2006 proposed fee schedule - American Society of Clinical Oncology
2006 proposed fee schedule - American Society of Clinical Oncology 2006 proposed fee schedule - American Society of Clinical Oncology
statistical areas (MSAs) or their equivalents, and areas 140 outside of MSAs in each State, respectively. (51 FR 29411) Section 4201(a)(2) of OBRA 1990 (Pub. L. 101-508) froze the composite payment rates, and the basis for their calculation, at the level in effect as of September 30, 1990 (except for subsequent statutory updates that did not affect the data used to calculate wage indexes). The OBRA 1990 restriction on revising the ESRD composite payment rates has had another effect. ESRD facilities located in counties classified as rural based on the 1980 Census, but which subsequently are classified as urban, are still considered rural for purposes of determining whether urban or rural composite payment rates apply. The rural rates are generally lower than those for urban ESRD facilities. In addition, restrictions also apply to the wage index values used to compute the ESRD composite payment rates. Payments to facilities in areas where labor costs fall below 90 percent of the national average, or exceed 130 percent of that average, are not adjusted beyond the 90 percent or 130 percent level. (See the Prospective Reimbursement for Dialysis Services and Approval of Special Purpose Renal Dialysis Facilities final rule (48 FR 21254) and the Composite Rates and Methodology for Determining the Rates final notice (51 FR 29404)). This effectively means that ESRD facilities located in areas with wage index values less
141 than 0.9000 are paid more than they would otherwise receive if we fully adjusted for area wage differences. Conversely, facilities in locales with wage index values greater than 1.3000 are paid less than they would receive if we fully adjusted the rates based on actual wage levels. Section 1881(b)(12)(D) of the Act, as amended by section 623(d) of the MMA, gave the Secretary the discretionary authority to revise the current wage index. That provision also requires that any revised measure be phased-in over a multiyear period. In the November 15, 2004 final rule establishing new case-mix adjusted composite payment rates (69 FR 66332), we stated that we were deferring replacing the current wage index pending further assessment. We have completed our review, and believe that modernizing the current ESRD wage index is a matter of some urgency. After further analysis we are proposing to use OMB’s revised geographic definitions announced in OMB Bulletin No. 03-04, issued June 6, 2003. These new definitions are known as Core-Based Statistical Areas (CBSAs). In conjunction with the CBSAs, we are also proposing to recalculate the ESRD wage indexes based on acute care hospital wage and employment data for FY 2002, as reported to us in connection with the development of the wage index used in the inpatient hospital prospective payment system (IPPS). In addition, we are also proposing
- Page 89 and 90: challenge the validity of a new loc
- Page 91 and 92: ones reconfigured). Yet we also rec
- Page 93 and 94: The issue of payment locality desig
- Page 95 and 96: specialties listed infrequently as
- Page 97 and 98: for premium rating purposes. ISO co
- Page 99 and 100: psychology to the nonsurgical risk
- Page 101 and 102: to anesthesiology which is 2.84 rat
- Page 103 and 104: 103 However, as noted previously in
- Page 105 and 106: ● Category #1: Services that are
- Page 107 and 108: G0270, G0271 and 97802 through 9780
- Page 109 and 110: Group Medical Nutritional Therapy (
- Page 111 and 112: 111 furnished in the group setting
- Page 113 and 114: CMS Review 113 As noted previously,
- Page 115 and 116: system that permits the physician a
- Page 117 and 118: 117 associated with the provided se
- Page 119 and 120: 119 overlapping surgeries, the teac
- Page 121 and 122: anesthesia programs that have arran
- Page 123 and 124: 123 Section 623 of the MMA also req
- Page 125 and 126: 125 hospital-based facilities; whil
- Page 127 and 128: 127 The next step would be to devel
- Page 129 and 130: Drugs Second Quarter ASP +6 Percent
- Page 131 and 132: 131 independent facilities, to acco
- Page 133 and 134: 133
- Page 135 and 136: distributed this over a total proje
- Page 137 and 138: 137 additional 0.7 percent addition
- Page 139: 139 billed drugs regardless of sett
- Page 143 and 144: adoption of the new hospital wage i
- Page 145 and 146: of geographic designations for purp
- Page 147 and 148: and they may or may not be suitable
- Page 149 and 150: the Medicare Geographic Classificat
- Page 151 and 152: (2) Metropolitan Divisions Under OM
- Page 153 and 154: 153 applying revised composite paym
- Page 155 and 156: ased on the labor components establ
- Page 157 and 158: 157 actual cost structure faced by
- Page 159 and 160: 159 ESRD facilities is 53.711, as s
- Page 161 and 162: from the cost reports. To avoid dou
- Page 163 and 164: from Worksheet A. The resulting mar
- Page 165 and 166: (1) Hospital Data Used In this prop
- Page 167 and 168: wage data ended. However, since the
- Page 169 and 170: approach to phasing-in the proposed
- Page 171 and 172: facilities that would receive lower
- Page 173 and 174: 173 wage index values and then simu
- Page 175 and 176: 175 Because Neighborhood Dialysis C
- Page 177 and 178: 177 detected through our receipt of
- Page 179 and 180: 179 CBSA Code Urban Area Wage (Cons
- Page 181 and 182: 181 CBSA Code Urban Area Wage (Cons
- Page 183 and 184: 183 CBSA Code Urban Area Wage (Cons
- Page 185 and 186: 185 CBSA Code Urban Area Wage (Cons
- Page 187 and 188: 187 CBSA Code Urban Area Wage (Cons
- Page 189 and 190: 189 CBSA Code Urban Area Wage (Cons
statistical areas (MSAs) or their equivalents, and areas<br />
140<br />
outside <strong>of</strong> MSAs in each State, respectively. (51 FR 29411)<br />
Section 4201(a)(2) <strong>of</strong> OBRA 1990 (Pub. L. 101-508) froze<br />
the composite payment rates, and the basis for their<br />
calculation, at the level in effect as <strong>of</strong> September 30, 1990<br />
(except for subsequent statutory updates that did not affect<br />
the data used to calculate wage indexes). The OBRA 1990<br />
restriction on revising the ESRD composite payment rates has<br />
had another effect. ESRD facilities located in counties<br />
classified as rural based on the 1980 Census, but which<br />
subsequently are classified as urban, are still considered<br />
rural for purposes <strong>of</strong> determining whether urban or rural<br />
composite payment rates apply. The rural rates are<br />
generally lower than those for urban ESRD facilities.<br />
In addition, restrictions also apply to the wage index<br />
values used to compute the ESRD composite payment rates.<br />
Payments to facilities in areas where labor costs fall below<br />
90 percent <strong>of</strong> the national average, or exceed 130 percent <strong>of</strong><br />
that average, are not adjusted beyond the 90 percent or 130<br />
percent level. (See the Prospective Reimbursement for<br />
Dialysis Services and Approval <strong>of</strong> Special Purpose Renal<br />
Dialysis Facilities final rule (48 FR 21254) and the<br />
Composite Rates and Methodology for Determining the Rates<br />
final notice (51 FR 29404)). This effectively means that<br />
ESRD facilities located in areas with wage index values less
Change language