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On July 6, CMS issued a proposed rule
that proposes to update payment policies and rates under the End-Stage
Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis
services furnished to beneficiaries on or after January 1, 2021. This
rule also proposes updates to the Acute Kidney Injury (AKI) dialysis
payment rate for renal dialysis services furnished by ESRD facilities to
individuals with AKI and proposes changes to the ESRD Quality Incentive
Program (QIP).
In addition to the annual technical
updates for the ESRD PPS, the proposed rule proposes the following:
- An addition to the ESRD PPS base rate to include
calcimimetics in the ESRD PPS bundled payment
- Changes to the eligibility criteria and
determination process for the Transitional add-on Payment adjustment
for New and Innovative Equipment and Supplies (TPNIES)
- Expansion of the TPNIES to include new and
innovative capital-related assets that are home dialysis machines
- A change to the low-volume adjustment eligibility
criteria and attestation requirement to account for the COVID-19
public health emergency
- An update to the ESRD PPS wage index to adopt the
new Office of Management and Budget delineations with a transition
period
- Information received from two manufacturers whose
products, a dialyzer and a cartridge for a home dialysis machine,
are being considered for TPNIES in CY 2021
Additionally, the proposed rule proposes
the following updates to the ESRD QIP:
- Scoring methodology changes to the
ultrafiltration rate reporting measure
- Updates to the National Healthcare Safety Network
validation study
The proposed CY 2021 ESRD PPS base rate
is $255.59, an increase of $16.26 to the current base rate of $239.33.
This proposed amount reflects the application of the proposed wage index
budget-neutrality adjustment factor (.998652), the proposed addition to
the base rate of $12.06 to include calcimimetics, and a proposed
productivity-adjusted market basket increase as required by section
1881(b)(14)(F)(i)(I) of the Act (1.8 percent), equaling $255.59 (($239.33
x .998652) + $12.06) x 1.018 = $255.59).
The proposed rule also includes:
- Annual update to the wage index
- Update to the outlier policy
- Low-volume eligibility criteria and attestation
requirement
- Impact analysis
For More Information:
On July 6, CMS updated MLN Matters
Article SE20016 to clarify how Rural Health
Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can apply
the Cost Sharing (CS) modifier to preventive services furnished via
telehealth. This update includes:
- Additional claim examples
- New section on the RHC Productivity Standard
The
Medicare Learning Network®, MLN Connects®, and MLN Matters®
are registered
trademarks of the U.S. Department of Health and Human Services
(HHS).
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