CY2025 ESRD PPS Final Rule
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Update: On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2025. This rule also finalizes an update to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year (CY) 2025 and extends Medicare payment to dialysis in the home setting for beneficiaries with AKI. In addition, the final rule modifies how CMS will calculate the Transitional Drug Add-on Payment Adjustment (TDAPA) for oral-only phosphate binders beginning January 1, 2025. Furthermore, the rule updates requirements for the ESRD Quality Incentive Program (QIP), ESRD Facility Conditions for Coverage, and ESRD Treatment Choices Model. Read the full CMS press release here.
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RHA Members can view the Final Rule Summary here.
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On Monday, August 26, 2024, RHA submitted comments to CMS on the CY2025 ESRD PPS Proposed Rule. Read the RHA Comment Letter here.
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On June 27, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment rates and policies and includes requests for information under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2025. This rule also proposes an update to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year (CY) 2025 and proposes to extend Medicare payment to dialysis in the home setting for beneficiaries with AKI. In addition, the rule provides information on how CMS will operationalize the inclusion of oral-only drugs in the ESRD PPS payment as of January 1, 2025. Furthermore, the rule proposes to update requirements for the ESRD Quality Incentive Program (QIP).
For CY 2025, CMS is proposing to increase the ESRD PPS base rate to $273.20, which would increase total payments to all ESRD facilities, both freestanding and hospital-based, by approximately 2.2%. The CY 2025 ESRD PPS proposed rule also includes a proposed change to the methodology for calculating the ESRD facility wage index, proposed changes to the Low-Volume Payment Adjustment (LVPA) methodology, and several proposed changes to the ESRD outlier policy.
Read the RHA Summary here.
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