMS proposes implementing lead item pricing, establishing a new single payment amount (SPA) calculation method, and establishing three temporary fee schedule adjustments depending on the area in which services are furnished.
The proposed temporary fee schedule adjustments apply to:
- areas that were formerly competitive bidding areas (CBAs) when there is a temporary lapse in the CBP, by adjusting the fee schedule based on the SPAs in effect on the last day before contract periods of performance ended, increased by the projected change in the consumer price index (CPI);
- items and services furnished in rural and non-contiguous non-CBAs, by extending the current methodology for blending adjusted and unadjusted fee schedule amounts through December 31, 2020; and
- items and services furnished in non-CBAs that are not rural or non-contiguous, by using the adjusted payment amount for dates of service from January 1, 2019 through December 31, 2020.
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