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Federal Register / Vol. 86, No. 213 / Monday, November 8, 2021 / Rules and Regulations
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TABLE 17 : E sf1mated P aymentReducfions p aymentYears 2018 th rough2025
Payment year PY2025
PY2024
PY2023
PY2022
PY2021
PY2020
PY2019
PY2018

Estimated payment reductions $17,104,030.59
$17,104,030.59
$15,770,179 85 FR 71483
$0279

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f. Effects on Medicare Beneficiaries The ESRD QIP is applicable to dialysis facilities. Since the Programs inception, there is evidence on improved performance on ESRD QIP
measures. As we stated in the CY 2018
ESRD PPS final rule, one objective measure we can examine to demonstrate the improved quality of care over time is the improvement of performance standards 82 FR 50795. As the ESRD
QIP has refined its measure set and as facilities have gained experience with the measures included in the Program, performance standards have generally continued to rise. We view this as evidence that facility performance and therefore the quality of care provided to Medicare beneficiaries is objectively improving. We are in the process of monitoring and evaluating trends in the quality and cost of care for patients under the ESRD QIP, incorporating both existing measures and new measures as they are implemented in the Program.
We will provide additional information about the impact of the ESRD QIP on beneficiaries as we learn more.
However, in future years we are interested in examining these impacts through the analysis of available data from our existing measures.
g. Alternatives Considered In section IV.D. of this final rule, we are finalizing a special rule to modify the scoring methodology such that no facility will receive a payment reduction for PY 2022. Under this special rule for PY 2022, we will calculate measure rates for all measures for that payment year, but will not use those measure rates to generate an achievement or improvement score, domain scores, or a TPS. We considered retaining our current scoring policy for PY 2022.
However, we concluded that this was not feasible because of the EQRS system issues described in section IV.B.2., and 279 As discussed in section IV.D of this final rule, we are finalizing our proposed special scoring methodology and payment policy for PY 2022.
Under this policy, we will not apply any payment reductions to ESRD facilities for PY 2022.

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additionally, due to the impact of the COVID19 PHE on some of the PY 2022
ESRD QIP measures, as described more fully in section IV.C. of this final rule.
This approach will help to ensure that a facility would not be penalized due to extraordinary circumstances beyond the facilitys control.
d. ETC Model 1. Overview Under the ESRD PPS under Medicare Part B, a single per-treatment payment is made to an ESRD facility for all of the renal dialysis services defined in section 1881b14B of the Act and furnished to individuals for the treatment of ESRD
in the ESRD facility or in a patients home. Under the Physician Fee Schedule, medical management of an ESRD beneficiary receiving dialysis by a physician or other practitioner is paid through the MCP. The ETC Model is a mandatory payment model designed to test payment adjustments to certain dialysis and dialysis-related payments, as discussed in the Specialty Care Models final rule 85 FR 6114, for ESRD facilities and for Managing Clinicians for claims with dates of service from January 1, 2021 to June 30, 2027. The requirements for the ETC
Model are set forth in 42 CFR part 512, subpart C. The changes in this final rule discussed in detail in section V.B of this final rule will impact model payment adjustments for PPA Period 3, starting in July 1, 2023.
Under the current ETC Model, there are two payment adjustments designed to increase rates of home dialysis and kidney transplant waitlisting through financial incentives. The HDPA is an upward payment adjustment on certain home dialysis claims for ESRD facilities, as described in the final rule in 512.340 and 512.350, and to certain home dialysis-related claims for Managing Clinicians, as described in the final rule in 512.345 and 512.350, during the initial 3 years of the ETC
Model.
The PPA is an upward or downward payment adjustment on certain dialysis
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and dialysis-related claims submitted by ETC Participants, as described in the final rule in 512.375a and 512.380
for ESRD facilities and 512.375b and 512.380 for Managing Clinicians, which will apply to claims with claim service dates beginning on July 1, 2022
and increase in magnitude over the duration of the Model. We will assess each ETC Participants home dialysis rate, as described in the final rule in 512.365b, and ETC transplant waitlist rate, as described in 512.365c, for each Measurement Year MY. The ETC Participants transplant waitlist rate, will be aggregated, as described in 512.365e, and the ETC
Participants home dialysis rate will be aggregated, as described in 512.365e.
The ETC Participant will receive a Modality Performance Score MPS
based on the weighted sum of the higher of the ETC Participants achievement score or improvement score for the home dialysis rate and the higher of the ETC Participants achievement score or improvement score for the transplant waitlist rate, as described in 512.370d.
For MY1 and MY2 January 1, 2021
through July 6, 2022, the achievement scores will be calculated in relation to a set of benchmarks based on the historical rates of home dialysis and inclusion on the transplant waitlist among ESRD facilities and Managing Clinicians located in Comparison Geographic Areas. The improvement scores will be calculated in relation to a set of benchmarks based on the ETC
Participants own historical performance. The ETC Participants MPS for a MY will determine the magnitude of its PPA during the corresponding 6-month PPA Period, which will begin 6 months after the end of the MY. An ETC Participants MPS
will be updated on a rolling basis every 6 months.
As mentioned in section IV.C.2.b1 of the Specialty Care Models final rule 85
FR 61351, the intention was to increase achievement benchmarks over time through subsequent notice and
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$32,196,724 83 FR 57062
$31,581,441 81 FR 77960
$15,470,309 80 FR 69074
$11,576,214 79 FR 66257