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CHA Issues Summary of CY 2020 End-Stage Renal Disease PPS and DMEPOS Final Rule

For CEOs, CFOs, finance & reimbursement staff, post-acute care staff

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CHA has issued a detailed summary, prepared by Health Policy Alternatives, of the changes in the calendar year 2020 end-stage renal disease (ESRD) prospective payment system (PPS) and the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) final rule.

The final rule establishes a new process for determining fee schedule amounts for new DMEPOS items and finalizes policies intended to streamline requirements for ordering DMEPOS items. CMS also has consolidated the previously separate lists into a single list of DMEPOS items potentially subject to a face-to-face encounter, written orders prior to delivery, and/or prior authorization requirements.

CMS has adopted an ESRD PPS base rate of $239.33, which is an increase of $4.06 compared to CY 2019. In addition, CMS has established a transitional add-on payment for facilities that introduce new renal dialysis equipment and supplies for two calendar years. CMS estimates that the updates for CY 2020 will increase the total payments to all ESRD facilities by 1.6% compared with CY 2019. For hospital-based ESRD facilities, CMS projects an increase in total payments of 2.1%.

The provisions of the final rule are effective on Jan. 1.

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