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CMS Issues Calendar Year 2020 ESRD/DMEPOS Proposed Rule

For CEOs, CFOs, Finance & Reimbursement Staff, Post-Acute Care Staff

The Centers for Medicare & Medicaid Services (CMS) has issued its proposed rule revising the end-stage renal disease (ESRD) prospective payment system (PPS) and policies related to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for calendar year (CY) 2020. CHA has made available a detailed summary of the proposed rule, prepared by Health Policy Alternatives. Comments on the proposed rule are due Sept. 27.

Following review of its policies for establishing the fee schedule for DMEPOS items and services – in particular, new items for which reasonable charge data do not exist – CMS proposes changes to its current practice of “gap-filling” to estimate what Medicare would have paid for an item. Specifically, CMS proposes to compare new DMEPOS items with older items based on physical, mechanical, and electronic components, as well as function and intended use. If the old item and the new item are comparable, CMS proposes using the old item’s fee schedule for the new item. If there is no comparison, the fee schedule would be based on commercial pricing data, including internet retail prices.

In addition, CMS proposes policies intended to streamline requirements for ordering DMEPOS items, including clarifying the documentation necessary to satisfy face-to-face encounter requirements, and proposed standardized elements for written orders. CMS also proposes to develop a single list of DMEPOS items potentially subject to a face-to-face encounter; written orders prior to delivery; and/or prior authorization requirements.

The proposed rule also includes an increase of $5 to the ESRD PPS base rate, to $240.27. In addition, CMS proposes a transitional add-on payment for facilities that introduce new renal dialysis equipment and supplies for two calendar years.

CMS also proposes changes to the ESRD Quality Incentive Program, including updating the scoring methodology for the National Healthcare Safety Network Dialysis Event; requiring facilities to report an anemia measure; and codifying the reporting period, data submission requirement, and exceptions reporting.

A CMS fact sheet on the proposed rule is available.