CY2024 ESRD PPS Final Rule
Update: On October 27, CMS released the CY 2024 ESRD Prospective Payment System (PPS) Acute Kidney Injury, ESRD Quality Incentive Program, ESRD Treatment Choices (ETC) Model final rule. The summary includes an outline of major policies finalized in the rule, and please access a detailed summary of the rule here: RHA Final Rule Summary.
On Friday, August 25, RHA submitted comments to CMS on the CY2024 ESRD PPS Proposed Rule. Read the RHA Comment Letter here.
On June 26, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes 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, 2024. 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) 2024. In addition, the rule proposes to update requirements for the ESRD Quality Incentive Program (QIP).
- For CY 2024, CMS is proposing to increase the ESRD PPS base rate to $269.99, increasing total payments to ESRD facilities by approximately 1.6 percent. The CY 2024 ESRD PPS proposed rule also includes several proposals and requests for information related to ESRD PPS payment policies.
- First, this rule includes a proposed payment adjustment that would increase payment for certain new renal dialysis drugs and biological products after the Transitional Drug Add-on Payment Adjustment (TDAPA) period ends. This proposed increase would help ensure payment is not a barrier to accessing innovative treatments for Medicare ESRD beneficiaries. Additionally, in order to explore options regarding payment, the CY 2024 ESRD PPS proposed rule includes requests for information to inform potential future rulemaking regarding updates to the Low-Volume Payment Adjustment (LVPA) methodology and the possible creation of a new payment adjustment that would increase payment to geographically isolated ESRD facilities.
- The rule also proposes to create certain exceptions to the LVPA attestation process for ESRD facilities affected by disasters and other emergencies. Additionally, this rule includes proposals to require reporting of “time on machine” data (that is, the amount of time that a beneficiary spends receiving an in-center hemodialysis treatment) and reporting of discarded and unused amounts of certain renal dialysis drugs and biological products from single-dose containers and single-use packages, on ESRD PPS claims.
- This rule also includes a proposed transitional add-on pediatric ESRD dialysis payment adjustment for CYs 2024, 2025, and 2026, which is expected to promote equitable and accurate payments, since treatment for the pediatric ESRD population tends to be especially complex and costly.