Medicare ESRD PPS Proposed Rule: What You Need to Know

Medicare ESRD PPS Proposed Rule: What You Need to Know

July 24, 2023

The Centers for Medicare & Medicaid Services (CMS) recently released the proposed End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) rule for renal dialysis services for Calendar Year 2024.

This proposed rule is expected to give providers a 1.6% reimbursement increase, which is significantly lower than the inflationary increases providers have experienced and fails to answer calls from the kidney care community for meaningful relief to address the ongoing workforce crisis. Additionally, the proposed rule proposes a new drug policy that is not sufficient to protect patient access to innovative drugs and biologics, which will further inequities these patients already face.

KCP is deeply disappointed with the CMS ESRD PPS Proposed Rule. We are concerned that:

  • CMS failed to acknowledge or provide relief to address the ongoing workforce crisis.
  • CMS’ payment policies are inadequate and do not allow for innovative treatment options.
  • These policies will widen disparities for individuals living with kidney disease or failure.
  • The proposed payment for post-transitional drug add-on payment adjustment (TDAPA) drugs will create significant access concerns for patients when the drug or biologic is medically needed for only a small percentage of patients.

KCP urges CMS to hear the concerns of our community and reconsider these insufficient proposals.

CMS needs to hear from members of the kidney community about the negative impact these policies will have on kidney care quality and innovation.

We encourage you to submit a letter to CMS urging them to address our community’s concerns through our easy-to-use grassroots portal. Click here to get started now.

To read KCP’s statement on the proposed rule, click here.