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CMS has made two major announcements regarding kidney care and dialysis treatments. These announcements are in regards to the Model Measurement Year 2 (MY2) Benchmarks and the proposed rule for Prospective Payment in 2022. If approved, these two changes will go in effect January 01, 2022.
Model Measurement Year 2 (MY2) Benchmarks
The End Stage Renal Disease (ESRD) Treatment Choices (ETC) Model Measurement Year 2 (MY2) achievement benchmarks are available. Measurement Year 2 began July 1, 2021 and ends June 30, 2022.
Achievement benchmarks for the ETC Model are based on historical home dialysis and transplant rates for non-participating ESRD facilities and Managing Clinicians who provide care in comparison geographic areas, i.e., HRRs that were not selected to participate in the ETC Model.
Achievement benchmarks are based on a 12-month time period, referred to as the benchmark year (BY), that begins 18 months before the start of the MY and ends 6 months prior to the MY. The BY for MY2 is January 1, 2020 through December 31, 2020.
CMS calculated BY2 home dialysis and transplant rates for ESRD facilities and Managing Clinicians in comparison geographic areas at the aggregation group level as described in the ETC final rule. CMS then calculated the 30th, 50th, 75th and 90th percentiles of the distributions of home dialysis and transplant rates.
The rates corresponding to each percentile cut-point will serve as benchmarks for assessing the performance of aggregation groups of ETC Participants during MY2. All ETC Participants are subject to the same achievement benchmarks.
Achievement benchmarks for MY2 are shown in the table below:
Proposed Rule for 2022 Prospective Payment
CMS has announced a proposal for its End-Stage Renal Disease (ESRD) Prospective Payment for 2022. The proposed changes are focused on encouraging dialysis providers to decrease disparities of home dialysis and transplants among lower income patients. This rule will reward ESRD facilities and clinicians for improving this disparity rate. If this rule is finalized, the following changes will take effect on January 01, 2022:
- Base Rate Updates. The new rule proposes increasing the base rate for ESRD to $255.55 which would be a $2.52 increase from the current rate of $253.13. Along with this, individuals with acute kidney injury will see an increase in rate to $255.55.
- Outlier Policy. Based on 2020 data, CMS has proposed to update the outlier services fixed-dollar loss amount. The fixed-dollar loss amount and Medicare allowable payment amount will decrease for pediatric and adult beneficiaries as follows: pediatric beneficiaries fixed-dollar amount from $44.78 to $30.38; Medicare allowable payment from $30.88 to $28.73, adult beneficiaries fixed-dollar amount from $122.49 to $111.18; Medicare allowable payment from $50.92 to $47.87.
- Quality Data Measurements. The proposal recommends suppression of some quality incentive payment program measures such as the standardized hospitalization ratio measure and standardized readmission ratio for payment adjusting purposes due to the COVID-19 pandemic.
- Removal of Payment Reductions for 2022. CMS proposes to change scoring and payment processes for 2022. Facilities will not receive a payment reduction in this performance year due to the COVID-19 pandemic. Providers can still expect payment increases for high performance.