End Stage Renal Disease (ESRD) CY 2020 Proposed Rule (CMS-1716-P)
On July 29, 2019, CMS issued a proposed rule that would update payment policies and rates under the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services effective January 1, 2020. The ESRD PPS provides a patient-level and facility-level adjusted per treatment payment to the ESRD facilities for dialysis services, whether done in the facility or the patient’s home. This classification also provides for high cost outliers when the type or amount of care occurs.
The proposed CY 2020 ESRD PPS base rate is $240.47, which is an increase of $5.00 to the current base rate of $235.27. This amount reflects both a decrease in the market basket amount (1.7 percent) and addition of the wage index budget-neutrality adjustment factor (1.004180). The ERSD wage indices are updated annually based on current hospital data; and Core-Based Statistical Area (CBSA), which accounts for the different wage levels in different ESRD facility locations. Updates will be made for CY 2020 based on the latest available data.
Also included in this proposed rule are updates to the Acute Kidney Injury (AKI) dialysis payment rate for dialysis services provided through ESRD facilities to AKI patients, which is proposed at $240.27. Changes were proposed to the ESRD Quality Incentive Program (QIP) including updates to the scoring methodology, which is the measure by which ERSD facilities receive payment.
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