Regulatory Advisory

CMS Releases CY 2013 ESRD and Home Health PPS Final Rules

The Centers for Medicare & Medicaid Services (CMS) has issued the final payment rule updating the prospective payment system (PPS) for end-stage renal disease (ESRD) services for calendar year (CY) 2013. The final rule increases payments for outpatient maintenance dialysis treatments by 2.3 percent and makes changes to the ESRD quality incentive program, including expanding the scope of reporting measures to cover a broader range of patients who receive dialysis care. In addition, as required by the Middle Class Tax Extension and Job Creation Act of 2012, the rule finalizes a provision that reduces bad debt payments for eligible Medicare providers and removes the cap on bad debt reimbursement to ESRD facilities. CMS has also issued the home health PPS final payment rule, which makes a relatively small update, reducing payments to home health agencies by approximately 0.01 percent, or about $10 million in CY 2013. CMS also finalized a number of provisions intended to provide additional flexibility in certifying patients as eligible for the home health benefit and ensuring patients maintain access to therapy services. Both final rules, attached, go into effect Jan. 1, 2013.