Medicare end-stage renal disease (ESRD) prospective payment system (PPS) payments are expected to increase by 1.6% — or about $210 million — in calendar year (CY) 2019 under the final rule published on November 14, 2018. The Centers for Medicare & Medicaid Services (CMS) has adopted a CY 2019 ESRD PPS base rate of $235.27, up from $232.37 in 2018. This rate is based on a 1.3% productivity-adjusted market basket increase and the application of a wage index budget-neutrality adjustment factor of 0.999506. CMS also expects that outlier policy changes in the final rule will increase payments by 0.3%.
The final rule updates a number of other ESRD policies, including: expanded Transitional Drug Add-on Payment Adjustment (TDAPA) eligibility and a revised payment basis for new renal dialysis drugs and biological products beginning January 1, 2020; revised low-volume payment adjustment regulations; an update to the acute kidney injury dialysis rate to $235.27 (the same as the CY 2019 ESRD PPS base rate); and modifications to ESRD Quality Incentive Program (QIP) reporting requirements and measures.
Furthermore, this rule included significant changes to Medicare reimbursement policies pertaining to durable medical equipment, prosthetics, orthotics and supplies; these policies are summarized in a separate post.