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CMS Issues CY 2021 End-Stage Renal Disease PPS Proposed Rule

For CEOs, CFOs, government relations staff

The Centers for Medicare & Medicaid Services (CMS) has issued its proposed rule updating the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2021. The proposed rule also includes updates to the acute kidney injury dialysis payment rate and changes to the ESRD Quality Incentive Program. Comments on the proposed rule are due Sept. 4.  

CMS proposes an ESRD PPS base rate of $255.59 for CY 2021 — an increase of $16.26 compared to the current base rate of $239.33. CMS also proposes to adopt the latest core-based statistical area delineations for the wage index, and to apply a 5% cap to any decrease in a facility’s wage index from the prior calendar year.  

CMS also updates the eligibility criteria and determination process for the transitional add-on payment adjustment for new and innovative equipment and supplies, and proposes to expand the add-on payment to include new and innovative home dialysis machines. In response to the COVID-19 public health emergency, CMS proposes changes to the low-volume adjustment eligibility criteria and attestation requirements. 

A CMS fact sheet provides additional information and a detailed summary of the proposed rule, prepared by Health Policy Alternatives, Inc., is available for CHA members.