CMS has published its final rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates and policies for CY 2017. CMS expects the rule to increase overall Medicare payments to ESRD facilities by 0.73 percent in 2017 compared with CY 2016 levels, for an aggregate increase of $80 million. This update reflects a 0.55 percent market basket increase and wage index and self-dialysis training budget-neutrality adjustment factors. The final CY 2017 ESRD PPS base rate is $231.55, compared to the CY 2016 base rate of $230.39. The final rule also updates outlier fixed dollar loss amounts and Medicare Allowable Payments, and increases the hours of nurse training time that is accounted for by the home and self-dialysis training add-on payment adjustment. In response to comments, CMS did not finalize its proposal to establish a new equivalency payment for hemodialysis when more than three treatments are furnished in a week, given the substantial burden it could place on providers.
In addition, the final rule implements 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. Payment will equal the ESRD PPS base rate, as adjusted by the wage index. In addition, 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 adopts 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 final rule also adopts 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. The final rule is scheduled to be published on November 4, 2016.