2006 proposed fee schedule - American Society of Clinical Oncology

subject to the “protection” clause under section
224
422(a)(2)(C) of BIPA, we propose to continue all exception
rates in effect on the same basis. Since section
422(a)(2)(B) of BIPA allows existing exception rates to
continue in effect as long as the exception rate exceeds the
facility’s updated composite payment rate, we expect that
the facilities will compare their existing exception rates
to their basic case-mix adjusted composite rates to
determine which is the best payment rate for their facility.
We expect that each ESRD facility would choose to be paid at
the higher of its existing exception rate or its basic case-
mix composite rate (which includes all the payment
adjustments required under section 623 of the MMA). If the
facility retains its exception rate, the rate is not subject
to any of the adjustments specified in section 623 of the
MMA. We believe the determination as to whether an ESRD
facility’s exception rate per treatment will exceed its
average case-mix adjusted composite rate per treatment is
best left to the affected entity. An ESRD facility that has
an existing exception rate may give up that rate if it
determines that it should be paid instead under the case-mix
adjusted composite rate methodology.
In §413.180, we propose to revise our regulations to
provide that each ESRD facility must notify its fiscal
intermediary (in writing) if it wishes to give up its