Dialysis facilities will get the same amount of Medicare reimbursement in calendar year 2014 as they did in CY 2013 under the final end-stage renal disease prospective payment system (ESRD PPS) released Nov. 22 by the Centers for Medicare and Medicaid Services (CMS). According to CMS, the final rule also implements a provision in the American Taxpayer Relief Act of 2012 that reduces payments to account for changes in the utilization of ESRD-related drugs and biologicals. However, the final rule provides for a multiyear phase-in of this adjustment to mitigate its impact on providers, the agency said. The final rule (CMS-1526-F) will be published in the Federal Register Dec. 2 and will take effect Jan. 1. Ordinarily, CMS said it provides a 60-day delay in the effective date of final rules after the date they are issued. However, the final rule was delayed as a result of the government shutdown, and the agency said “it would be contrary to the public interest to delay the effective date” of the ESRD PPS and ESRD Quality Incentive Program portions of the final rule. The rule also addresses issues related to the coverage of and payment for durable medical equipment, prosthetics, orthotics, and […]
Dialysis facilities will get the same amount of Medicare reimbursement in calendar year 2014 as they did in CY 2013 under the final end-stage renal disease prospective payment system (ESRD PPS) released Nov. 22 by the Centers for Medicare and Medicaid Services (CMS).
According to CMS, the final rule also implements a provision in the American Taxpayer Relief Act of 2012 that reduces payments to account for changes in the utilization of ESRD-related drugs and biologicals. However, the final rule provides for a multiyear phase-in of this adjustment to mitigate its impact on providers, the agency said.
The final rule (CMS-1526-F) will be published in the Federal Register Dec. 2 and will take effect Jan. 1. Ordinarily, CMS said it provides a 60-day delay in the effective date of final rules after the date they are issued. However, the final rule was delayed as a result of the government shutdown, and the agency said “it would be contrary to the public interest to delay the effective date” of the ESRD PPS and ESRD Quality Incentive Program portions of the final rule.
The rule also addresses issues related to the coverage of and payment for durable medical equipment, prosthetics, orthotics, and supplies. Additionally, the rule will make changes to the ESRD Quality Incentive Program for payment year 2016.
The final rule is a change from the proposed rule, in which ESRD facilities were scheduled to see their Medicare payments cut by $970 million in CY 2014.
The CMS in the final rule estimated that Medicare spending (total Medicare program payments) for ESRD facilities in CY 2014 will be approximately $8.8 billion. The estimate takes into account a projected increase in fee-for-service Medicare dialysis beneficiary enrollment of 3.1 percent in CY 2014, the agency said.
Under the ESRD PPS, beneficiaries are responsible for paying 20 percent of the ESRD PPS payment amount. As a result of the projected 0 percent overall increase in the final ESRD PPS payment amounts in CY 2014, the agency estimated that there will be no increase in beneficiary coinsurance.
The rule also finalized a 50 percent increase to the home dialysis training add-on payment adjustment that is made for both peritoneal dialysis and home hemodialysis training treatments.
Bundled Payments
According to the agency, the bundled payment under the ESRD PPS includes all renal dialysis services furnished for outpatient maintenance dialysis, including ESRD-related drugs and biologicals (with the exception of certain oral-only ESRD drugs until 2016) and other ESRD-related items and services that were formerly separately payable under the previous payment methodologies, the CMS said.
Under the CY 2014 final rule, the CMS finalized a marketbasket update—minus a multifactor productivity (MFP) factor—of 2.8 percent. That update reflects the CY 2014 marketbasket increase of 3.2 percent, minus the current forecast of the MFP adjustment of 0.4 percent.
Takeaway: Dialysis facilities will not see their Medicare payments cut in 2014.
