CMS kidney care payment final rule: 6 things to know

CMS issued a final rule Oct. 31 that raises the base payment rate under the End-Stage Renal Disease Prospective Payment System and decreases supplemental payments to healthcare facilities for treatment of high-cost Medicare patients who use the payment system. 

Six things to know about the final rule, which will take effect Jan. 1:

Base rate

1. CMS will increase the base payment rate to healthcare facilities that provide renal dialysis services to Medicare beneficiaries for treatment of end-stage renal disease. The base rate will rise 1.7 percent, from $235.27 in 2019 to $239.33 in 2020.

Outlier payments 

2. CMS will decrease the outlier services fixed-dollar loss amounts for pediatric patients from $57.14 in 2019 to $41.04 in 2020. In addition, Medicare allowable payment amounts for pediatric patients will decrease from $35.18 in 2019 to $32.32. For adult patients, the fixed-dollar loss amount will be $48.33 in 2020, compared to the current amount of $65.11. The Medicare allowable payment amount for adult patients will decrease from $38.51 to $35.78.  

Transitional drug add-on payment adjustment for calcimimetics

3. CMS said it will still pay traditional drug add-on payment adjustments for calcimimetics, drugs that mimic the action of calcium on tissues, in 2020 but it is working to reduce the basis of payment. CMS now calculates payment adjustments for calcimimetics from the average sales price plus 6 percent. It is looking to change it to 100 percent of the average sales price.

Renal dialysis equipment and supplies

4. CMS will begin paying a transitional add-on payment adjustment for certain renal dialysis equipment or supplies provided by healthcare facilities that treat patients with end-stage renal disease. The agency will pay the adjustment for equipment and supplies that meet specific requirements. Those requirements include being designated as a renal dialysis service, being granted marketing authorization by the FDA on or after Jan. 1 and being classified as "innovative."

Erythropoiesis-stimulating agent monitoring policy

5. CMS said in 2020 it will no longer apply the erythropoiesis-stimulating agent monitoring policy under the new payment system for end-stage renal disease. Erythropoiesis-stimulating agents are medications that stimulate the bone marrow to make red blood cells. 

Acute kidney injury dialysis payment rate

6. CMS updated the acute kidney injury dialysis payment rate to healthcare facilities that provide renal dialysis services for acute kidney injury patients. TheI dialysis payment rate for them in 2020 will be $239.33.

Read more about the final rule here.

 

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