The ESRD PPS final rule will allow certain equipment and supplies used for dialysis treatment in the home to qualify for an additional Medicare payment.
Along with the usual annual payment adjustments, including increasing the end-stage renal disease (ESRD) prospective payment system (PPS) base rate, CMS’ ESRD PPS final rule allows an additional payment for certain in-home dialysis equipment. In the advance release of the final rule, scheduled to publish in the Federal Register on November 9, 2020, CMS also includes an addition to the ESRD PPS base rate that allows calcimimetics in the ESRD PPS bundled payment. CMS makes a change to the low-volume payment adjustment eligibility criteria and attestation requirement as well to account for the COVID-19 Public Health Emergency (PHE). Finally, the rule updates the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to patients with AKI and finalizes changes to the ESRD Quality Incentive Program (QIP), among other changes.
New and innovative equipment and supplies. Last year, CMS introduced an expansion of the eligibility for the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES). The rule takes it a step further to cover qualifying new dialysis machines when used in the home. According to CMS, an additional Medicare payment when qualifying innovative equipment and supplies are used will expand access to new home dialysis machines and facilitate quicker availability to Medicare beneficiaries.
ESRD PPS. For 2021, the ESRD PPS base rate is $253.13, an increase of the $13.80 to the current base rate of $239.33. Other ESRD PPS changes include updating wage index values to reflect the most recent data and updating outlier policies including the fixed-dollar loss (FDL) amounts and Medicare allowable payment (MAP) amounts as follows:
- pediatric FDL: from $41.04 to $44.78
- pediatric MAP: from $32.32 to $30.88
- adult FDL: from $48.22 to $122.49
- adult MAP: from $35.78 to $50.92
Inclusion of calcimimetics. Beginning January 1, 2021, CMS is changing the ESRD PPS base rate to include calcimimetics in the ESRD PPS bundled payment. Based on the most recent data available, according to CMS, CMS is adding $9.93 to the ESRD base rate.
AKI dialysis payment. The AKI dialysis payment rate for renal dialysis services is $253.13 beginning January 1, 2021. CMS updated the AKI dialysis payment rate to equal the 2021 ESRD PPS base rate and to apply the 2021 wage index.
Changes to QIP. Previously proposed changes to ESRD QIP are finalized under the rule. The changes include (1) updating the scoring methodology for the Ultrafiltration Rate Reporting Measure to score facilities based on the number of eligible patient-months as opposed to facility-months, and (2) updating the National Healthcare Safety Network (NHSN) validation study to reduce the number of required records from 20 records across each of the first two quarters (total of 40 records) to 20 records for any two quarters.
COVID-19 adjustment. ESRD facilities that would have qualified for the Low Volume Payment Adjustment (LVPA), but for a temporary increase in dialysis treatments furnished in 2020 because of the COVID-19 PHE, will still qualify. In addition, CMS is allowing an exception to the November 1, 2020 attestation deadline due to the COVID-19 PHE. As a result, CMS is extending the deadline to December 31, 2020, for ESRD facilities to submit attestations for payment year 2021.
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