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Hospital-based end-stage renal disease facilities to get 1.8% payment increase

Simplified durable medical equipment bidding will increase access for patients, competition and affordability, CMS says.

Susan Morse, Senior Editor

Credit: <a href="https://en.wikipedia.org/wiki/United_States_Department_of_Health_and_Human_Services#/media/File:DHHS2_by_Matthew_Bisanz.JPG">Matthew Bisanz</a>.Credit: Matthew Bisanz.

The Centers for Medicare and Medicaid Services on Wednesday released proposed payment changes for durable medical equipment prosthetics, orthotics and supplies and the end-stage renal disease programs.

Payments for 2019 to end-stage renal disease facilities are expected to increase by 1.7 percent compared to this year.

For hospital-based ESRD facilities, CMS projects an increase in total payments of 1.8 percent, while for freestanding facilities, the projected increase in total payments is 1.7 percent.

For 2019, Medicare expects to pay approximately $10.6 billion to approximately 7,000 ESRD facilities for the cost associated with furnishing chronic maintenance dialysis services.

The proposed ESRD prospective payment system base rate is $235.82, an increase of $3.45 from the current base rate of $232.37.

The proposed reduction in renal facility documentation burden and other measures is expected to save renal disease facilities $12 million, according to CMS Administrator Seema Verma.

Under the rule, CMS, as the largest payer for kidney care, is giving incentives for new renal dialysis drugs and therapies for patients on dialysis.

CMS is expanding the end-stage-renal disease transitional drug add-on payment adjustment, or TDAPA. All new renal dialysis drugs and biologicals, as of January 1, 2019 regardless of whether they fit into an existing functional category, are to be eligible for TDAPA until the end of the period.

"At CMS, we celebrate innovation in the healthcare system and encourage new therapies that will help save lives and lower costs for patients," Verma said.

New simplified bidding proposals for durable medical equipment aim to increase access for patients and to increase competition and affordability.

Stakeholders had raised concerns about beneficiary access to items and services, CMS said.

There is currently no process for recompeting contracts with suppliers currently in effect. When current contracts expire on December 31, beneficiaries may receive items from any Medicare enrolled supplier until new contracts are awarded.

CMS expects to issue information on the next round of bidding at a later date.

As required by the 21st Century Cures Act, the rule also includes proposals that address Medicare fee schedule payments for durable medical equipment furnished on or after January 1, 2019 in areas of the country where competitive bidding is not in effect.

There are also facility-level adjustments for ESRD facilities that have a low patient volume for facilities in rural areas. For high-cost patients, an ESRD facility may be eligible for outlier payments.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

 

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