ESRD Reports and Educational Resources

This webpage provides educational resources for the End Stage Renal Disease (ESRD) provider community.

Analysis of the ESRD PPS Payment Model

CMS contracted with a data contractor to conduct research and analysis to refine the case-mix adjustment model. Below, we will post information about this project as it progresses.

Data Collection

A Technical Expert Panel (TEP) was held on December 6, 2018 to discuss options for improving data collection for refining the ESRD PPS case-mix adjustment model. This TEP represented the first step in acquiring stakeholder and expert input to inform these refinements. The slides used during this TEP, as well as a report that summarizes the discussion and recommendations of the Technical Expert Panel, may be found below:

• End Stage Renal Disease Prospective Payment System Technical Expert Panel Presentation December 2021 (PDF)
• End Stage Renal Disease Prospective Payment System Technical Expert Panel Summary Report April 2022 for December 2021 TEP (PDF)
• End Stage Renal Disease Prospective Payment System Technical Expert Panel Presentation December 2020 (PDF)
• End Stage Renal Disease Prospective Payment System Technical Expert Panel Summary Report April 2021 for December 2020 TEP (PDF)
• End Stage Renal Disease Prospective Payment System Technical Expert Panel Presentation December 2019 (PDF)
• End Stage Renal Disease Prospective Payment System Technical Expert Panel Summary Report May 2020 for December 2019 TEP (PDF)
• End Stage Renal Disease Prospective Payment System Technical Expert Panel Presentation December 2018 (PDF)
• End Stage Renal Disease Prospective Payment System Technical Expert Panel Summary Report June 2019 for December 2018 TEP (PDF)

CY 2022 ESRD PPS RFI Summary of Comments

• CY 2022 ESRD PPS RFI Summary of Comments (PDF)

CY 2023 ESRD PPS RFI Summary of Comments

• CY 2023 ESRD PPS Equity RFI Summary of Comments (PDF)
• CY 2023 ESRD PPS Payment After TDAPA RFI Summary of Comments (PDF)

CY 2024 ESRD PPS RFI Summary of Comments

• CY 2024 ESRD PPS LVPA RFI Summary of Comments (PDF)

CMS Decision Memos

• Part D Payment for Drugs for Beneficiaries Receiving Renal Dialysis Services (PDF), 11/14/2014

CMS Manual References

• Medicare Claims Processing Manual, Chapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims (PDF)
• Medicare Claims Processing Manual, Chapter 16 - Laboratory Services (PDF), Section 40.6 and Exhibit 1.
• Medicare Benefit Policy Manual, Chapter 11 - End Stage Renal Disease (ESRD) (PDF)
• Medicare Secondary Payer (MSP) Manual, Chapter 2 - MSP Provisions (PDF), Section 20

Medicare Coverage Database

• Medicare Coverage Database - search National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions
• Medicare Coverage of Kidney Dialysis and Kidney Transplant Services

Medicare Learning Network® (MLN) Resources

• MLN Matters® Articles – search database for national CMS articles related to ESRD

Legislative Citations

• Section 153(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
• Section 3401(h) of the Patient Protection and Affordable Care Act (the Affordable Care Act or ACA)
• Section 632 of the American Taxpayer Relief Act of 2012 (ATRA)
• Section 217 of Protecting Access to Medicare Act of 2014 (PAMA)
• Section 204 of Stephen Beck, Jr., Achieving a Better Life Experience Act of 2014 (ABLE)
• Section 808 of the Trade Preferences Extension Act of 2015

Reports

• Analysis to Support the 2016 Refinements to the ESRD PPS (PDF) 6/2016
• Analysis to Inform the Design and Implementation of the End-Stage Renal Disease Prospective Payment System (PDF) 12/2015
• End Stage Renal Disease Payment System: Results of Research on Case-mix Adjustment for an Expanded Bundle (PDF) 2/2008
• A Design for a Bundled End Stage Renal Disease Prospective Payment System (PDF) 2008 Report to Congress

Other ESRD Related Websites

• Dialysis Facility Compare
• End Stage Renal Disease and Clinical Laboratories Open Door Forums
• End Stage Renal Disease (ESRD) Center
• Erythropoietin Stimulating Agents Policies
• ESRD Network Organizations
• ESRD PC Pricer
• ESRD Quality Incentive Program
• Medicare Part B Drug Average Sales Price
• National Kidney Disease Education Program (NKDEP)
• Preventive Services
• Survey & Certification - Certification & Compliance - Transplant
• Survey & Certification - Guidance to Laws & Regulations - Dialysis
• Telehealth