View Rule

This annual proposed rule would update the bundled payment system for ESRD facilities by January 1, 2018. The rule would also update the quality incentives in the ESRD program and implement changes to the DMEPOS competitive bidding program.

Statement of Need:

On January 1, 2011, CMS implemented the ESRD prospective payment system (PPS), a case-mix adjusted, bundled prospective payment system for renal dialysis services furnished by ESRD facilities.  Annually, we update and make revisions to the ESRD PPS and requirements for the ESRD Quality Incentive Program (QIP).  The ESRD QIP is the most recent step in fostering improved patient outcomes by establishing incentives for dialysis facilities to meet or exceed performance standards established by CMS.  Additionally, we annually adjust the methodology for adjusting DMEPOS fee schedule amounts.

Summary of the Legal Basis:

Section 1881(b)(14) of the Social Security Act (the Act), as added by section 153(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Public Law 110-275), and section 1881(b)(14)(F) of the Act, as added by section 153(b) of MIPPA and amended by section 3401(h) of the Affordable Care Act Public Law 111-148), established that beginning CY 2012, and each subsequent year, the Secretary will annually increase payment amounts by an ESRD market basket increase factor, reduced by the productivity adjustment described in section 1886(b)(3)(B)(xi)(II) of the Act.  Additionally, the QIP program is authorized under section 1881(h) of the Social Security Act (the Act).

Alternatives:

None.  This is a statutory requirement.

Anticipated Costs and Benefits:

Total expenditures will be adjusted for CY 2018.

Risks:

If this regulation is not published timely, ESRD facilities will not receive accurate Medicare payment amounts for furnishing outpatient maintenance dialysis treatments beginning January 1, 2018.