Updated payment rates and policies and included requests for data under ESRD PPS for renal dialysis services furnished to Medicare beneficiaries on/after Jan. 1, 2025.
Also proposed an update to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year (CY) 2025.
Additionally, CMS requested public comment on a potential future health equity payment adjustment and potential future updates to the data validation policy.
ESRD PPS Provisions
Increased the ESRD PPS base rate to $273.20, which would increase total payments to all ESRD facilities, both freestanding and hospital-based, by approximately 2.2%.
Proposal established a methodology for calculating the ESRD facility wage index.
Set Low-Volume Payment Adjustment (LVPA) methodology and amended outlier policy.
Expanded list of ESRD outlier services to include drugs and biological products that were/would have been included in composite rate prior to establishment of ESRD PPS.
Provided data on how CMS will operationalize inclusion of oral-only drugs and biological products as well as budgetary estimates of effects of inclusion for public awareness.
AKI Provisions
Allowed payment for AKI renal dialysis services furnished to beneficiaries in homes.
Additionally, CMS proposed to permit ESRD facilities to bill Medicare for the home and self-dialysis training add-on payment adjustment for beneficiaries with AKI.
Updated AKI dialysis payment rate for 2025 to $273.20, equal to ESRD PPS base rate.
Proposed to apply CY 2025 ESRD PPS wage index to calculate AKI dialysis payments.
ESRD Facility Conditions for Coverage
Expanded coverage of home dialysis for beneficiaries with AKI, increasing patient options; proposed change reflects efforts to increase home dialysis access and uptake.
Made conforming changes throughout ESRD facility conditions for coverage (CfCs) to clarify home dialysis is available to all dialysis patients, including AKI, ESRD patients.
ESRD Quality Incentive Program
Beginning with payment year (PY) 2027, CMS is proposing to replace the Kt/V Dialysis Adequacy Comprehensive clinical measure, which scores facility performance.
With a Kt/V Dialysis Adequacy measure topic, comprised of 4 individual Kt/V measures and scored based on separate set of performance standards for each measure.
Under proposed update, individual Kt/V measures would be adult hemodialysis (HD) Kt/V, adult peritoneal dialysis (PD) Kt/V, pediatric HD Kt/V, and pediatric PD Kt/V.
Score measures as Kt/V Dialysis Adequacy Measure Topic, limit total weight of topic to 11% of TPS, weight of current Kt/V Dialysis Adequacy Comprehensive clinical measure
Proposed to remove the National Healthcare Safety Network (NHSN) Dialysis Event reporting measure from the ESRD QIP measure set beginning with PY 2027.
Consultation
Comments on proposed amendments must be submitted by Aug. 26, 2024.
Nov. 2024 CMS Final Rule
On Nov. 1, 2024, CMS issued final rule updating payment rates and policies under the ESRD PPS for renal dialysis services for Medicare beneficiaries on or after Jan. 1, 2025.
For calendar year (CY) 2025, CMS is increasing the ESRD PPS base rate to $273.82
Finalizes update to the AKI dialysis payment rate for renal dialysis services for 2025.
Extends Medicare payment to dialysis in the home setting for beneficiaries with AKI.
In addition, the final rule modifies how CMS will calculate the transitional drug add-on payment adjustment (TDAPA) for oral-only phosphate binders beginning Jan. 1, 2025.
Modifies the LVPA policy to create a two-tiered LVPA; facilities that furnished fewer than 3,000 treatments per cost-reporting year will receive 28.9% upward adjustment.
ESRD facilities that furnished 3,000 to 3,999 treatments receive an 18.3% adjustment.
Updates requirements for the ESRD Quality Incentive Program (QIP), ESRD Facility Conditions for Coverage, ESRD Treatment Choices Model, and ESRD outlier policy.
Includes changes to the methodology for calculating the ESRD facility wage index.
Nov. 2024 HHS Fed Reg Final Rule
On Nov. 11, 2024, CMS published final rule in federal register; effective Jan. 1, 2025.
