The Centers for Medicare & Medicaid Services issued a final rule on Oct. 28 that updates payment policies and rates for the End-Stage Renal Disease Prospective Payment System for 2017. The final rule also made changes to the ESRD Quality Incentive Program (QIP), including payment years 2019 and 2020.

Changes to the ESRD PPS for 2017

  • The finalized CY 2017 ESRD PPS base rate will increase $1.16 to $231.55, compared to the 2016 rate of $230.39. This amount reflects a reduced market basket (0.55%), application of the wage index budget-neutrality adjustment factor (0.999781), as well as the application of a home and self-dialysis training budget-neutrality adjustment factor (0.999737). The finalized CY 2017 ESRD PPS base rate is an increase of $1.16 from the CY 2016 base rate of $230.39
  • For CY 2017, CMS is not making any changes to the application of the wage index floor, and will continue to apply the current wage index floor (0.4000) to areas with wage index values below the floor.
  • CMS is updating the outlier services fixed dollar loss amounts for adult and pediatric patients and Medicare Allowable Payments (MAPs) for CY 2016 using 2015 claims data. The fixed-dollar loss amount for pediatric beneficiaries will increase from $62.19 to $68.49 and the MAP amount will decrease from $39.20 to $38.29, compared to CY 2016 values.  For adult beneficiaries, the fixed-dollar loss amount will decrease from $86.97 to $82.92 and the MAP amount will decrease from $50.81 to $45.00.
  • The 2017 home and self-dialysis training add-on payment adjustment will be $95.60, an increase of $45.44, compared to the 2016 add-on of $50.16. CMS said it used an updated RN hourly wage of $35.94 and an increase to the hours of nurse training time from 1.5 hours to 2.66 hours.
  • CMS also said it will provide coverage and payment for renal dialysis services in 2017 by an ESRD facility to an individual with acute kidney injury.  Under the law, the payment will be the amount of the ESRD PPS base rate, as adjusted by the wage index. The agency also said that biologicals, laboratory services, and supplies that ESRD facilities are certified to furnish, but that are not renal dialysis services, may be paid for separately when furnished to individuals with AKI.

CMS said it expects to pay approximately $9 billion to approximately 6,000 ESRD facilities for the costs associated with furnishing chronic maintenance dialysis services in 2017.

The agency said it projects that the updates for CY 2017 will increase the total payments to all ESRD facilities by 0.73% compared with CY 2016.  For hospital-based ESRD facilities, CMS projects an increase in total payments of 0.9%, while for freestanding facilities, the projected increase in total payments is 0.7%.  Aggregate ESRD PPS expenditures are projected to increase by approximately $80 million from CY 2016 to CY 2017.