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End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
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This rule proposes to update and make revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014. This rule also proposes to set forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2016 and beyond. In addition, this rule proposes to clarify the grandfathering provision related to the 3-year minimum lifetime requirement (MLR) for Durable Medical Equipment (DME). In addition, it provides clarification of the definition of routinely purchased DME. This rule also proposes the implementation of budget-neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician’s office. Finally, this rule would make a few technical amendments and corrections to existing regulations related to payment for DMEPOS items and services.

The Addenda applicable to this proposed rule are available in the “Download” section below.  Addendum A is the wage indices for Urban Areas and Addendum B is the wage indices for Rural Areas used under the ESRD PPS.  An ESRD facility-level impact file based on the CY 2014 proposed provisions is also provided below.  Addendum C is applicable to DME policy and is the proposed reasonable charge amounts for splints, casts, and intraocular lenses inserted in a physician’s office.  

Also, included under the “Download” section, is an excel spreadsheet that provides the preliminary figures used in the calculation of the proposed adjustment to the ESRD PPS base rate to reflect change in utilization of ESRD-related drugs and biologicals discussed in section II.B.2.a.iv. of CMS-1526-P (78 FR 40843).