FEDERAL REGISTER 2017 ESRD PPS UPDATE

Under the ESRD PPS for CY 2016, Medicare expects to pay approximately $9.0 billion to approximately 6,000 ESRD facilities for the costs associated with furnishing chronic maintenance dialysis services. For high-cost patients, an ESRD facility may be eligible for outlier payments. There are also additional adjustments for ESRD facilities that have a low patient volume and for home dialysis training. The bundled payment rate is case-mix adjusted for a number of factors relating to patient characteristics. The bundled payment under the ESRD PPS includes all renal dialysis services furnished for outpatient maintenance dialysis, including drugs and biologicals (with the exception of oral-only ESRD drugs until 2025) and other renal dialysis items and services that were formerly separately payable under the previous payment methodologies. Under the ESRD QIP, facilities that do not achieve a minimum total performance score with respect to quality measures established in regulation receive a reduction in their payment rates under the ESRD PPS.ĮSRD PPS BACKGROUND: Section 153(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amended the Social Security Act to require CMS to implement a bundled PPS for renal dialysis services furnished to Medicare beneficiaries for the treatment of ESRD effective January 1, 2011. This proposed rule also includes changes to the ESRD Quality Incentive Program (QIP) for payment years (PYs) 2017-2019 under which payment incentives are applied to dialysis facilities to improve the quality of dialysis care.

Provisions in these rules are helping to move our health care system to one that values quality over quantity and focuses on reforms such as measuring for better health outcomes, focusing on disease prevention, helping patients live successfully at home, helping manageand improve chronic diseases, and fostering a more efficient and coordinated health care systems.

The ESRD proposed rule is one of several rules for calendar year 2016 that reflect a broader Administration-wide strategy to deliver better care at lower cost by finding better ways to deliver care, pay providers, and use information.

This rule also proposes new quality and performance measures to improve the quality of care by dialysis facilities treating patients with end-stage renal disease.

FEDERAL REGISTER 2017 ESRD PPS UPDATE

OVERVIEW: On June 26, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that will update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2016. The proposed rule will be published in the July 1 Federal Register withĬMS Proposed Updates to Policies and Payment Rates for End-Stage Renal Disease Facilities for CY 2016 and Proposed Changes to the ESRD Quality Incentive Program Specifically, the rule would replace four dialysis adequacy measures with a single clinical measure and adopt new quality reporting measures for ultrafiltration rate and flu vaccination. The Centers for Medicare & Medicaid Services (CMS) Friday issued a proposed rule for calendar year 2016.ĬMS proposes three new measures for the ESRD Quality Incentive Program for payment year 2019.

Federal register 2017 esrd pps