CMS Extends ESRD PPS Proposed Rule Comment Period

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  • November 13, 2009
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End-stage renal disease (ESRD) facilities concerned about a proposed ESRD prospective payment system (PPS) that would replace the current payment system and methodologies still have time to stand up and be heard. The Centers for Medicare & Medicaid Services (CMS) has extended the comment period out by 30 days.

CMS posted a notice, Nov. 4, extending the comment period for the ESRD PPS proposed rule from Nov. 16 to Dec. 16.

The ESRD PPS proposed rule is significant because it proposes a completely new payment system for outpatient ESRD services.

CMS explains in the notice that, “Due to the complexity and scope of the September 29, 2009 proposed rule, we believe additional time is necessary for the public to examine the proposed rule and to provide meaningful comments on its provisions.”

The proposed rule would replace the current basic case-mix adjusted composite payment system and methodologies for the reimbursement of separately billable outpatient ESRD services and implement a case-mix adjusted bundled PPS for Medicare outpatient ESRD dialysis patients beginning Jan. 1, 2011. Composite rate and separately billable services would be combined into a single base rate of $198.64, based on 2007 claims data.

This base rate would be further adjusted using patient specific case-mix adjustment factors, as well as urban and rural differences in area wage levels. ESRD facilities treating patients with unusually high resource requirements would be entitled to outlier payments; and facilities treating a low volume of ESRD pediatric patients would receive a special adjustment, according to the proposed rule.

The ESRD PPS provides a four-year phase-in period under which facilities would receive a blend of payments under the prior case-mix adjusted composite payment system and the new ESRD PPS.

Read more about the ESRD PPS proposed rule with comment period on the CMS Web site. The Nov. 4 notice provides commenting instructions.

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