The Centers for Medicare & Medicaid Services (CMS) released the final calendar year (CY) 2021 prospective payment system (PPS) for end stage renal disease (ESRD) facilities (fact sheet; press release).
- What it is. The final rule outlines ESRD PPS payment policies applying to dialysis facilities beginning on or after Jan. 1, 2020. The rule also includes final changes to the acute kidney injury (AKI) dialysis payment rate, as well as changes to the ESRD Quality Incentive Program (QIP).
- Why it is important for you. Under this final rule, CMS expects to pay $10.3 billion to approximately 7,400 facilities for furnishing dialysis services. Pursuant to the Trump administration’s executive order last year (WHG summary), this final rule establishes policies to encourage greater uptake of home dialysis technology by implementing add-on payments for the use of such services. In response to the COVID-19 pandemic, CMS is also finalizing a provision that will allow low-volume facilities to continue receiving low-volume facility payment adjustments if a facility’s case load increases to such a level that would normally disqualify it from receiving such adjustments, if the increase in services is attributable to COVID-19.
- Potential next steps. The finalized provisions go into effect on January 1, 2021.