2006 proposed fee schedule - American Society of Clinical Oncology

adoption of the new hospital wage index, we began a
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five-year phase-in of the new measure. During the phase-in
period, we had intended to use a weighted wage index, under
which the BLS portion would decrease 20 percent and the
share represented by the hospital wage index would increase
20 percent each year. During the second year of the
phase-in, for which the hospital and BLS portions of the
wage index were 40 percent and 60 percent, respectively, the
wage index was frozen as a result of the OBRA 1990
prohibition on composite payment rate revisions.
The wage indexes are calculated for each urban and
rural area. In general, an urban area is a MSA or New
England County Metropolitan Area as defined by OMB based on
1980 U.S. Census definitions. A rural area consists of all
counties within each State outside of an urban area. The
counties which comprise the urban locales currently used to
compute the wage index values incorporated in the urban
composite payment rates were last published in the Federal
Register on May 30, 1986 (51 FR 19738-19739). Although OMB
has revised the definitions of the MSAs since that time, the
composite payment rate urban/rural designations have not
been changed due to the prohibition on revising the ESRD
payment methodology established under section 4201(a)(2) of
OBRA 1990. More current MSAs are used in connection with
several other non-acute care Medicare PPSs that we