CMS Finalizes 2021 End-Stage Renal Disease Prospective Payment System Rule

King & Spalding

On November 2, 2020, CMS issued a final rule updating Medicare payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services for 2021. Under the final rule, the 2021 ESRD PPS base rate will be $253.13, which represents an increase of $13.80 to the 2020 base rate. CMS estimates this equates to an approximately $210 million increase in ESRD expenditures for 2021. The rule also sets a payment rate of $253.13 for treatment of acute kidney injuries provided by dialysis facilities and updates the ESRD Quality Incentive Program by (1) changing the scoring methodology for the Ultrafiltration Rate reporting measure and (2) updating the National Healthcare Safety Network (NHSN) validation study requirements.

In addition, CMS will expand eligibility for the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES) “to include certain capital-related assets that are home dialysis machines when used in the home for a single patient.” CMS will evaluate TPNIES applications to determine whether the home dialysis machine represents an advance that substantially improves the diagnosis or treatment of Medicare beneficiaries, and meets the other requirements under 42 C.F.R. § 413.236(b).

The final rule also includes the following additional updates:

  • an update to the ESRD PPS wage index to adopt the 2018 Office of Management and Budget delineations with a transition period;
  • an addition to the ESRD PPS base rate to include calcimimetics in the ESRD PPS bundled payment; and
  • a change to the low-volume payment adjustment eligibility criteria and attestation requirement to account for the COVID-19 Public Health Emergency.

The final rule is available here. The CMS press release regarding the final rule is available here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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