The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. CMS anticipates that the proposed rule would increase total Medicare payments to ESRD facilities by 0.8% in 2018, with hospital-based ESRD facilities having an estimated 1.0% increase and freestanding facilities having an estimated 0.8% increase. CMS proposes a 0.7% rate update, which reflects a projected 2.2% market basket increase that is offset by a 1% reduction under the Protecting Access to Medicare Act (PAMA) and a 0.5% multifactor productivity reduction. Based on this update, the proposed CY 2018 ESRD PPS base rate would be $233.31, up slightly from the 2017 base rate of $231.55.
The proposed rule also would, among other things: update outlier fixed dollar loss amounts and Medicare Allowable Payments; allow the use of any pricing methodology under section 1847A of the Social Security Act to determine the cost of drugs and biologicals when average sales price (ASP) data is not available for outlier payment purposes; and set the acute kidney injury (AKI) dialysis rate to equal the proposed ESRD PPS base rate. Furthermore, CMS proposes changes in ESRD Quality Incentive Program (QIP) quality measures and methodologies for payment years 2019 – 2021. CMS also solicits comments on the treatment of AKI patients under the ESRD QIP and whether CMS should account for social risk factors under the ESRD QIP.
Finally, as in other recent proposed Medicare payment rules, CMS includes a "Request for Information on Medicare Flexibilities and Efficiencies" that invites suggestions for ways to "increase quality of care, lower costs, improve program integrity, and make the health care system more effective, simple and accessible."
CMS will accept comments on the proposed rule until August 28, 2017.
This article is presented for informational purposes only and is not intended to constitute legal advice.
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