CMS Releases CY 2023 End-Stage Renal Disease Prospective Payment System Final Rule

On October 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Calendar Year (CY) 2023 final rule (CMS-1768-F). The rule generally builds upon policies finalized in last year’s ESRD payment rule that sought to improve health equity, enhance access to treatment options and address the continuing impacts of the COVID-19 public health emergency (PHE). The rule finalizes changes to the base payment rate, updates the ESRD Quality Incentive Program (QIP) and changes the ESRD Treatment Choices (ETC) Model. These policies generally take effect on January 1, 2023.

Key takeaways from the CY 2023 ESRD PPS Final Rule:

  • CMS updated the ESRD PPS base payment rate, wage index and outlier policy for CY 2023. CMS also added the word “functional” to the definition of “oral-only drug” (effective on January 1, 2025) and clarified the functional category definitions accordingly.
  • CMS finalized several updates to the ESRD QIP, including suppression of certain measures for payment year 2023 and additional updates for subsequent payment years.
  • CMS finalized changes to the ETC Model, including a modification of the performance payment adjustment (PPA) achievement scoring methodology (beginning in performance year five) and clarifications regarding the provision of kidney disease patient education services.
  • CMS considered three products for the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES) but ultimately did not award TPNIES to any new products for CY 2023.

Read on for a topline summary of the major provisions in the final rule.

  • The final rule text is available here.
  • The final rule CMS fact sheet is available here.

Click here to download the detailed summary of the key provisions in the final rule.