CMS Releases ESRD PPS Proposed Rule

King & Spalding

On June 26, 2015, CMS released a Proposed Rule to increase payments by 0.3% for end-stage renal disease (ESRD) care providers in 2016 under the ESRD Prospective Payment System (PPS) for renal dialysis services.  CMS estimates that the proposed rule will result in an increase of approximately $20 million in payments in 2016: a 0.5% increase for hospital-based ESRD facilities, and a 0.2% increase for freestanding facilities.  Comments on the Proposed Rule are due by August 25, 2015.

The proposed rule also includes provisions for adding new injectable and intravenous products into the bundled payment under the ESRD PPS and increasing outlier payments for ESRD beneficiaries requiring higher resource utilization, as well as revisions to the Low Volume Payment Adjustment eligibility criteria (excluding facilities of common ownership located within 5 miles from one another), and the continuing delay of payment for inclusion of oral-only ESRD drugs until January 1, 2025.

Additionally, the Proposed Rule addresses the ESRD Quality Incentive Program, proposing changes including, among others:

  • A potential reduction of up to 2% from Medicare payments each year for facilities that fail to achieve a minimum score for performance on certain quality measures;
  • A reinstatement of the qualifying patient attestations for the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems measure beginning in 2017;
  • Additions to the quality measure sets for the payment years 2018 and 2019;
  • Replacement of the four individual dialysis adequacy clinical measures with a single comprehensive clinical measure (the “Dialysis Adequacy clinical measure”);
  • Adoption of two new reporting measures beginning in 2019—the Ultrafiltration Rate reporting measure and the Full-Season Influenza Vaccination reporting measure;
  • Modification of the “small-facility adjuster” calculation; and
  • Continuation of the current data validation pilot program.

The proposal is set for publication in the Federal Register on July 1, 2015, with comments due August 25.  The CMS fact sheet regarding the Proposed Rule is available here.

Reporter, Katy Lucas, Atlanta, +1 404 572 2822,

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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