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2019-11-08
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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) Fee Schedule Amounts, DMEPOS Competitive Bidding Program (CBP) Amendments, Standard Elements for a DMEPOS Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements
Part III
Rules and Regulations
D09002ee1bdb6ac0c
D09002ee1bdb6accd
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) 2020. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also updates requirements for the ESRD Quality Incentive Program (QIP). In addition, this rule establishes a methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services, and a methodology for making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within 5 years of establishing the initial fee schedule amounts. This rule also revises existing regulations related to the DMEPOS competitive bidding program. This rule also streamlines the requirements for ordering DMEPOS items, and develops a new list of DMEPOS items potentially subject to a face-to-face encounter, written orders prior to delivery and/or prior authorization requirements. Finally, this rule summarizes responses to requests for information on data collection resulting from the ESRD PPS technical expert panel, changing the basis for the ESRD PPS wage index, and new requirements for the competitive bidding of diabetic testing strips.
84 FR 60648
https://www.govinfo.gov/app/details/FR-2019-11-08/2019-24063
2019-24063
fr08no19-15
RIN 0938-AT70
4120-01-P
CMS-1713-F
https://www.govinfo.gov/app/details/FR-2019-11-08/2019-24063
https://www.govinfo.gov/content/pkg/FR-2019-11-08/html/2019-24063.htm
https://www.govinfo.gov/content/pkg/FR-2019-11-08/pdf/2019-24063.pdf
Federal Health Insurance for the Aged and Disabled
Administrative Practice and Procedure
Diseases
Health Facilities
Health Professions
Medical Devices
Medicare
Reporting and Recordkeeping Requirements
Rural Areas
X-Rays
Laboratories
Biologicals
Drugs
162 p.
60648
60809
84 FR 60648
Code of Federal Regulations
Title 42 Part 405
42 CFR Part 405
Code of Federal Regulations
Title 42 Part 410
42 CFR Part 410
Code of Federal Regulations
Title 42 Part 413
42 CFR Part 413
Code of Federal Regulations
Title 42 Part 414
42 CFR Part 414
Regulation Identification Number 0938-AT70
RIN 0938-AT70
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) Fee Schedule Amounts, DMEPOS Competitive Bidding Program (CBP) Amendments, Standard Elements for a DMEPOS Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements; Federal Register Vol. 84, Issue
RULE
2019-24063
III
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
2020-01-01
CMS-1713-F
4120-01-P
2019-24063
Final rule.
This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2020. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also updates requirements for the ESRD Quality Incentive Program (QIP). In addition, this rule establishes a methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services, and a methodology for making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within 5 years of establishing the initial fee schedule amounts. This rule also revises existing regulations related to the DMEPOS competitive bidding program. This rule also streamlines the requirements for ordering DMEPOS items, and develops a new list of DMEPOS items potentially subject to a face-to-face encounter, written orders prior to delivery and/or prior authorization requirements. Finally, this rule summarizes responses to requests for information on data collection resulting from the ESRD PPS technical expert panel, changing the basis for the ESRD PPS wage index, and new requirements for the competitive bidding of diabetic testing strips.
These regulations 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.
Federal Health Insurance for the Aged and Disabled
Administrative Practice and Procedure
Diseases
Health Facilities
Health Professions
Medical Devices
Medicare
Reporting and Recordkeeping Requirements
Rural Areas
X-Rays
Laboratories
Biologicals
Drugs
Medicare Program:
End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc.,
DMEPOS@cms.hhs.gov
ESRDPayment@cms.hhs.gov
ESRDQIP@cms.hhs.gov
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https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/Educational_Resources.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-Claims-Based-Monitoring.html
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/ESRD-Transitional-Drug.html
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https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c08.pdf
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf
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https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R200BP.pdf
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Federal Register
Vol. 84, no. 217
Office of the Federal Register, National Archives and Records Administration
2019-11-08
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https://www.govinfo.gov/app/details/FR-2019-11-08
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