CMS Proposes ESRD Medicare Policy and Payment Changes

CMS has issued proposed rules to update Medicare payment rates and policies for End-Stage Renal Disease facilities paid under the ESRD Prospective Payment System, according to an AHA News Now report.

Medicare payments to the 5,633 ESRD facilities nationwide in CY 2013 are expected to total $8.7 billion.

Payment rates for outpatient maintenance dialysis treatments are expected to increase by 2.5 percent — the percentage comes from an ESRD bundled market basket increase of 3.2 percent minus a productivity adjustment of 0.7 percent, required by statute.

All policy changes combined, CMS anticipates payments to ESRD facilities to increase by 3.1 percent, with a 3.7 percent increase for hospital-based facilities.

CMS' proposed rule changes would also implement new requirements for the ESRD Quality Incentive Program, adding new measures as well as expanding the scope of some existing ones. For instance, new QIP rules would add a reporting measure for anemia management as well as clinical measures to evaluate dialysis adequacy.

Additionally, the proposed rule codifies provisions of the Middle Class Tax Extension and Job Creation Act of 2012 that require reductions in Medicare bad debt payments to acute care inpatient hospitals for assistance to low-income Medicare beneficiaries. The proposed rule lowers the current reduction level of 70 percent to 65 percent for FY 2013. The reduction level for critical access hospitals would lower from 100 percent to 65 over three years.

CMS will accept comments on the proposed rule changes through Aug. 31.

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