CMS moves calcimimetics to dialysis payment bundle, proposes to add $16 to composite rate
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CMS has proposed a $16.26 increase to the Medicare composite rate for dialysis treatments in 2021 to help cover the inclusion of calcimimetics in the payment bundle.
The payment increase, part of a proposed rule released on July 6 that updates rates and payment policies under the End-Stage Renal Disease Prospective Payment System, also includes financial incentives for using innovative equipment for patients on home dialysis.
If approved in the final rule, the new Medicare base rate for a dialysis treatment would be $255.59, a 1.6% increase compared with the 2020 payment rate.
Other items in the proposed rule include a 5% cap on any year-over-year decrease in a dialysis facility's wage index, phased in during a period of 2 years.
In a statement, Kidney Care Partners (KCP) said it “supports CMS’ decision to add new dollars to the ESRD PPS for calcimimetics, which will be added to the ESRD PPS bundle in 2021. While we will review the analytics underpinning the payment amount proposed, we believe the policy, which recognizes the need to adjust the bundle to provide adequate reimbursement, is the appropriate step forward. It is important that the PPS rate be appropriately balanced to support innovation.”
KCP said it was disappointed, however, that CMS has not proposed changes to the adjusters currently used in the ESRD PPS bundle.
“Both the Moran Company and [Medicare Payment Advisory Commission] MedPAC have demonstrated why the underlying methodology used to create the current adjusters gets them wrong and leads to money being taken away from patient care,” KCP noted.
KCP expressed support for expansion of the transitional add-on payment adjustment for new and innovative equipment and supplies to home dialysis, saying, “As the administration has recognized, fostering innovation is critically important to providing access to new therapy options for patients with kidney failure who require dialysis.”
In an email response to questions about the proposed rule, National Renal Administrators Association president Maria Regnier, RN, MSN, CNN, said the low volume adjuster allowance offered by CMS to help dialysis facilities during the COVID-19 pandemic “is something we have advocated for and we believe was heard by CMS.”
The low volume adjuster allowance would “hold harmless ESRD facilities that would otherwise qualify for the [allowance] but for a temporary increase in dialysis treatments furnished in 2020 due to the Public Health Emergency (PHE) for the COVID-19 pandemic,” CMS said.
The agency is proposing for purposes of determining LVPA eligibility for payment years 2021 through 2023 that ESRD facilities “would attest that their total dialysis treatments for any 6 months (consecutive or non-consecutive) of their cost-reporting period ending in 2020 is less than 2,000 and that, although the total number of treatments furnished in the entire year otherwise exceeded the LVPA threshold, the excess treatments furnished were due to temporary patient shifting resulting from the COVID-19 PHE.”
The expansion of the transitional add-on payment adjustment for innovative dialysis equipment and supplies for home dialysis in the proposed rule “is beneficial as we strongly support the ongoing need to encourage more innovation in the home field which could allow patients more options for home dialysis care,” Regnier told Healio Nephrology. The NRAA is still assessing whether the $12.06, the portion set aside in the proposed composite rate increase for calcimimetics, is “adequate, in particular for low volume facilities,” she added.
The proposed rule also updates payment to dialysis providers that treat patients with AKI. The payment rate would be the same as the base rate proposed under the ESRD PPS for calendar year 2021.
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