On June 30, 2023, CMS released the CY 2024 Proposed Rule that would increase the payment rates for freestanding End Stage Renal Disease (“ESRD”) facilities and hospital-based facilities by 1.6% and 2.6%, respectively, and the ESRD Prospective Payment System (“PPS”) base rate to $269.99. For the CY 2024 wage index update, CMS intends to use FY 2020 hospital cost report data from areas in which ESRD facilities are located but states it will use more recent data if it becomes available before the publication of the final rule.
There are several new proposals:
- CMS proposes two transitional add-on payment adjustments to allow it to obtain and analyze additional data and to seek additional comments on these adjustments. The proposed rule includes a transitional pediatric ESRD dialysis add-on payment adjustment for CYs 2024, 2025, and 2026. CMS estimates that providing dialysis services to children costs 40% more than providing dialysis services to adults, for which current adjusters account for only 10%. The new transitional adjuster represents a 30% increase, an approximate increase of $80 to $100 per pediatric ESRD dialysis treatment.
- CMS proposes a new three-year add-on payment for new renal dialysis drugs and biological products at the end of the current two-year Transitional Add-on Payment Adjustment (“TDAPA”). This decision represents CMS’s decision to forego adding the cost of new drugs and biological products into the ESRD base rate at the end of the TDAPA and gives it time to analyze cost reports to eventually incorporate the costs into ESRD market basket proxies.
- CMS waives the current low volume payment amount attestation requirement for ESRD facilities affected by disasters and other emergencies. The proposed rule updates the low-volume payment adjustment methodology and creates a new adjustment that increases payment to low-volume, geographically isolated and rural ESRD facilities as well as those facilities serving pediatric patients.
- The proposed rule codifies current quality reporting measures, removes two quality measures and adds a five-question quality measure on health equity, the Facility Commitment to Health Equity. CMS also proposes to add two measures on Social Drivers of Health in the payment year 2027 as part of the ESRD Quality Incentive Program.
Comments on this proposed rule are due August 25, 2023.
If you have any questions on this topic, or would like assistance preparing comments, please contact the following:
- Sue Andersen at sandersen@hallrender.com or (301) 785-3996;
- Elizabeth Elias at eelias@hallrender.com or (317) 977-1468; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.
