CMS Issues CY 2023 Proposed Rules for End Stage Renal Disease (ESRD) Prospective Payment System (PPS)
The Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS). These proposed rules cover renal dialysis services furnished to beneficiaries on or after January 1, 2023. Highlights are described below:
- Rebase and revise the ESRD market basket to a 2020 base year, which reflects the most recent and complete set of Medicare cost report data and other publicly available data.
- Propose base rate for the ESRD PPS at $64.09, which applies to ESRD and AKI patients receiving renal dialysis.
- Apply permanent 5 percent cap on any ESRD facility’s wage index decrease, and increase the wage index floor from 0.5000 to 0.6000.
- Update the requirements for the End-Stage Renal Disease Quality Incentive Program (ESRD QIP) to include a proposed measure suppression policy for the duration of the COVID-19 public health emergency (PHE).
- Update the ESRD Treatment Choices (ETC) Model to include revisions to the home dialysis rate, transplant rate, Performance Payment Adjustment (PPA) benchmarking methodology and scoring.
- Change to the definition of “oral-only drug” to include the word functional, which refers to functional equivalence as part of the current drug designation process based on ESRD PPS functional categories.
The complete ESRD PPS proposed rule summary can be found on the GORE Coding Resource Center website under “Education – CMS Rules Updates”: https://gore.rccsclients.com/education/rules-updates/.
