The Centers for Medicare & Medicaid Services (CMS) has issued a final rule updating Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates for 2020 – which CMS expects to increase total payments to ESRD facilities by 1.6% compared with 2019. The final 2020 ESRD PPS base rate is $239.33, compared with the 2019 rate of $235.27. The same rate will apply to renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI).
The final rule also:
- Restricts drugs that may qualify for the Transitional Drug Add-on Payment Adjustment (TDAPA) "by focusing eligibility on those drugs that are innovative," and modifies the payment basis for the TDAPA.
- Establishes a new "Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies" to "support ESRD facilities in the uptake of certain new and innovative renal dialysis equipment and supplies under the ESRD PPS."
- Updates outlier services fixed-dollar loss and Medicare Allowable Payment amounts.
- Discontinues the erythropoiesis-stimulating agent monitoring policy.
- Modifies ESRD Quality Incentive Program policies.
- Updates wage index values.
As part of this rulemaking, CMS adopted significant changes to Medicare payment policies for durable medical equipment, prosthetics, orthotics, and supplies; these provisions are summarized in a separate post.
This article is presented for informational purposes only and is not intended to constitute legal advice.