The Centers for Medicare & Medicaid Services (CMS) has issued its final rule updating 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. The provisions of the final rule are effective on Jan. 1.
The final rule establishes a new process for determining fee schedule amounts for new DMEPOS items, under which the agency will use the fee schedule amounts for the older items to establish the payment amounts for the new items. If there is no comparison, the fee schedule will be based on commercial pricing data, including internet retail prices.
In addition, CMS has finalized policies intended to streamline requirements for ordering DMEPOS items, including clarifying the documentation necessary to satisfy face-to-face encounter requirements, and standardized elements for written orders. CMS has also developed 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, 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 percent.
CMS also finalized several changes to the ESRD Quality Incentive Program, including updating the scoring methodology for the National Healthcare Safety Network Dialysis Event. Notably, CMS did not finalize its proposal to revise the scoring methodology for the Medication Reconciliation measure. Additional information on the final rule is available in a CMS fact sheet.