Sec. 217. Revisions under the Medicare ESRD prospective payment system
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Section 632(b)(1) of the American Taxpayer Relief Act of 2012 ( 42 U.S.C. 1395rr note) is amended— by striking 2016 and inserting 2024 ; and by adding at the end the following new sentence: Notwithstanding section 1881(b)(14)(A)(ii) of the Social Security Act ( . 42 U.S.C. 1395rr(b)(14)(A)(ii) ), implementation of the policy described in the previous sentence shall be based on data from the most recent year available. Section 1881(b)(14)(I) of the Social Security Act ( 42 U.S.C. 1395rr(b)(14)(I) ) is amended by inserting and before January 1, 2015, after January 1, 2014, .
Section 1881(b)(14)(F)(i) of the Social Security Act ( 42 U.S.C. 1395rr(b)(14)(F)(i) ) is amended— in subclause (I)— by striking subclause
(II)and inserting subclauses
(II)and
(III); and by adding at the end the following new sentence: In order to accomplish the purposes of subparagraph
(I)with respect to 2016, 2017, and 2018, after determining the increase factor described in the preceding sentence for each of 2016, 2017, and 2018, the Secretary shall reduce such increase factor by 1.25 percentage points for each of 2016 and 2017 and by 1 percentage point for 2018. ; in subclause (II), by striking For 2012 and inserting Subject to subclause (III), for 2012 ; and by adding at the end the following new subclause: Notwithstanding subclauses
(I)and (II), in order to accomplish the purposes of subparagraph
(I)with respect to 2015, the increase factor described in subclause
(I)for 2015 shall be 0.0 percent pursuant to the regulation issued by the Secretary on December 2, 2013, entitled Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; Final Rule (78 Fed. Reg. 72156). . As part of the promulgation of annual rule for the Medicare end stage renal disease prospective payment system under section 1881(b)(14) of the Social Security Act ( 42 U.S.C. 1395rr(b)(14) ) for calendar year 2016, the Secretary of Health and Human Services (in this subsection referred to as the Secretary ) shall establish a process for— determining when a product is no longer an oral-only drug; and including new injectable and intravenous products into the bundled payment under such system. Section 1881(h)(2) of the Social Security Act ( 42 U.S.C. 1395rr(h)(2) ) is amended— in subparagraph (A)— in clause (ii), by striking and at the end; by redesignating clause
(iii)as clause (iv); and by inserting after clause
(ii)the following new clause: for 2016 and subsequent years, measures described in subparagraph (E)(i); and ; in subparagraph (B)(i), by striking (A)(iii) and inserting (A)(iv) ; and by adding at the end the following new subparagraph: The measures described in this subparagraph are measures specified by the Secretary that are specific to the conditions treated with oral-only drugs. To the extent feasible, such measures shall be outcomes-based measures. In specifying the measures under clause (i), the Secretary shall consult with interested stakeholders. Subject to subclause (I), any measures specified under clause
(i)must have been endorsed by the entity with a contract under section 1890(a). If the entity with a contract under section 1890(a) has not endorsed a measure for a specified area or topic related to measures described in clause
(i)that the Secretary determines appropriate, the Secretary may specify a measure that is endorsed or adopted by a consensus organization recognized by the Secretary that has expertise in clinical guidelines for kidney disease. . The Secretary of Health and Human Services shall conduct audits of Medicare cost reports beginning during 2012 for a representative sample of providers of services and renal dialysis facilities furnishing renal dialysis services. For purposes of carrying out paragraph (1), the Secretary of Health and Human Services shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of the Social Security Act ( 42 U.S.C. 1395t ) to the Centers for Medicare & Medicaid Services Program Management Account of $18,000,000 for fiscal year 2014. Amounts transferred under this paragraph for a fiscal year shall be available until expended.
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- 78 FR 72156
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Sec. 217
Revisions under the Medicare ESRD prospective payment system
Fed. Reg.78 FR 72156
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