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June 28, 2024
Health Law Weekly

CMS Proposes $170 Million Bump in Medicare Payments for Dialysis Facilities in 2025

  • June 28, 2024

The Centers for Medicare & Medicaid Services (CMS) issued June 27 a proposed rule that would boost Medicare payments under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) by 2.2% in calendar year 2025.

Under the proposed rule, slated for publication in the July 5 Federal Register, CMS estimates that the aggregate ESRD PPS expenditures would increase by about $170 million next year overall. Beneficiary coinsurance payments are projected to increase by 2.2%, or roughly $30 million, in 2025.

Breaking down the numbers further, CMS said total Medicare payments would increase by a projected 3.9% for hospital-based dialysis facilities and 2.1% for freestanding facilities in 2025, according to a fact sheet.

Medicare expects to pay $7.2 billion to the roughly 7,700 dialysis facilities in 2025, CMS said. The proposed rule sets the ESRD PPS base rate at $273.20, an increase of $2.18 from the 2024 base rate of $271.02. 

CMS also is proposing to expand the list of ESRD outlier services to include drugs and biological products that were or would have been included in the composite rate prior to establishment of the ESRD PPS, the fact sheet said.

The proposed rule also would create a two-tier Low-Volume Payment Adjustment where dialysis facilities that furnished fewer than 3,000 treatments per cost reporting year would receive a 28.4% upward adjustment to the base rate, and facilities that furnished 3,000 to 3,999 treatments would receive an 18.1% adjustment.

In addition, CMS is proposing to extend payment for acute kidney injury renal dialysis furnished to beneficiaries their homes. Under the proposal, ESRD facilities could bill Medicare for the home and self-dialysis training add-on payment adjustment for beneficiaries with AKI, the fact sheet said.

Comments on the proposed rule are due August 26.