The Centers for Medicare & Medicaid Services (CMS) on Oct. 29 issued the Calendar Year (CY) 2022 End Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule.
The final rule increased the ESRD PPS base rate for freestanding and hospital-based dialysis facilities from $253.13 to $257.90 in CY 2022, which is projected to increase total payments to all ESRD facilities by 2.5%. However, hospital-based facilities are projected to receive a slightly higher 3.3% increase in total payments.
Additionally, the rule finalized an identical rate increase for the Acute Kidney Injury dialysis payment rate and finalized changes to the ESRD Treatment Choices (ETC) Model policies to encourage certain health care providers to decrease disparities in rates of home dialysis and kidney transplants among ESRD patients with lower socioeconomic status. The AAMC submitted comments on the proposed changes to the ETC model on June 28 [refer to Washington Highlights, July 1].
Among several finalized changes to the ETC Model, CMS will stratify the achievement benchmark based on the proportion of beneficiaries that are eligible for both Medicare and Medicaid (i.e., dual-eligible), which will create two different achievement thresholds used to set financial bonuses or penalties. Additionally, CMS added an upside-only Health Equity Incentive to increase health equity. Under the final policy, participants will receive the Health Equity Incentive if they increase the home dialysis rate or transplant rate among dual-eligible beneficiaries or Low-Income Subsidy recipients by 2.5 percentage points relative to the participant’s benchmark year. CMS proposed to require a 5% increase but agreed with the AAMC and other commenters to finalize a lower 2.5% threshold.
Finally, CMS made several changes to the ESRD Quality Incentive Program, including calculating performance standards for performance year (PY) 2024 using CY 2019 data, which is the most recently available full calendar year of data. Additionally, CMS finalized suppression of the Standardized Hospitalization Ratio and Standardized Readmission Ratio clinical measures. CMS also finalized a policy to ensure that no facility will receive a payment reduction for PY 2022, in order to address technical issues with the ESRD Quality Reporting System, and additionally, due to the impact of the COVID-19 public health emergency.