CMS issued a proposed rule July 6 that updates rates and payment policies under the End-Stage Renal Disease Prospective Payment System.
Five things to know:
1. CMS is proposing a $16.26 pay increase that would bring the 2021 end-stage renal disease payment base rate to $255.59. Of the increase to the base rate, $12.06 comes from a proposed update to the methodology that would include calcimimetic medication in the bundled payment.
2. CMS aims to increase the use of home dialysis machines by adding payment adjustments. Products from two manufacturers that include a dialyzer and a cartridge for a home dialysis machine are being considered for add-on payment adjustments in 2021.
3. The agency wants a 5 percent cap on any year-over-year decrease in a dialysis facility's wage index. The wage index is applied to the labor-related share of the payment rate to reflect differing wage levels in areas where dialysis facilities operate. The cap would be phased in over two years.
4. The rule would update the outlier services fixed-dollar loss amounts, as well as Medicare allowable payment amounts, for adult and pediatric patients. For adults, the new fixed-dollar loss would be $133.52, and the new Medicare-allowable payment would be $54.26. For pediatric patients, the new fixed-dollar loss would be $47.73, and the new Medicare-allowable payment would be $33.08.
5. CMS expects the proposed changes to increase total payments to dialysis facilities by 1.6 percent in 2021 compared to this year. Hospital-based dialysis facilities would see a decrease in total payments of 0.4 percent, and freestanding facilities would see a 1.6 percent increase.
Read the full rule here.