The Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule (CMS-1768-F) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023.
Here’s what you need to know:
- Under the ESRD PPS for CY 2023, Medicare expects to pay $7.9 billion to approximately 7,800 ESRD facilities for furnishing renal dialysis services. The CY 2023 ESRD PPS base rate is $265.57, which is an increase of $7.67 from the current base rate of $257.90.
- CMS is revising the End-Stage Renal Disease Bundled (ESRDB) market basket to a 2020 base year using data from the Medicare Cost Report and other publicly available data. In addition, CMS is updating the labor-related share, as it is based on the labor-related cost share weights in the ESRDB market basket. The final CY 2023 labor-related share is 55.2% based on the 2020-based ESRDB market basket weights.
- Beginning CY 2023, CMS is increasing the wage index floor from 0.5 to 0.6. Additionally, CMS is establishing a permanent policy to apply a permanent 5% cap on decreases in the ESRD PPS wage index beginning CY 2023.
- Based on the latest available data, the fixed-dollar loss (FDL) amount for pediatric beneficiaries will decrease from $26.02 to $23.29, and the Medicare allowable payment (MAP) amount will decrease from $27.15 to $25.59, as compared to CY 2022 values. For adult beneficiaries, based on the latest data and finalized methodology, the FDL amount will decrease from $75.39 to $73.19, and the MAP amount will decrease from $42.75 to $39.62.
- CMS to include the word “functional” in the definition of oral-only drug at 42 C.F.R. § 413.234(a), effective January 1, 2025. Specifically, under the revised definition, an oral-only drug is a drug or biological product with no injectable functional equivalent or other form of administration other than an oral form.
- CMS is finalizing revisions to clarify the descriptions of the ESRD PPS functional categories to ensure they reflect current policies.
- As required by section 1834(r) of the Act, CMS is updating the AKI dialysis payment rate for CY 2023 to equal the CY 2023 ESRD PPS base rate and to apply the CY 2023 wage index. The CY 2023 AKI payment rate is $265.57.
- The policy finalizes changes to the End-Stage Renal Disease Quality Incentive Program (ESRD QIP) and changes to the ESRD Treatment Choices Model.
Source: U.S. Centers for Medicare & Medicaid Services (CMS)
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