The Centers for Medicare & Medicaid Services (CMS) has proposed updating Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates by 1.7% for calendar year 2020. This update reflects a proposed 2.1% market basket increase, partially offset by a -0.4% productivity adjustment. After application of a wage index budget-neutrality adjustment, the proposed CY 2020 ESRD PPS base rate is $240.27, compared with the 2019 rate of $235.27. The same rate would apply to renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI).
CMS proposes to revise the eligibility criteria for the Transitional Drug Add-on Payment Adjustment (TDAPA). In addition, CMS proposes to change the basis for TDAPA payment for calcimimetics (from average sales price (ASP) plus 6% to ASP without any markup.. The proposed rule also addresses: a new transitional add-on payment adjustment for new and innovative equipment and supplies; discontinuation of the erythropoiesis-stimulating agent (ESA) monitoring policy; annual outlier payment adjustments; modifications to ESRD Quality Incentive Program policies; and comment solicitations regarding the ESRD PPS wage index and options for improving data collection to refine the ESRD PPS case-mix adjustment model. CMS will accept comments on the proposed rule until September 27, 2019.
As part of this rulemaking, CMS proposes 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.