CMS Issues CY 2024 Final Rule for End Stage Renal Disease (ESRD) Prospective Payment System (PPS)
On October 27, 2023, The Centers for Medicare and Medicaid Services (CMS) issued the final rule for the Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS) for Calendar Year (CY) 2024. This final rule covers renal dialysis services furnished to beneficiaries on or after January 1, 2024. Highlights are described below:
- Continue to use the finalized CY 2023 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.
- Continue to use the finalized CY 2023 labor-related share of 55.2 percent.
- CMS finalized a base rate for the ESRD PPS of $271.02, which applies to ESRD and AKI patients receiving renal dialysis.
- CMS finalized to update the requirements for the End-Stage Renal Disease Quality Incentive Program (ESRD QIP) to include a revision and codification of the definition of “minimum total performance score” to more accurately describe the calculation of the median national ESRD facility performance on reporting measures.
- CMS finalized to update the ESRD Treatment Choices (ETC) Model to include revisions regarding the availability and time specifics for the CMS Administrator review of targeted review requests.
- CMS finalized to modify the low-volume payment adjustment (LVPA) methodology and develop a new payment adjustment based on geographic isolation.
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/.
