CMS Issues CY 2022 Final Rule for End Stage Renal Disease (ESRD) Prospective Payment System (PPS)
The Centers for Medicare and Medicaid Services (CMS) issued the final rule for the Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS). This final rule covers renal dialysis services furnished to beneficiaries on or after January 1, 2022. Highlights are described below:
- The finalized base rate for the ESRD PPS is $257.90, which applies to both ESRD and AKI patients receiving renal dialysis.
- The finalized wage index values are based on the latest data available data and CMS will be continuing the 2-year transition to the Office of Management and Budget (OMB) delineations as described in the September 14, 2018 OMB Bulletin No. 18–04.
- The finalized labor-related share is 52.3 percent, which is a continuation of the CY 2019 ESRD PPS final rule.
- The final CY 2022 average per treatment offset amount for Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) for capital-related assets that are home dialysis machines is $9.50. This offset amount reflects the application of the productivity-adjusted market basket increase of 1.9 percent ($9.32 × 1.019 = $9.50).
- Updates to the requirements for the End-Stage Renal Disease Quality Incentive Program (ESRD QIP) include a finalized measure suppression policy for the duration of the COVID-19 public health emergency (PHE); adoption of special scoring and payment policies to ensure no facility would receive a payment reduction; and calculation of performance standards using CY 2019 data.
- Changes to the ESRD Treatment Choices (ETC) Model include revisions to the home dialysis rate, transplant rate, Performance Payment Adjustment (PPA) benchmarking methodology and scoring, and Medicare waivers.
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/.
