2006 proposed fee schedule - American Society of Clinical Oncology

facilities that would receive lower payments using the
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revised wage adjustment to have an additional year to adapt
to the lower payment amount. This approach, if coupled with
allowing facilities that do better to move immediately to
the new wage index, would have a more significant impact on
the budget neutrality adjustment required by MMA. (See
budget neutrality discussion below.).
We are specifically seeking comments on the proposed
transition or any of the alternative approaches mentioned
above.
(5) ESRD Wage Index Budget Neutrality
Section 623(d) of MMA amended section 1881(b)(12)(E)(i)
of the Act which requires that any revisions to the ESRD
composite rate payment system as a result of the MMA
provision (including the geographic adjustment) be made in a
budget neutral manner. This means that aggregate payments
to ESRD facilities in CY 2006 should be the same as
aggregate payments would have been if we had not made any
changes to the geographic adjusters. In order to achieve
budget neutrality, we are proposing to apply a budget
neutrality adjustment factor directly to the revised ESRD
wage index values, rather than applying the adjustment to
the base composite payment rates. For payment purposes, we
believe this is the simplest approach since it allows us to
maintain a base composite rate for hospital-based facilities