Payment Matters: Final Rule on ESRD PPS and Quality Incentive Program Issued

On November 10, 2011, CMS published a final rule that updated and made certain revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2012 [PDF]. In the same rule, CMS also finalized the final rule with comment period originally published on April 6, 2011, regarding the transition budget-neutrality adjustment under the ESRD PPS, and set out requirements for the ESRD quality incentive program (QIP) for payment years (PYs) 2013 and 2014.

In the final rule, CMS made the following announcements:

- For CY 2012, the composite rate portion of the ESRD PPS blended payment will be $141.94. The $141.94 reflects the addition of the CY 2011 part D per treatment amount ($0.49) to the CY 2011 composite rate of $138.53, and application of the ESRDB market basket minus productivity adjustment ($138.53 + 0.49 = $139.02; $139.02 x 1.021 = $141.94)...