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HHS/CMS RIN: 0938-AT04 Publication ID: Fall 2016 
Title: ●CY 2018 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (CMS-1674-P) 
Abstract:

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.

 
Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: First time published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: Yes  Unfunded Mandates: Undetermined 
EO 13771 Designation: uncollected 
CFR Citation: 42 CFR 413   
Legal Authority: 42 U.S.C. 1302    42 U.S.C. 1395d(d)    42 U.S.C. 1395f(b)    42 U.S.C. 1395g    ...   
Legal Deadline:
Action Source Description Date
Final  Statutory    11/01/2017 

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.

Timetable:
Action Date FR Cite
NPRM  06/00/2017 
Regulatory Flexibility Analysis Required: Undetermined  Government Levels Affected: Undetermined 
Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Michelle Cruse
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare, MS: C5-05-27, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-7540
Email: michelle.cruse@cms.hhs.gov