2006 proposed fee schedule - American Society of Clinical Oncology

● Extraordinary circumstances (§413.188).
● Self-dialysis training costs (§413.190).
● Frequency of dialysis (§413.192).
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Under section 1881(b)(7) of the Act, when a facility’s
costs were higher than the prospectively determined
composite rate, we could, under certain conditions, grant
the facility an exception to its composite payment rate and
set a higher prospective rate. The facility had to show, on
the basis of projected cost and utilization trends, that it
would have an allowable cost per treatment higher than its
prospective composite payment rate and that any excess costs
were attributable to one or more of the specific exception
criteria.
As explained further below, ESRD facility exception
rates in effect on December 31, 2000, or those that were
subsequently approved based on an application under section
422(a)(2)(B) of BIPA, (collectively hereinafter termed
“existing exception rates”), will remain in effect under
section 422(a)(2)(C) of BIPA as long as the exception rate
exceeds the facility’s updated composite payment rate.
Section 623 of the MMA amended BIPA to provide that the
prohibition on exceptions to the ESRD composite rate does
not apply to pediatric facilities that do not have an
exception rate in effect on October 1, 2002. As a result,
only pediatric facilities can now qualify for exception