2006 proposed fee schedule - American Society of Clinical Oncology

effect as long as the rate exceeds the updated composite
rate.
221
By prohibiting future exceptions to the composite rate
for ESRD facilities, we believe the Congress intended to
make the ESRD composite rate payment system more compatible
with other Medicare PPSs that do not allow exceptions to
their payment rates. By providing for the continuation of
existing exception rates as long as those rates exceed the
updated case-mix adjusted composite rate, we believe the
Congress intended, in effect, to provide for the transition
of most ESRD facilities to payment under the composite rate
payment system.
In response to ESRD facility concerns about the current
composite rate payment methodology, the Congress enacted
section 623 of the MMA, which revised ESRD facility
prospective composite payment rates. As a result, effective
January 1, 2005, ESRD facility prospective composite payment
rates were increased 1.6 percent and include a drug add-on
of 8.7 percent. These increases were implemented in the PFS
final rule published on November 15, 2004
(69 FR 66319-66320). Section 623 also amended section
422(a)(2) of BIPA to provide that the prohibition on
exceptions to the ESRD composite rates does not apply as of
October 1, 2002, to pediatric facilities that do not have an
exception rate in effect on October 1, 2002--in effect