On June 27, 2024, CMS issued a proposed rule (the “Proposed Rule”) that would update payment rates and policies under the End Stage Renal Disease (ESRD) Prepaid Payment System (PPS) for renal dialysis services provided to Medicare beneficiaries on or after January 1, 2025.
CMS' proposed rule would also update dialysis payment rates for acute kidney injury (AKI) and expand Medicare payments to AKI beneficiaries receiving dialysis at home. Comments are due by August 26, 2024.
Proposed Updates to the ESRD PPS for 2025
The ESRD PPS provides a bundled per-treatment payment to facilities providing ESRD care, including all renal dialysis services provided for outpatient maintenance dialysis. The proposed PPS base rate for 2025 is $273.20. The current base rate for 2024 is $271.02. CMS estimates that this update will result in a 2.2% increase in total payments to all ESRD facilities from 2024.
CMS also proposes to include oral-only renal dialysis medications and biologics in the ESRD PPS starting in 2025.
Additionally, CMS proposed a new wage index to be used to adjust ESRD PPS payments for different geographic areas. In the previous rule, the hospital wage index value for each geographic area was used to adjust local ESRD PPS payments. In this proposed rule, CMS noted in previous comments that because hospitals have different proportions of registered nurses, technicians, and administrative staff than ESRD facilities, relying on hospital wage values may not accurately represent the relative wages paid to ESRD facilities.
Under CMS' proposed wage index, geographic adjustments to ESRD PPS payments would be based on data from the Bureau of Labor Statistics' Occupational Employment Wage Statistics and cost reports from freestanding ESRD facilities, rather than relying on hospital wage index values. CMS also proposes to expand outlier eligibility to all drugs and biologics that were considered composite rate services prior to the creation of the ESRD PPS in 2011.
Proposed Changes to the ESRD Quality Incentive Program
CMS is proposing to replace the current test to determine whether to reduce payments to facilities that do not meet a minimum overall performance score, beginning in 2027. The current test (Kt/V Comprehensive Clinical Measure of Dialysis Adequacy) is a single performance standard test for facilities. The new test will focus on separate scores for outcomes related to four different categories: (i) adult hemodialysis (HD) Kt/V, (ii) adult peritoneal dialysis (PD) Kt/V, (iii) pediatric HD Kt/V, and (iv) pediatric PD Kt/V.
Proposed Changes in Payment for Dialysis Services Provided to Patients with AKI
CMS is proposing to allow payment for AKI renal dialysis services provided to Medicare beneficiaries in their homes, beginning in 2025. CMS is also proposing to allow ESRD facilities to bill Medicare for an additional payment adjustment for training in home dialysis care for Medicare beneficiaries with AKI.
The proposed rule would also update the payment rate for AKI dialysis to $273.20, the same base rate proposed for the ESRD PPS.
The proposed rule: Federal Register Scheduled for release on July 5, 2024 here.
