News: CMS releases 2024 PPS final rule on end-stage renal disease

CDI Strategies - Volume 17, Issue 49

According to a press release, CMS has released its end-stage renal disease (ESRD) prospective payment system (PPS) final rule for the 2024 calendar year.

The ruling includes updates to base pay rates, new reporting requirements, additional pediatric ESRD dialysis payments, as well as updates to the acute kidney injury dialysis payment rates.

Here are some of the highlights of the new rule:

  • Annual update to the ESRD PPS base rate: According to CMS, Medicare is expected to pay $6.7 billion to approximately 7,900 ESRD facilities for treatment services. For 2024, the ESRD PPS base rate is set at $271.02, a $5.45 increase from the 2023 base rate.
  • Low-volume payment adjustment: CMS has created an exception process that will allow ESRD facilities “to close temporarily and reopen” in the event of a disaster or other emergency, while still maintaining the ability to receive a low-volume payment adjustment. CMS also noted that the adjustment will remain if the hospital exceeds the threshold “due to treating additional patients displaced by a disaster or other emergency.”
  • Measuring patient-level resource usage: Effective January 1, 2025, CMS will require ESRD facilities, in their ESRD PPS claims, to report “time on machine” (e.g., the number of minutes a patient spends receiving in-center hemodialysis treatment).
  • Transitional ESRD add-on payment: To address concerns regarding pediatric versus adult resource consumption, CMS is finalizing a transition pediatric ESRD add-on payment adjustment of 30% per treatment amount. CMS noted that this payment will begin on January 1, 2024, and extend throughout 2024, 2025, and 2026.

Editor’s note: To read the CMS press release, click here. To read the entire final rule, click here.