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ETC Managing Clinician PPA and KCF PBA Implementation

This Change Request (CR) will begin implementation of ETC's managing clinician PPA and KCF's PBA. The remainder of the work implementing those payment adjustments will be requested for implementation in April 2022.
The End Stage Renal Disease (ESRD) Treatment Choices (ETC) Model is a mandatory model (demo code: 94) for which about a third of the nation’s nephrologists and other clinicians who manage dialysis patients, referred to as Managing Clinicians, will be required to participate based on zip code. The ETC Model started on January 1, 2021, and ends on June 30, 2027. The KCC Model includes two options, each with its own demo code: Comprehensive Kidney Care Contracting (CKCC) (demo code: 93) and CMS Kidney Care First (KCF) (demo code: 97). The Kidney Care Choices (KCC) Model begins on January 1, 2022, and ends on December 31, 2024, or optionally, December 31, 2026. This CR primarily focuses on two payment mechanisms: the Performance Payment Adjustment (PPA) from the ETC model and the Performance Based Adjustment (PBA) from the KCC model. These adjustments apply to ESRD Monthly Capitation Payment (MCP) claims and start from July 1, 2022. The ETC model has another payment adjustment called the Home Dialysis Payment Adjustment (HDPA), which overlaps with the PPA and PBA and is also mentioned in this CR for appropriate processing of the claims and adjustments.

Download the Guidance Document

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: December 21, 2021

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.