United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2018_register executive 2018-11-14 article Part II Rules and Regulations D09002ee1c7dec455 D09002ee1c7dec565 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2019. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). In addition, it updates and rebases the ESRD market basket for CY 2019. This rule also updates requirements for the ESRD Quality Incentive Program (QIP), and makes technical amendments to correct existing regulations related to the Competitive Bidding Program (CBP) for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Finally, this rule finalizes changes to bidding and pricing methodologies under the DMEPOS competitive bidding program; adjustments to DMEPOS fee schedule amounts using information from competitive bidding for items furnished from January 1, 2019 through December 31, 2020; new payment classes for oxygen and oxygen equipment and a new methodology for ensuring that new payment classes for oxygen and oxygen equipment are budget neutral; payment rules for multi- function ventilators or ventilators that perform functions of other durable medical equipment (DME); and revises the payment methodology for mail order items furnished in the Northern Mariana Islands. This rule also includes a summary of the feedback received for the request for information related to establishing fee schedule amounts for new DMEPOS items and services. 83 FR 56922 https://www.govinfo.gov/app/details/FR-2018-11-14/2018-24238 2018-24238 fr14no18-11 RIN 0938-AT28 4120-01-P CMS-1691-F https://www.govinfo.gov/app/details/FR-2018-11-14/2018-24238 https://www.govinfo.gov/content/pkg/FR-2018-11-14/html/2018-24238.htm https://www.govinfo.gov/content/pkg/FR-2018-11-14/pdf/2018-24238.pdf Health Facilities Kidney Diseases Medicare Reporting and Recordkeeping Requirements Administrative Practice and Procedure Health Professions Medicare Reporting and Recordkeeping Requirements 152 p. 56922 57073 83 FR 56922 Title 42 Part 413 42 CFR Part 413 Title 42 Part 414 42 CFR Part 414 RIN 0938-AT28 Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments To Correct Existing Regulations Related to the CBP for Certain DMEPOS; Federal Register Vol. 83, Issue RULE 2018-24238 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2019-01-01 CMS-1691-F 4120-01-P 2018-24238 Final rule.

This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2019. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). In addition, it updates and rebases the ESRD market basket for CY 2019. This rule also updates requirements for the ESRD Quality Incentive Program (QIP), and makes technical amendments to correct existing regulations related to the Competitive Bidding Program (CBP) for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Finally, this rule finalizes changes to bidding and pricing methodologies under the DMEPOS competitive bidding program; adjustments to DMEPOS fee schedule amounts using information from competitive bidding for items furnished from January 1, 2019 through December 31, 2020; new payment classes for oxygen and oxygen equipment and a new methodology for ensuring that new payment classes for oxygen and oxygen equipment are budget neutral; payment rules for multi- function ventilators or ventilators that perform functions of other durable medical equipment (DME); and revises the payment methodology for mail order items furnished in the Northern Mariana Islands. This rule also includes a summary of the feedback received for the request for information related to establishing fee schedule amounts for new DMEPOS items and services.

These regulations are effective January 1, 2019, except the amendments to 42 CFR 413.234, which are effective January 1, 2020. ESRDPayment@cms.hhs.gov, for issues related to the ESRD PPS and coverage and payment for renal dialysis services furnished to individuals with AKI. Health Facilities Kidney Diseases Medicare Reporting and Recordkeeping Requirements Administrative Practice and Procedure Health Professions Medicare Reporting and Recordkeeping Requirements Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments to Correct Existing Regulations Related to the CBP for Certain DMEPOS , DMEPOS@cms.hhs.gov ESRDPayment@cms.hhs.gov CMS.gov http://kidneycarepartners.com/wp-content/uploads/2014/11/tbKCQA_NQFendorsedSpecs10-26-17.pdf http://medpac.gov/docs/default-source/reports/june-2015-report-to-the-congress-medicare-and-the-health-care-delivery-system.pdf http://www.acphs.edu http://www.cms.gov/ESRDPayment/PAY/list.asp http://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/EndStageRenalDiseaseSystemFile.html http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/MarketBasketResearch.html http://www.gpo.gov/fdsys/ http://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities http://www.medpac.gov/docs/default-source/contractor-reports/jun13_geoadjustment_contractor.pdf?sfvrsn=0 http://www.qualityforum.org/SES_Trial_Period.aspx http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=86357 http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=86972 http://www.sba.gov/content/small-business-size-standards http://www.whitehouse.gov/omb/circulars_a004_a-4 https://aspe.hhs.gov/pdf-report/medicare-part-b-drugs-pricing-and-incentives https://aspe.hhs.gov/pdf-report/report-congress-social-risk-factors-and-performance-under-medicares-value-based-purchasing-programs https://aspe.hhs.gov/system/files/pdf/187581/PartBDrug.pdf https://medpac.gov/docs/default-source/reports/mar18_medpac_ch6_sec.pdf?sfvrsn=0 https://oig.hht.gov/oas/reports/region1/11400505.pdf https://www.bls.gov.oes/current/oes291141.htm https://www.bls.gov.oes/current/oes292071.htm https://www.bls.gov/oes/2015/may/oes_pr.htm https://www.bls.gov/oes/2017/may/naics4_621100.htm https://www.bls.gov/oes/current/oes113011.htm https://www.bls.gov/opub/btn/volume-2/expenditures-of-urban-and-rural-households-in-2011.htm https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Application_Form_and_Instructions.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid/index.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/End-Stage-Renal-Disease-ESRD-Payment-Regulations-and-Notices.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/ESRD-Transitional-Drug.html https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/061_TechnicalSpecifications.html https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/Downloads/NQF-2988-Patients-Receiving-Care-at-Dialysis-Facilities.pdf https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/MMF/General-info-Sub-Page.html https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c11.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c17.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c15.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107c03.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4PR242.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/Downloads/LVP_RTC_2_09_06.pdf https://www.ers.usda.gov/amber-waves/2017/july/urban-areas-offer-higher-earnings-for-workers-with-more-education/ https://www.qualityforum.org/Publications/2018/02/2018_Considerations_for_Implementing_Measures_Final_Report_-_Hospitals.aspx https://www.qualityforum.org/Setting_Priorities/Partnership/Measure_Applications_Partnership.aspx https://www.usrds.org/2017/view/v2_01.aspx https://www.usrds.org/2017/view/v2_06.aspx https://www.whitehouse.gov/omb/bulletins/ https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/bulletins/2017/b-17-01.pdf Vol. 83, no. 220 Office of the Federal Register, National Archives and Records Administration 2018-11-14 continuing daily deposited born digital 613 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2018-11-14 P0b002ee19dbe5f77 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr14no18 https://www.govinfo.gov/app/details/FR-2018-11-14 https://www.govinfo.gov/content/pkg/FR-2018-11-14/pdf/FR-2018-11-14.pdf https://www.govinfo.gov/content/pkg/FR-2018-11-14/xml/FR-2018-11-14.xml fdlp 56699 57306 DGPO 2018-11-14 2024-06-01 FR-2018-11-14 machine generated eng FR FR-2018-11-14 83 220