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Laws & Regulations

The Law Establishing the ESRD QIP

Section 153(c) of The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 directs the Secretary of the Department of Health and Human Services (HHS) to establish quality incentives for facilities furnishing renal dialysis services. The law outlines certain requirements regarding the selection of measures and scoring, the identification of performance standards and performance periods, and the opportunity for facility review of scores and public reporting. The language delineating the ESRD QIP requirements can be found in Section 1881(h) of the Social Security Act (SSA).  

ESRD QIP Rulemaking

For each year of the program, CMS writes a proposed rule, followed by a comment period and the publication of a final rule. All official CMS rules are published in the Federal Register. In our rule texts, we outline how we will implement the law establishing the ESRD QIP. The rules specify, in part, the following elements of the program for the applicable PY:

  • Performance standards for each measure
  • Performance period, or the time frame from which data will be used to evaluate facility performance
  • Methodology that will be used to score facilities
  • Payment reduction scale

Guide to ESRD QIP Rules

CMS uses the annual ESRD Prospective Payment System rule to establish ESRD QIP rules each payment year. Below is a guide to each of the rules CMS has published about the ESRD QIP. Note that the "calendar years" (CYs) referenced in the rule titles refer to the time frames for the ESRD Prospective Payment System itself, not necessarily ESRD QIP PYs.   

 

Rule Title Publication Date ESRD QIP-specific Provisions

ESRD Prospective Payment System Final Rule for CY 2011

August 10, 2010 Established general ESRD QIP provisions along with some information about PY 2012

ESRD QIP Final Rule (stand-alone)

January 5, 2011 Policies covering PY 2012

ESRD Prospective Payment System Final Rule for CY 2012

November 10, 2011 Policies covering PYs 2013 and PY 2014

ESRD Prospective Payment System Final Rule for CY 2013

November 9, 2012 Policies covering PY 2015

ESRD Prospective Payment System Final Rule for CY 2014

December 2, 2013 Policies covering PY 2016

ESRD Prospective Payment System Final Rule for CY 2015

November 6, 2014 Policies covering PYs 2017 - PY 2018

ESRD Prospective Payment System Final Rule for CY 2016

November 6, 2015 Policies covering PYs 2017 - PY 2019

ESRD Prospective Payment System Final Rule for CY 2017

November 4, 2016 Policies covering PYs 2018 - PY 2020

ESRD Prospective Payment System Final Rule for CY 2018

November 1, 2017 Policies covering PYs 2019 - PY 2021

ESRD Prospective Payment System Final Rule for CY 2019

November 14, 2018 Policies covering PYs 2021 - PY 2022

 

ESRD Prospective Payment System  

The ESRD Prospective Payment System (PPS) was revised in a separate but related part of MIPPA. The intent of the revised PPS is to encourage facilities to provide care more efficiently to beneficiaries with ESRD.  Under the law, payments for items and services that were previously paid separately are now “bundled” according to an established formula. This includes payments for dialysis treatments, prescription drugs, and clinical laboratory tests.

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