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On July 6, 2020, CMS issued a proposed rule underneath the Finish Stage Renal Illness (ESRD) Potential Fee System (PPS). The rule proposes to replace fee insurance policies and charges for renal dialysis providers furnished to beneficiaries beginning in CY 2021 and additional proposes updates to the acute kidney harm (AKI) dialysis fee fee for renal dialysis providers furnished by ESRD amenities. It additional proposes adjustments to the ESRD High quality Incentive Program (QIP). Along with the annual technical updates, CMS additionally proposes a number of different adjustments. The proposed rule was revealed within the Federal Register right now. CMS is accepting feedback till September 4, 2020.
Replace to the ESRD PPS Base Charge
The proposed CY 2021 ESRD PPS base fee is $255.59, a rise of $16.26 to the present base fee. This displays the appliance of the proposed wage index budget-neutrality adjustment issue (.998652), the proposed addition to the bottom fee of $12.06 to incorporate calcimimetics, and a proposed productivity-adjusted market basket improve as required by part 1881(b)(14)(F)(i)(I) of the Social Safety Act (1.eight p.c), equaling $255.59.
Low-Quantity Eligibility Standards and Attestation Requirement
CMS is proposing to carry innocent ESRD amenities that will in any other case qualify for the Low Quantity Fee Adjustment (LVPA) however for a short lived improve in dialysis remedies furnished in 2020 because of the public well being emergency (PHE) for the COVID-19 pandemic. CMS is proposing that, for functions of figuring out LVPA eligibility for fee years 2021, 2022, and 2023, ESRD amenities would attest that their whole dialysis remedies for any 6 months (consecutive or non-consecutive) of their cost-reporting interval ending in 2020 is lower than 2,000 and that, though the whole variety of remedies furnished in all the 12 months in any other case exceeded the LVPA threshold, the surplus remedies furnished had been attributable to non permanent affected person shifting ensuing from the COVID-19 PHE. Medicare Administrative Contractors (MACs) would then annualize the variety of remedies reported for these six months by multiplying the variety of remedies by two. As well as, CMS decided that the COVID-19 pandemic justifies an exception to the November 1, 2020 attestation deadline. Due to this fact, for fee 12 months 2021, CMS is proposing to permit extra time for ESRD amenities to submit attestations by shifting the deadline to December 31, 2020.
New OMB Delineations and 2-Yr Transition Coverage
CMS proposes adopting the OMB delineations as described within the September 14, 2018 OMB Bulletin No. 18-04, starting with the CY 2021 ESRD PPS wage index. As well as, CMS is proposing to use a 5-percent cap on any lower in an ESRD facility’s wage index from the ESRD facility’s wage index from the prior calendar 12 months. This transition could be phased in over two years, such that the estimated discount in an ESRD facility’s wage index could be capped at 5 p.c in CY 2021, and no cap could be utilized to the discount within the wage index for the second 12 months, CY 2022.
Modifications to the Eligibility Standards and Dedication Course of Deadlines for the Transitional Add-On Fee for New and Modern Gear and Provides (TPNIES)
CMS is proposing adjustments to the TPNIES eligibility standards in mild of the adjustments carried out in CY 2020 to supply bi-annual coding cycles for code functions for brand new Healthcare Frequent Process Coding System (HCPCS) Degree II codes for sturdy medical tools, orthotics, prosthetics and provides (DMEPOS) objects and providers. For functions of eligibility for the TPNIES, CMS proposes that the HCPCS code software have to be submitted by the HCPCS Degree II code software deadline for biannual Coding Cycle 2 for DMEPOS objects and providers as specified within the HCPCS Degree II coding steering on the CMS web site. As well as, the Meals and Drug Administration (FDA) advertising and marketing authorization have to be submitted to CMS by the HCPCS Degree II code software deadline for the tools or provide to be eligible for the TPNIES the next 12 months. CMS defines “new” for functions of the TPNIES coverage as three years starting on the date of the FDA advertising and marketing authorization.
Inclusion of Calcimimetics within the ESRD PPS Base Charge
CMS is proposing the methodology for modifying the ESRD PPS base fee to incorporate calcimimetics within the ESRD PPS bundled fee. Utilizing the proposed methodology primarily based on the newest out there knowledge, CMS is proposing so as to add $12.06 to the ESRD PPS base fee starting in CY 2021.
CMS initiatives that the updates for CY 2021 will improve the whole funds to all ESRD amenities by 1.6 p.c in contrast with CY 2020. For hospital primarily based ESRD amenities, CMS initiatives a lower in whole funds of 0.Four p.c, whereas for freestanding amenities, the projected improve in whole funds is 1.6 p.c.
Moreover, there are proposed adjustments to the fee for renal dialysis providers furnished to people with AKI. As required by part 1834(r) of the Social Safety Act, CMS is proposing to replace the AKI dialysis fee fee for CY 2021 by the fee fee replace issue (1.eight p.c), the proposed wage index finances neutrality issue (.998652), and the proposed addition to the ESRD PPS base fee to incorporate calcimimetics. The proposed CY 2021 fee fee is $255.59, which is similar as the bottom fee proposed underneath the ESRD PPS for CY 2021.
Lastly, there are proposed adjustments to the ESRD QIP, underneath which CMS assesses the whole efficiency of every facility on measures specified for a fee 12 months and applies an applicable fee discount to every facility that doesn’t meet a minimal whole efficiency rating, and publicly experiences the outcomes.
If finalized, the adjustments will take impact for providers rendered after January 1, 2021.
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