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ESRD PPS Rates – CY 2012

From: MLN #MM7617 – 11/04/11

The CY 2012 PPS rates were released by CMS on November 4, 2011.  CY 2012 is the second year of this new PPS program.  There is a 4-year transition timeframe. In year two, ESRD facilities that are receiving a blended payment under the transition will be paid a 50% of the basic case-mix adjusted composite payment amount and 50% of the ESRD PPS payment amount.  This MLN article provides the nuts and bolts of the payment rate calculation for 2012.

Final Rules – ESRD PPS & Quality Incentive Program; Ambulance Fee Schedule & Other – CY 2012

CMS-1577-F; Posted 11/1/11; FR 11/10/11

CMS Summary:

This final rule updates and makes certain revisions to the End-Stage Renal

Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2012. We are also finalizing the interim final rule with comment period published on April 6, 2011, regarding the transition budget-neutrality adjustment under the ESRD PPS,. This final rule also sets forth requirements for the ESRD quality incentive program (QIP) for payment years (PYs) 2013 and 2014. In addition, this final rule revises the ambulance fee schedule regulations to conform to statutory changes. This final rule also revises the definition of durable medical equipment (DME) by adding a 3-year minimum lifetime requirement (MLR) that must be met by an item or device in order to be considered durable for the purpose of classifying the item under the Medicare benefit category for DME. Finally, this final rule implements certain provisions of section 154 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) related to the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) Competitive Acquisition Program and responds to comments received on an interim final rule published January 16, 2009, that implemented these provisions of MIPPA effective April 18, 2009.

CMS-1577-P; filed 7/1/11; FR Publication 7/8/11

CMS is proposing a 1.8% overall increase to the ESRD PPS rates beginning January 1, 2012. Total payments to ESRD facilities in 2012 is estimated to be $8.3 billion. This release also addresses a one-year extension of certain payment rate increases for both ground and air ambulance services as well as establishing a 3-year minimum lifetime for equipment to be considered durable for purposes of payment under the benefit category for durable medical equipment.

Summary in Proposed Rule:

This proposed rule would update and make certain revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2012. This proposed rule would also set forth proposed requirements for the ESRD quality incentive program (QIP) for payment years (PYs) 2013 and 2014. In addition, this proposed rule would revise the ambulance fee schedule regulations to conform with statutory changes. Finally, this proposed rule would revise the definition of durable medical equipment (DME) by adding a 3-year minimum lifetime criterion that must be met by an item or device in order to be considered durable for the purpose of classifying the item under the Medicare benefit category for DME. (See the Table of Contents for a listing of the specific issues addressed in this proposed rule.)

Click here to view CMS’s July 1^st press release.

4/6/2011 Federal Register – Interim Final rule

Federal Register Summary:

This interim final rule with comment will revise the end-stage renal disease (ESRD) transition budget-neutrality adjustment finalized in the CY 2011 ESRD Prospective Payment System (PPS) final rule for renal dialysis services provided on April 1, 2011 through December 31, 2011. We are revising the transition budget-neutrality adjustment to reflect the actual election decision to receive payment under the ESRD PPS for renal dialysis services furnished on or after January 1, 2011 made by ESRD facilities, rather than projected elections using the same methodology as described in the ESRD PPS proposed and final rules. This results in a zero percent adjustment for renal dialysis services furnished April 1, 2011 through December 31, 2011.

Read more here:  Changes to the End-Stage Renal Disease Prospective Payment System Transition Budget-Neutrality Adjustment