2006 proposed fee schedule - American Society of Clinical Oncology

estoring the exception process for pediatric facilities.
Pediatric facilities are defined as “renal facilities at
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least 50 percent of whose patients are individuals under 18
years of age.”
Existing exception rates are protected under section
422(a)(2)(C) of BIPA 2000. The “protection” clause for
existing exception rates provides that exception rates in
effect on December 1, 2000 (or approved based on an
application by July 1, 2001) shall remain in effect as long
as the facility’s exception rate is higher than the updated
composite rate. Pediatric ESRD facility exception rates
granted under the provisions of section 623 of the MMA are
not subject to the “protection” clause for existing
exception rates.
b. Summary of Proposed Changes to Part 413, Subpart H
As a result of the statutory changes discussed above,
we are proposing to revise both the content and the
organization of the existing regulations at 42 CFR Part 413,
subpart H (Payment for ESRD Services and Organ Procurement
Costs) by limiting certain qualifications and clarifying the
regulations. Currently, all of the Medicare rules for
requesting exceptions to composite rate payments for covered
outpatient maintenance dialysis treatments can be found at
§413.180 through §413.192. We propose to revise the current
regulations at part 413, Subpart H by--