CHA News Article

CMS Finalizes Payment Policies for End-Stage Renal Disease Prospective Payment System
For CEOs, CFOs, government relations staff, post-acute care staff

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule updating payment policies and rates under the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2021. The rule also finalizes updates to the acute kidney injury dialysis payment rate and finalizes changes to the ESRD Quality Incentive Program. 

The final CY 2021 ESRD PPS base rate is $253.13 – an increase of $13.80 compared to the current base rate of $239.33. CMS estimates that the updates for CY 2021 will increase the total payments to all ESRD facilities by 2% compared with CY 2020. For hospital-based ESRD facilities, CMS projects a decrease in total payments of 0.2%. 

In addition, the final rule: 

  • Updates to the ESRD PPS wage index to adopt the 2018 Office of Management and Budget delineations with a transition period 
  • Includes an addition to the ESRD PPS base rate to include calcimimetics in the ESRD PPS bundled payment 
  • Makes changes to the eligibility criteria and determination process for the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES) 
  • Expands the TPNIES to include new and innovative home dialysis machines 
  • Makes changes to the low-volume payment adjustment eligibility criteria and attestation requirement in response to the COVID-19 public health emergency 

A CMS fact sheet provides additional information. 

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