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.

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.