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Federal Register / Vol. 86, No. 213 / Monday, November 8, 2021 / Rules and Regulations
2 Effects on Other Providers Under section 1834r of the Act, as added by section 808b of TPEA, we are updating the payment rate for renal dialysis services furnished by ESRD
facilities to beneficiaries with AKI. The only two Medicare providers and suppliers authorized to provide these outpatient renal dialysis services are hospital outpatient departments and ESRD facilities. The patient and his or her physician make the decision about where the renal dialysis services are furnished. Therefore, this change will have zero impact on other Medicare providers.
3 Effects on the Medicare Program We estimate approximately $60
million will be paid to ESRD facilities in CY 2022 as a result of patients with AKI receiving renal dialysis services in the ESRD facility at the lower ESRD PPS
base rate versus receiving those services only in the hospital outpatient setting and paid under the outpatient prospective payment system, where services were required to be administered prior to the TPEA.

4 Effects on Medicare Beneficiaries Currently, beneficiaries have a 20
percent co-insurance obligation when they receive AKI dialysis in the hospital outpatient setting. When these services are furnished in an ESRD facility, the patients will continue to be responsible for a 20 percent coinsurance. Because the AKI dialysis payment rate paid to ESRD facilities is lower than the outpatient hospital PPSs payment amount, we expect beneficiaries to pay less co-insurance when AKI dialysis is furnished by ESRD facilities.
5 Alternatives Considered As we discussed in the CY 2017 ESRD
PPS proposed rule 81 FR 42870, we considered adjusting the AKI payment rate by including the ESRD PPS casemix adjustments, and other adjustments at section 1881b14D of the Act, as well as not paying separately for AKI
specific drugs and laboratory tests. We ultimately determined that treatment for AKI is substantially different from treatment for ESRD and the case-mix adjustments applied to ESRD patients may not be applicable to AKI patients and as such, including those policies and adjustment is inappropriate. We continue to monitor utilization and trends of items and services furnished to individuals with AKI for purposes of refining the payment rate in the future.
This monitoring will assist us in developing knowledgeable, data-driven proposals.
c. ESRD QIP
a. Effects of the PY 2022 ESRD QIP on ESRD Facilities The ESRD QIP is intended to prevent reductions in the quality of ESRD
dialysis facility services provided to beneficiaries. Although the general methodology that we use to determine a facilitys TPS is described in our regulations at 42 CFR 413.178e, we are finalizing our proposal to codify special
TABLE 11 : E sf 1mated
lotter on DSK11XQN23PROD with RULES2

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Percent of Facilities 75.66%

1,338
357
70
23

18.22%
4.86%
0.95%
0.31%

2024, we scored each facility on achievement and improvement on
PO 00000

Any reductions in the ESRD PPS
payments as a result of a facilitys performance under the PY 2024 ESRD
QIP will apply to the ESRD PPS
payments made to the facility for services furnished in CY 2024, as codified in our regulations at 42 CFR
413.177.
For the PY 2024 ESRD QIP, we estimate that, of the 7,717 dialysis facilities including those not receiving a TPS enrolled in Medicare, approximately 24.3 percent or 1,788 of the facilities that have sufficient data to calculate a TPS would receive a payment reduction for PY 2024. We are presenting an estimate for the PY 2024
ESRD QIP to update the estimated impact that was provided in the CY
2021 ESRD PPS final rule 85 FR 71481
through 71483. As a result of our finalized policies, the total estimated payment reductions for all the 1,788
facilities expected to receive a payment reduction in PY 2024 would decrease from $18,247,083.76 to approximately $17,104,030.59. Facilities that do not receive a TPS do not receive a payment reduction.
Table 11 shows the overall estimated distribution of payment reductions resulting from the PY 2024 ESRD QIP.

Number of Facilities 5,557

0.5%
1.0%
1.5%
2.0%
372 facilities not scored due to insufficient data
VerDate Sep<11>2014

b. Effects of the PY 2024 ESRD QIP on ESRD Facilities
oISt rI"bUfIOll 0f PY 2024 ESRD QIP P ayment Rd e UCtions
Payment Reduction 0.0%

To estimate whether a facility would receive a payment reduction for PY

scoring policies for PY 2022 at 42 CFR
413.178h. Under these finalized regulations, we will calculate measure rates for all measures but will not calculate achievement and improvement points for any measures. We will also not calculate or award a TPS for any facility. Finally, we will not reduce payment to any facility for PY 2022.
We believe there will be no effects of the PY 2022 ESRD QIP on ESRD
Facilities resulting from these finalized policies because no facilities will receive a TPS or payment reductions for PY 2022.

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several clinical measures we have previously finalized and for which there
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treatments in thousands. Column C
shows the effect of the final CY 2022
wage indices. Column D shows the effect of the CY 2022 ESRD PPS
payment rate update. The ESRD PPS
payment rate update is 1.9 percent, which reflects the ESRDB market basket percentage increase factor for CY 2022
of 2.4 percent and the productivity adjustment of 0.5 percent.
Column E reflects the overall impact, that is, the effects of the updated wage index and the payment rate update. We expect that overall ESRD facilities will experience a 1.9 percent increase in estimated payments in CY 2022. The categories of types of facilities in the impact table show impacts ranging from an increase of 0.0 percent to 2.5 percent in their CY 2022 estimated payments.