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Reminder: Annual Mandatory Deadline for Submitting Low Volume ESRD Facility Adjustment Requests for CY 2020 Are Due by 11/1/2019

Attention End-Stage Renal Dialysis Facilities

Per 42 CFR Section 413.232, CMS notified ESRD providers that November 1st of each year is now the mandatory deadline for the submission of low volume attestations.

Thus, 11/1/2019 is the mandatory deadline for ESRD facilities to request continuation of their ESRD facility's low volume exception or to request a new exception when the facility believes they are eligible to receive the low volume payment adjustment for CY 2020.

To qualify for a low-volume adjustment to the facility's ESRD PPS rate the facility must have furnished less than 4,000 treatments in each of the three years preceding the payment year and has not opened, closed, or received a new provider number due to a change in ownership during the three years preceding the payment year. The three years preceding treatment data should be reflected on the last two settled cost reports and the most recent must be filed.

In addition, prior to 1/1/2016, the geographic proximity criterion is only applicable to ESRD facilities that are Medicare certified on or after 1/1/2011, to furnish outpatient maintenance dialysis treatments.

CR9478 instructs that effective 1/1/2016, CMS has:

  1. Removed the grandfathering of ESRD facilities that were Medicare certified prior to 1/1/2011 and
  2. Changed the geographic proximity criterion.

Specifically, (for the purposes of determining the number of treatments under the definition of a low-volume facility) beginning CY 2016, the number of treatments considered furnished by any ESRD facility (regardless of when it came into existence and was Medicare certified) will be equal to

  • the aggregate number of treatments actually furnished by the ESRD facility and
  • the number of treatments furnished by other ESRD facilities that are both
  • under common ownership with the ESRD facility in question and
  • five road miles or less from the ESRD facility in question.

If there is a change in ownership that does not result in a change in provider number but does cause a change in the original fiscal year to that of the new provider, resulting in two non-standard cost reporting periods, then the MAC should either:

  • Combine the two non-standard cost reports that equals 12 consecutive months, or
  • Where the two non-standard cost reporting periods in combination exceed 12 consecutive months, prorate the data to equal a full 12 consecutive month period.

In the situation where a hospital has multiple locations of a hospital-based ESRD facility under its governing body, the aggregate cost and treatment data of all of the locations (not just the treatment count of one of the sub-units or satellite entities) are reported on the hospital’s cost report. In the case where a hospital has multiple locations reported on its cost report, the MAC may consider other supporting data in addition to the total treatments reported in each of the 12-consecutive month cost reports, including other supporting documentation which may include individual facility treatment counts, rather than the hospital’s cost report alone. The hospital must provide the documentation to support the total treatment count for all the facilities that make up the total treatment count on the cost report for the MAC to review, even if not all the facilities are applying for the low volume adjustment.

Requirements for Submission of the Low Volume Request

The provider must notify National Government Services by 11/1/2019 if they believe they are eligible for the low-volume adjustment and include electronic documentation (prefer PDF) to support the request in accordance with basic low volume criteria.

  • Please do not send hard-copy mail.
  • This documentation must include a signed attestation by provider official regarding no new, closed, or change of ownership situations (in prior three years) (PDF format).
  • Providers should also include some form of documentation (internal provider statistical data, etc.) supporting less than 4,000 treatments in each of the prior three years (also in PDF, excel, or other electronic format). Please ensure that no PHI is sent via email.

Requests may be submitted electronically to:

All requests for the low-volume adjustment should be submitted via NGS Connex or emailed to NGS via one of the following: 

  • Providers in the J6 MAC states of Illinois, Minnesota and Wisconsin should contact: Kim.Toloday@anthem.com
  • Providers in the JK MAC states of Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont should contact: Jeff.Foster@anthem.com

When submitting email requests to designated NGS staff below, please include your RDF name and Medicare PTAN (legacy) number (e.g. 14-25XX, 33-23XX,  52-25XX, etc.) in the subject line of the email.  

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