November 11, 2015
On November 6, 2015, the Centers for Medicare and Medicaid Services (CMS) published the final rule regarding the end-stage renal disease (ESRD) prospective payment system (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2016, and also regarding modifications to the ESRD quality incentive program (QIP). (80 Federal Register 68968, et seq.)
The final rule sets a base reimbursement rate of $230.39 per dialysis treatment for renal dialysis services provided in calendar year (CY) 2016, which is a $9.04 reduction from the CY 2015 base rate of $239.43. The final rule also codifies a statutory provision that delays the incorporation of oral-only drugs into the ESRD PPS until January 1, 2025.
In addition to finalizing the 2016 ESRD PPS payment policy, some highlights from the final rule include the following: