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

On June 21, 2022, the Centers for Medicare & Medicaid Services (CMS) released the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Calendar Year (CY) 2023 Proposed Rule (CMS-1768-P). The proposed rule includes changes to the base payment rate, updates to the ESRD Quality Incentive Program (QIP) and changes to the ESRD Treatment Choices (ETC) Model. It also contains several requests for information (RFIs) and considers applications for the Transitional Add-On Payment for New and Innovative Equipment and Supplies (TPNIES) for three products.

The proposed rule generally builds upon policies finalized in last year’s ESRD payment rule that sought to improve health equity and enhance access to treatment options, including home dialysis. If finalized, the changes in the proposed rule would generally take effect January 1, 2023. Comments on the proposed rule are due by August 22, 2022.

Key Takeaways

  • CMS proposes to update the ESRD PPS base rate, wage index and outlier policy for CY 2023. CMS also proposes to add the word “functional” to the definition of “oral-only drug” beginning January 1, 2025, and to clarify the functional category definitions.
  • CMS proposes several updates to the ESRD QIP, including suppression of certain measures for payment year 2023 and updates for subsequent payment years. CMS also seeks input on potentially adding quality measures for home dialysis, expanding reporting programs to better understand healthcare disparities, and including two social drivers of health screening measures.
  • CMS proposes modifications to the ETC Model, such as updates to the Performance Payment Adjustment (PPA) achievement scoring methodology beginning in performance year 5 and clarifications to the requirements for qualified staff to furnish and bill kidney disease patient education services under the ETC Model’s Medicare program waivers. CMS also communicates its intent to publish participant-level performance information.
  • CMS is considering three products for the TPNIES payment adjustment: a monitoring system for peritoneal dialysis, a post-dialysis compression sleeve and a dialyzer.
  • The proposed rule includes RFIs that solicit input on a potential add-on payment adjustment for certain new renal dialysis drugs and biological products, and on health equity issues with a focus on pediatric patients.
  • Click here to download the detailed summary of the key provisions in the proposed rule.