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CMS Finalizes 2021 End-Stage Renal Disease Prospective Payment System Rule Expanding Payments for In-Home Dialysis Equipment and Supplies
Thursday, November 5, 2020

On November 2, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized its 2021 End-Stage Renal Disease Prospective Payment System Rule. Among other things, the final rule expands Medicare payments for in-home dialysis equipment and supplies as part of an effort to encourage in-home care for populations vulnerable to COVID-19. We previously wrote about the proposed rule here.

To accomplish this, CMS will expand the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES) “to include certain capital-related assets that are home dialysis machines when used in the home for a single patient.” CMS will evaluate TPNIES applications to determine whether the home dialysis machine represents an advance that substantially improves the diagnosis or treatment of Medicare beneficiaries, and meets the other requirements under 42 CFR 413.236(b).

In addition to expanding the TPNIES, the finalized rule also:

  • Updates the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) wage index to adopt the 2018 Office of Management and Budget (OMB) delineations with a transition period;
  • adds to the ESRD PPS base rate to include calcimimetics in the ESRD PPS bundled payment; and
  • changes the low-volume payment adjustment eligibility criteria and attestation requirement to account for the COVID-19 Public Health Emergency (PHE).

A CMS fact sheet on the rule is available here. The final rule is set to be published in the Federal Register on November 9, 2020 and goes into effect on January 1, 2021.

This post was co-authored by Michael Lisitano, Law Clerk at Robinson+Cole. Michael is not yet admitted to practice law.

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