Sec. 217. REVISIONS UNDER THE MEDICARE ESRD PROSPECTIVE PAYMENT SYSTEM
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## SEC. 217 REVISIONS UNDER THE MEDICARE ESRD PROSPECTIVE PAYMENT SYSTEM ###
(a)Delay of Implementation of Oral-Only Policy Section 632(b)(1) of the American Taxpayer Relief Act of 2012 (42 U.S.C. 1395rr note) is amended— ####
(1)by striking “2016” and inserting “2024”; and ####
(2)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.”. ###
(b)Mitigation of the Application of Adjustment to ESRD Bundled Payment Rate To Account for Changes in the Utilization of Certain Drugs and Biologicals ####
(1)In general 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,”. ####
(2)Market basket Section 1881(b)(14)(F)(i) of the Social Security Act (42 U.S.C. 1395rr(b)(14)(F)(i)) is amended— #####
(A)in subclause (I)— ######
(i)by striking “subclause (II)” and inserting “subclauses
(II)and (III)”; and ######
(ii)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.”; #####
(B)in subclause (II), by striking “For 2012” and inserting “Subject to subclause (III), for 2012”; and #####
(C)by adding at the end the following new subclause: > > ###### “(III) > > 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).” > . ###
(c)Drug Designations **[**[42 U.S.C. 1395rr note](/us/usc/t42/s1395rr)**]** 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— ####
(1)determining when a product is no longer an oral-only drug; and ####
(2)including new injectable and intravenous products into the bundled payment under such system. ###
(d)Quality Measures Related to Conditions Treated by Oral-Only Drugs Under the ESRD Quality Incentive Program Section 1881(h)(2) of the Social Security Act (42 U.S.C. 1395rr(h)(2)) is amended— ####
(1)in subparagraph (A)— #####
(A)in clause (ii), by striking “and” at the end; #####
(B)by redesignating clause
(iii)as clause (iv); and #####
(C)by inserting after clause
(ii)the following new clause: > > ###### “(iii) > > for 2016 and subsequent years, measures described in subparagraph (E)(i); and” > ; ####
(2)in subparagraph (B)(i), by striking “(A)(iii)” and inserting “(A)(iv)”; and ####
(3)by adding at the end the following new subparagraph: > > ##### “(E) Measures specific to the conditions treated with oral-only drugs > > > ###### “(i) In general > > 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. > > > ###### “(ii) Consultation > > In specifying the measures under clause (i), the Secretary shall consult with interested stakeholders. > > > ###### “(iii) Use of endorsed measures > > > ###### “(I) In general > > Subject to subclause (I), any measures specified under clause
(i)must have been endorsed by the entity with a contract under section 1890(a). > > > ###### “(II) Exception > > 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.” > . ###
(e)Audits of Cost Reports of ESRD Providers as Recommended by MedPAC **[**[42 U.S.C. 1395rr note](/us/usc/t42/s1395rr)**]** ####
(1)In general 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. ####
(2)Funding 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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