On June 26, 2023, the Centers for Medicare & Medicaid Services (CMS) released the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Calendar Year (CY) 2024 Proposed Rule (CMS-1782-P). The proposed rule would make minimal increases to the ESRD PPS base payment rate, estimated to increase overall Medicare payments to ESRD facilities by 1.6%. The proposed rule includes proposals for new add-on payment adjustments, including a Transitional Pediatric ESRD Add-on Payment Adjustment for pediatric care and a payment adjustment for a three-year period after the Transitional Drug Add-on Payment Adjustment period ends for qualifying drugs and biological products. CMS also seeks feedback on potential changes to thresholds used to determine whether a facility qualifies as a “low-volume” facility (in order to receive the Low-Volume Payment Adjustment) and seeks feedback on the possible creation of a new payment adjustment that accounts for a facility’s isolation, rurality, and other geographic factors.
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Additionally, the proposed rule would add, remove, and modify several ESRD Quality Incentive Program (QIP) measures, and proposes changes to ESRD Treatment Choices (ETC) Model regulations to clarify that ETC participants can seek additional administrative review of their performance score. The proposed rule clarifies CMS’s evaluation of criteria for the Transitional Add-on Payment for New and Innovative Equipment and Supplies and provides the agency’s initial evaluation of one applicant product.
The following chart outlines key provisions of the proposed rule. Additional information is available in a CMS Fact Sheet. Comments are due by August 25, 2023, and the final rule is expected to be released in late October or early November 2023.