The Centers for Medicare & Medicaid Services (CMS) has issued its calendar year (CY) 2023 end stage renal disease (ESRD) proposed rule. Comments on the proposed rule are due 60 days from the date the rule is published in the Federal Register.
The proposed CY 2023 ESRD prospective payment system (PPS) base rate is $264.09, which would be an increase of $6.19 to the current base rate of $257.90. For hospital-based ESRD facilities, CMS projects an increase in total payments of 3.7% compared to CY 2022.
The rule proposes changes to the ESRD PPS methodology for calculating the outlier threshold for adult patients, and rebasing and revising the ESRD bundled market basket. It also proposes the following:increasing the labor-related share to 55.2%, a increasing the wage index floor from .5 to .6, andputting a permanent 5% cap on decreases to the ESRD PPS wage index.
In addition, it proposes an update to the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities for CY 2023.The rule also proposes to update requirements for the ESRD Quality Incentive Program (QIP), and includes requests for information on topics that are relevant to the ESRD QIP. CMS is proposing refinements to the ESRD Treatment Choices Model in this proposed rule.
In order to explore options regarding payment under the ESRD PPS, the CY 2023 ESRD PPS proposed rule includes requests for information regarding (1) a potential add-on payment adjustment for certain new renal dialysis drugs and biological products, and (2) health equity issues under the ESRD PPS, with a focus on pediatric dialysis payment. The rule also includes a proposed change to the definition of “oral-only drug” beginning Jan. 1, 2025, along with a proposal to clarify the descriptions of the ESRD PPS functional categories.