On Oct. 31, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2020. This rule also updates the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI and finalizes changes to the ESRD Quality Incentive Program (QIP).
The final rule is displayed in the October 31, 2019 Federal Register and can be downloaded at: https://www.federalregister.gov/documents/2019/11/08/2019-24063/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis
Changes to the End-Stage Renal Disease Quality Incentive Program (ESRD-QIP)
ESRD QIP Background: The End-Stage Renal Disease Quality Incentive Program (ESRD QIP) is authorized by section 1881(h) of the Act. Under the program, CMS assesses the total performance of each facility on measures specified for a payment year and applies an appropriate payment reduction to each facility that does not meet a minimum total performance score (TPS).
Finalized Policies for the ESRD QIP: This rule finalizes several programmatic updates beginning with the PY 2022 ESRD QIP, including an updated scoring methodology for the National Healthcare Safety Network (NHSN) Dialysis Event reporting measure so that new facilities and facilities that are eligible to report data on the measure for less than 12 months can receive a score on the measure, and the conversion of the Standardized Transfusion Ratio (STrR) clinical measure (NQF #2979) to a reporting measure while CMS continues to examine concerns raised by stakeholders about the measure’s validity. CMS is not finalizing its proposal to revise the scoring methodology for the Medication Reconciliation (MedRec) reporting measure and will continue to score that measure using the methodology it previously adopted.
CMS is also finalizing the performance and baseline periods for the PY 2023 ESRD QIP and that, beginning with the PY 2024 payment year, it will automatically adopt performance and baseline periods that are advanced 1 year from those specified for the previous payment year.
Finally, CMS is updating its regulation text for the program so that it better informs the public of the program’s requirements. The updates include a new policy that allows facilities to reject an extraordinary circumstances exception granted by CMS under certain circumstances.