CMS Issues Proposed Rule to Update Medicare ESRD PPS

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by Debra McCurdy  | Reed Smith

The Centers for Medicare & Medicaid Services (CMS) has published its proposed rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2017. CMS anticipates that the proposed rule would increase overall Medicare payments to ESRD facilities by 0.5 percent in 2017 compared with CY 2016 levels (with a slightly higher increase – 0.7 percent — for hospital-based ESRD facilities). This update reflects a 0.35 percent market basket increase and the application of wage index and self-dialysis training budget-neutrality adjustment factors. The proposed CY 2017 ESRD PPS base rate is $231.04, compared to the CY 2016 base rate of $230.39.

The proposed rule also would, among other things: update outlier fixed dollar loss amounts and Medicare Allowable Payments; increase the hours of nurse training time that is accounted for by the home and self-dialysis training add-on payment adjustment; and establish a new equivalency payment for hemodialysis when more than three treatments are furnished in a week (similar to the policy applied to peritoneal dialysis). In addition, CMS proposes to implement a statutory provision that provides coverage and payment for renal dialysis services furnished by an ESRD facility to an individual with acute kidney injury (AKI), effective January 1, 2017. Under this policy, drugs, biologicals, and laboratory services that ESRD facilities are certified to furnish, but that are not renal dialysis services, may be paid for separately when furnished by ESRD facilities to individuals with AKI. Furthermore, the rule proposes a variety of updates to the ESRD Quality Incentive Program for payment years 2018 through 2020, including revision to the reporting measures.

As discussed in a separate post, the proposed rule also includes a number of provisions impacting Medicare suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), including changes to competitive bidding program (CBP) requirements and adjustments to DMEPOS fee schedules based on CBP pricing.

CMS will accept comments on the June 30, 2016 proposed rule until August 23, 2016.

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