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CMS Proposes 2021 End Stage Renal Disease Prospective Payment System Rule

On July 6, 2020 the Centers for Medicare and Medicaid Services (CMS) proposed its calendar year 2021 End Stage Renal Disease (ESRD) Prospective Payment System (PPS) rule. ESRD PPS rules are promulgated on an annual basis providing updates to payment policies and rates for renal dialysis services furnished to beneficiaries. The 2021 proposed rule also proposes to update the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI, and proposes changes to the ESRD Quality Incentive Program. In addition to the annual technical updates, the 2021 rule proposes, at a high level:

  • Changes to the eligibility criteria and determination process for the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES), and defining “new” to be within 3 years beginning on the date of the FDA marketing authorization;

  • Expansion of the TPNIES to include new and innovative capital-related assets that are home dialysis machines, used in the home for a single patient;

  • Updates to the outlier policy and outlier services fixed-dollar loss amounts as well as the Medicare allowable payment amounts;

  • An addition to the ESRD PPS base rate to include calcimimetics in the ESRD PPS bundled payment;

  • A change to the low-volume payment adjustment eligibility criteria and attestation requirement to account for the COVID-19 public health emergency; and

  • An update to the ESRD PPS wage index to adopt the new Office of Management and Budget (OMB) delineations with a transition period.

If finalized the changes will take effect for services rendered after January 1, 2021. CMS is accepting comments referring to file code CMS-1732-P electronically, and by regular or overnight express mail until September 4, 2020.

This post was co-authored by Michael Lisitano, legal intern at Robinson+Cole

Copyright © 2020 Robinson & Cole LLP. All rights reserved.National Law Review, Volume X, Number 189

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Melissa Lisa Thompson Healthcare Lawyer Robinson Cole Law Firm
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Lisa Thompson advises companies, senior management, and their boards of directors, with a focus on the health care, life sciences and technology industries. She is a member of the firm’s Health Law Group and Data Privacy + Cybersecurity Team.  She is also an arbitrator on the Commercial panel and the Health Care panel of the American Arbitration Association.  

Health Care, Life Science and Technology Industries

Lisa represents domestic and international clients in the health care, life science and technology industries, including pharmaceutical companies,...

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