42 CFR Subpart H Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs | Code of Federal Regulations | US Law | LawStack Online

42 CFR Subpart H

Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs

June 11, 2020

Quality incentive program payment

ESRD quality incentive program

Procedures for requesting exceptions to payment rates

Amount of payments

Principles of prospective payment

Prospective rates for hospital-based and independent ESRD facilities

Criteria for approval of exception requests

Payment exception: Pediatric patient mix

Payment exception: Self-dialysis training costs in pediatric facilities

Limitation on Review

Notification of changes in rate-setting methodologies and payment rates

Recordkeeping and cost reporting requirements for outpatient maintenance dialysis

Payment of independent organ procurement organizations and histocompatibility laboratories

Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries

Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries

Conditions for payment under the end-stage renal disease (ESRD) prospective payment system

Basis of payment

Items and services included in the ESRD prospective payment system

Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011

Determining the per treatment payment amount

Adjustment for wages

Low-volume adjustment

Rural facility adjustment

Drug designation process

Patient-level adjustments

Transitional add-on payment adjustment for new and innovative equipment and supplies

Transition period

Pharmacy arrangements

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