MLN Connects® Special Edition for Tuesday, June 21, 2022

Home Health & ESRD Proposed CY 2023 Payment Rules

CMS issued a Calendar Year (CY) 2023 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule to update Medicare payment policies and rates for home health agencies. See a summary of key provisions. Proposals include:

Routine updates to the Medicare HH PPS and home infusion therapy services payment rates for CY 2023
Permanent prospective payment adjustment to the home health 30-day period payment rate
Requests for input on how best to implement a temporary payment adjustment for CYs 2020 and 2021, and collecting telehealth data on home health claims

We encourage you to review the rule, and submit formal comments by August 16, 2022.

CMS issued a Calendar Year 2023 ESRD Prospective Payment System (PPS) proposed rule to update Medicare payment policies and rates for renal dialysis services. See a summary of key provisions. Proposals include:

Rebase and revise ESRD Bundled market basket to a 2020 base year and update the labor-related share
Change ESRD PPS methodology for calculating the outlier threshold for adult patients
Apply a permanent 5% cap on decreases in the ESRD PPS wage index and increase the wage index floor
Change definition of “oral-only drug” beginning January 1, 2025, and clarify ESRD PPS functional category definitions
Request comments on whether three products meet eligibility criteria for the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES)
Request input on a potential add-on payment adjustment for new renal dialysis drugs and biological products and health equity issues under the ESRD PPS, with a focus on pediatric dialysis payment
Update requirements and input requests for the ESRD Quality Incentive Program

We encourage you to review the rule, and submit formal comments by August 22, 2022.

Posted 6/22/2022