CMS ESRD and DMEPOS CY 2020 Proposed Rule

Posted on by lad3

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2020. This rule also:

  • Proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI
  • Proposes changes to the ESRD Quality Incentive Program
  • Includes requests for information on data collection resulting from the ESRD PPS technical expert panel, on possible updates and improvements to the ESRD PPS wage index, and on new rules for the competitive bidding of diabetic testing strips.

In addition, this rule proposes a methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services and making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within five years of establishing the initial fee schedule amounts. This rule would also:

  • Make amendments to revise existing policies related to the competitive bidding program for DMEPOS
  • Streamline the requirements for ordering DMEPOS items, and create one Master List of DMEPOS items that could potentially be subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements

The proposed CY 2020 ESRD PPS base rate is $240.27, an increase of $5.00 to the current base rate of $235.27.  This proposed amount reflects a reduced market basket increase as required by section 1881(b)(14)(F)(i)(I) of the Act (1.7 percent) and application of the wage index budget-neutrality adjustment factor (1.004180).

The proposed rule also includes:

  • Annual update to the wage index
  • Update to the outlier policy
  • Eligibility criteria for the Transitional Drug Add-on Payment Adjustment (TDAPA)
  • Basis of Payment for the TDAPA for calcimimetics
  • Average sales price conditional policy for the application of the TDAPA:
  • New and innovative renal dialysis equipment and supplies
  • Discontinuing the application of the erythropoiesis-stimulating agent monitoring policy
  • Impact analysis:

For more information see:

See the full text of this excerpted CMS Fact Sheet (issued July 29, 2019).