November 4, 2020

Around the nation: CMS finalizes Medicare payment bumps for ESRD services

Daily Briefing

    Under the final rule, CMS will expand a transitional Medicare add-on payment to begin reimbursing providers at a higher rate if they treat end-stage renal disease patients with home dialysis machines, in today's bite-sized hospital and health industry news from Georgia, Maryland, and Massachusetts.

    • Georgia: CMS has approved Georgia's state innovation waiver request to eliminate its Affordable Care Act exchange portal beginning in 2023 and instead allow state residents to purchase exchange plans directly from private insurance companies or brokers via a new platform, called the Georgia Access Model. Under the new model, "private sector entities would provide all of the front-end consumer shopping experience and enrollment operations with the state providing back-end operations to handle eligibility determinations and enrollment reconciliation," according to a letter sent from CMS Administrator Seema Verma to Gov. Brian Kemp (R) approving the state's waiver request. In addition, Georgia beginning in 2022 will establish a reinsurance program intended to lower premiums for individual exchange plans (Morse, Healthcare Finance News, 11/2; Modern Healthcare, 11/1).

    • Maryland: CMS on Monday finalized a rule that will expand a transitional Medicare add-on payment to begin reimbursing providers at a higher rate if they treat end-stage renal disease (ESRD) patients with home dialysis machines. In addition, CMS under the rule—which is scheduled to take effect Jan. 1, 2021—will increase Medicare's ESRD Prospective Payment System base payment rate from $239.33 to $253.13 and will update Medicare payment rates for acute kidney injury dialysis. CMS under the final rule also will implement changes to the agency's ESRD Quality Incentive Program (Stein, Inside Health Policy, 11/2 [subscription required]; Brady, "Transformation Hub," Modern Healthcare, 11/2).

    • Massachusetts: The Boston Athletic Association (BAA) last week announced that it is delaying the Boston Marathon, which typically takes place on the third Monday in April, until the fall of 2021 because of America's coronavirus epidemic. The BAA said it will work with local, city, and state officials, as well as BAA's Covid-19 Medical & Event Operations Advisory Group, to "establish under what conditions the next live, in-person Boston Marathon can occur" (Mastrangelo, The Hill, 10/29).

    Have a Question?

    x

    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.

    X
    Cookies help us improve your website experience. By using our website, you agree to our use of cookies.