Laws & Regulations

Laws & Regulations

The Law Establishing the ESRD QIP

Section 153(c) of The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 directs the Secretary of the Department of Health and Human Services (HHS) to establish quality incentives for facilities furnishing renal dialysis services. The law outlines certain requirements regarding the selection of measures and scoring, the identification of performance standards and performance periods, and the opportunity for facility review of scores and public reporting. The language delineating the ESRD QIP requirements can be found in Section 1881(h) of the Social Security Act (SSA).

ESRD QIP Rulemaking

For each year of the program, CMS writes a proposed rule, followed by a comment period and the publication of a final rule. All official CMS rules are published in the Federal Register. In rule texts, CMS outlines how the law establishing the ESRD QIP will be implemented. The rules specify, in part, the following elements of the program for the applicable payment year (PY):

  • Performance standards for each measure
  • Performance period, or the time frame from which data will be used to evaluate facility performance
  • Methodology that will be used to score facilities
  • Payment reduction scale

Guide to ESRD QIP Rules

CMS uses the annual ESRD Prospective Payment System (PPS) rule to establish ESRD QIP rules each PY. Below is a guide to each of the rules CMS has published about the ESRD QIP. Note that the "calendar years" (CYs) referenced in the rule titles refer to the time frames for the ESRD PPS itself, not necessarily ESRD QIP PYs.

 

Rule TitlePublication DateESRD QIP-specific Provisions
ESRD Prospective Payment System Final Rule for CY 2024November 6, 2023Policies covering PY 2025 - PY 2026
ESRD Prospective Payment System Final Rule for CY 2023November 7, 2022Policies covering PY 2023 - PY 2026
ESRD Prospective Payment System Final Rule for CY 2022November 8, 2021Policies covering PY 2022 - PY 2025
ESRD Prospective Payment System Final Rule for CY 2021 (PDF)November 9, 2020Policies covering PYs 2023 - PY 2024
ESRD Prospective Payment System Final Rule for CY 2020 (PDF)November 8, 2019Policies covering PYs 2022 - PY 2024
ESRD Prospective Payment System Final Rule for CY 2019 (PDF)November 14, 2018Policies covering PYs 2020-PY 2022
ESRD Prospective Payment System Final Rule for CY 2018November 1, 2017Policies covering PYs 2019 - PY 2021
ESRD Prospective Payment System Final Rule for CY 2017November 4, 2016Policies covering PYs 2018 - PY 2020
ESRD Prospective Payment System Final Rule for CY 2016November 6, 2015Policies covering PYs 2017 - PY 2019
ESRD Prospective Payment System Final Rule for CY 2015November 6, 2014Policies covering PYs 2017 - PY 2018
ESRD Prospective Payment System Final Rule for CY 2014December 2, 2013Policies covering PY 2016
ESRD Prospective Payment System Final Rule for CY 2013November 9, 2012Policies covering PY 2015
ESRD Prospective Payment System Final Rule for CY 2012November 10, 2011Policies covering PYs 2013 and PY 2014
ESRD QIP Final Rule (stand-alone)January 5, 2011Policies covering PY 2012
ESRD Prospective Payment System Final Rule for CY 2011August 10, 2010

Established general ESRD QIP provisions

along with some information about PY 2012

 

ESRD Prospective Payment System  

The ESRD Prospective Payment System (PPS) was revised in a separate but related part of MIPPA. The intent of the revised PPS is to encourage facilities to provide care more efficiently to beneficiaries with ESRD. Under the law, payments for items and services that were previously paid separately are now “bundled” according to an established formula. This includes payments for dialysis treatments, prescription drugs, and clinical laboratory tests.

Page Last Modified:
09/10/2024 06:18 PM