The Centers for Medicare & Medicaid Services (CMS) has issued its final Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates and policies for calendar year 2018. CMS projects that the final rule will increase total Medicare payments to all ESRD facilities by 0.5% in 2018 (lower than the 0.8% increase forecast in the proposed rule); payments to hospital-based ESRD facilities are expected to rise by 0.7% in 2018, while payments will increase by 0.5% for freestanding facilities.
The final update to the ESRD base rate is 0.3%, resulting from a 1.9% market basket increase that is partially offset by a 1% reduction under the Protecting Access to Medicare Act (PAMA) and a 0.6% multifactor productivity reduction. After the application of the wage index budget-neutrality adjustment, the final base rate is $232.37, compared to the 2017 base rate of $231.55.
The final rule also:
- Updates outlier fixed dollar loss amounts and Medicare Allowable Payments;
- Allows the use of any pricing methodology under section 1847A of the Social Security Act when average sales price (ASP) data is not available to determine the cost of drugs and biologicals for outlier payment purposes;
- Sets the acute kidney injury (AKI) dialysis rate to equal the proposed ESRD PPS base rate ($232.37); and
- Updates ESRD Quality Incentive Program (QIP) measures for payment year (PY) 2021, revises the ESRD QIP Extraordinary Circumstances Exception policy, and simplifies the Performance Score Certificate (beginning in PY 2019).