CMS Issues Final Rule on ESRD Prospective Payment System

On November 1, the Centers for Medicare and Medicaid Services (CMS) issued a final rule updating payment rates under the End-Stage Renal Disease Prospective Payment System (PPS) for dialysis services provided to Medicare beneficiaries.

The CMS will raise the End-Stage Renal Disease PPS base rate to dialysis facilities to $273.82. The new rate will go into effect on January 1, 2025. This is expected to increase total payments to ESRD facilities by about 2.7%.

The final rule also extends Medicare payment to dialysis in the home setting for beneficiaries with acute kidney injury. CMS will permit ESRD facilities to bill Medicare for the home and self-dialysis training add-on payment adjustment for beneficiaries with AKI.

In addition, the final rule will incorporate oral-only phosphate binders into the ESRD PPS bundled payment. Previously, oral-only drugs were excluded because the CMS lacked pricing and utilization data for them.

The multistakeholder coalition Kidney Care Partners applauded the changes but warned that, “Reform is needed to ensure that the bundle rate can be permanently adjusted when new treatment options become available, as is done in the hospital and other provider settings.”