Federal Register - November 8, 2021
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Source: Federal Register
Federal Register / Vol. 86, No. 213 / Monday, November 8, 2021 / Rules and Regulations TABLE 18. Estimates of Medicare Proe:ram Savine:s
2022
2023
2024
2025
2026
2027
Net Impact to Medicare Spending Overall PPA Net & HDPA
Clinician PPA Downward Adjustment Clinician PPA Upward Adjustment Clinician PPA Net Clinician HDPA
Facility Downward Adjustment Facility Upward Adiustment Facility PPA Net Facility HDPA
Total PPA Downward Adiustment Total PPA Upward Adjustment Total PPA Net TotalHDPA
Kidney Disease Patient Education Services Costs
62015
15
9
-2
-10
-12
-18
-9
6.5 Year Total -28
14
7
-4
-12
-15
-21
-12
-43
-2
1
-1
0
-2
1
-1
-3
1
-2
-4
1
-2
-2
1
-1
0
-1
0
0
0
-13
5
-8
0
-21
12
-9
6
-25
15
-10
-31
18
-13
-39
20
-19
-21
10
-11
14
-9
5
-3
10
-146
80
-65
30
-22
13
-10
6
-28
16
-12
-34
19
-15
-42
21
-21
-23
11
-12
14
-9
6
-4
10
-159
86
-73
30
0
1
1
1
1
1
1
5
HD Training Costs 1
1
1
1
2
2
2
10
Totals may not sum due to rounding and from beneficiaries that have dialysis treatment spanning multiple years.
Negative spending reflects a reduction in Medicare spending. The Kidney Disease Patient Education Services Costs are less than $IM each year, but are rounded up to $IM to show what years they apply to. Similarly, the HD Training Costs are less than $ IM for years 2021-2024, but are rounded up to $ IM to indicate that costs were applied those years.
TABLE 19: Difference from the Proposed Rule 86 FR 36425 Rounded $M
Year of Model 2021
2022
2023
2024
2025
2026
2027
Net Impact to Medicare Spending
1
2
2
3
2
4.5 Year Total 10
Overall PPA Net & HDPA
1
2
2
3
2
10
Table 18 summarizes the estimated impact of the ETC Model when assuming preset benchmark updates where the achievement benchmarks for each year are set using the average of the home dialysis rates for year t-1 and year t-2 for the HRRs randomly selected for participation in the ETC Model. We estimate the Medicare program will save
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a net total of $43 million from the PPA
and HDPA between January 1, 2021 and June 30, 2027, less $15 million in increased training and education expenditures. Therefore, the net impact to Medicare spending is estimated to be $28 million in savings. In Table 18 and Table 19, negative spending reflects a reduction in Medicare spending, while positive spending reflects an increase.
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The results for both tables were generated from an average of 400
simulations under the assumption that benchmarks are rolled forward with a 1.5-year lag.
Table 19 is provided to isolate the total impact of the changes in this final rule for years 2023 going forward by calculating the difference from our final estimates in Table 18 less totals from the
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BILLING CODE 412001C
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Total PPA Downward Adiustment 1
1
1
1
1
4
Total PPA Upward Adjustment 0
1
1
2
1
5
Total PPA Net 1
2
2
3
2
10
TotalHDPA
0
Model changes effective for MY 3. Payments adjusted beginning in PPA Period 3, effective July 1, 2023 going forward. No changes to the HDPA. No changes to the Kidney Disease Patient Education Services Costs or the HD
Training Costs. See Table 18 for additional footnotes.
