CMS proposes 3.1% increase in payments to dialysis providers in 2023
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CMS has released a proposed rule that would add $6.19 starting in January to the current bundled payment rate for dialysis treatments.
The rule, announced in a press release on June 21, covers the End-Stage Renal Disease Prospective Payment System (PPS) for dialysis services furnished to Medicare beneficiaries and is updated yearly.
The renal community has until August 22 to submit comments on the proposed rule (CMS-1768-P) at www.regulations.gov.
Under the ESRD PPS, dialysis providers receive a bundled, per-treatment payment that includes all dialysis services, as well as drugs and biological products (except for oral-only ESRD drugs until 2025). The bundled payment rate can also include a training add-on payment adjustment for home and self-dialysis modalities, an outlier payment for high-cost patients, and add-on payment adjustments for certain drugs, equipment and supplies.
Payments to facilities
Under the proposed ESRD PPS for 2023, the payment-per-treatment base rate for a dialysis treatment would be $264.09, according to a CMS press release. That rate covers hemodialysis and peritoneal dialysis treatments. Medicare pays 80% of the bundled payment rate.
If the rate is approved, Medicare would pay $8.2 billion to approximately 7,800 dialysis facilities for furnishing renal dialysis services in 2023. CMS projects that the update would increase the total payments to all facilities by 3.1% compared with calendar year (CY) 2022 rates.
For hospital-based dialysis facilities, CMS projects an increase in total payments of 3.7%, and for freestanding facilities, CMS projects an increase in total payments of 3.1%, according to a press release from CMS.
The agency expects to pay an estimated $8.8 billion to approximately 7,700 dialysis facilities this year, based on 2022 rates, for furnishing dialysis services.
Rebasing the bundle
In the proposed rule, CMS would rebase and revise the ESRD bundled (ESRDB) market basket for 2023 “using data from the Medicare Cost Report and other publicly available data,” according to the release.
Beginning in January, CMS is also proposing to apply a permanent 5% cap on decreases in the ESRD PPS wage index. “Specifically, CMS is proposing that an ESRD facility’s wage index for CY 2023 would not be less than 95% of its final wage index for CY 2022, and that for subsequent years, a facility’s wage index would not be less than 95% of its wage index calculated in the prior CY,” according to the release.
CMS is also requesting views from kidney community members on several topics, including a potential add-on payment adjustment for certain new renal dialysis drugs and biological products, and how health equity issues under the ESRD PPS, with a focus on pediatric dialysis payment, should be evaluated.
The rule also includes a proposed change to the definition of “oral-only drug” beginning Jan. 1, 2025, along with a proposal to clarify the descriptions of the ESRD PPS functional categories. “These proposals, if finalized, would help ensure that CMS policies are appropriately supporting innovation for new drugs that are truly innovative and not simply variations of existing drugs, and the requests for information will help CMS collect information on ways to align resource use with payment and ensure that Medicare beneficiaries with ESRD have continued access to technologies that can improve health outcomes and quality of life,” according to the CMS release.
The proposed rule can be downloaded from the Federal Register at: www.federalregister.gov/public-inspection/2022-13449/medicare-program-end-stage-renal-disease-prospective-payment.
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