On June 26, 2015, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2016. CMS anticipates that the proposed rule would increase overall Medicare payments to ESRD facilities by 0.3% ($20 million) compared with CY 2015 payments. The proposed CY 2016 ESRD PPS base rate of $230.20 would be a $9.23 reduction from the CY 2015 base rate of $239.43. The proposed rule would, among other things, modify case mix and low-volume payment adjustments and update outlier Medicare Allowable Payment and fixed dollar loss amounts. CMS also proposes a variety of updates to the ESRD Quality Incentive Program (QIP) for payment years 2017 through 2019, including changes to the reporting measures and revisions to the Small Facility Adjuster. Furthermore, in conformance with the Protecting Access to Medicare Act of 2014 (PAMA), the proposed rule would establish a drug designation process for: (1) determining when a product would no longer be considered an oral-only drug; and (2) including new injectable and intravenous products into the bundled payment under the ESRD PPS (under current statutory provisions, payment for oral-only ESRD drugs cannot be made under the ESRD PPS prior to January 1, 2025). CMS will accept comments on the proposed rule until August 25, 2015. The official version of the rule will be published on July 1, 2015.
This article is presented for informational purposes only and is not intended to constitute legal advice.
