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<strong>CMS</strong>-1403-FC<br />

impact associated with CAP provisions in the CY 2009 PFS<br />

rule.<br />

D. Application of the HPSA Bonus Payment<br />

As discussed in section II.G. of this final rule with<br />

comment period, there are no program cost savings or<br />

increased expenditures associated with this change;<br />

however, we expect that the regulation will increase the<br />

number of physicians who receive the bonus automatically,<br />

while decreasing the number of physicians required to use a<br />

modifier in order to receive the payment. It will also<br />

provide assurance to physicians and eligible recipients,<br />

for example health care facilities that bill under the CAH<br />

II method in qualified areas, that they will receive the<br />

HPSA bonus payment throughout the calendar year.<br />

F. Provisions Related to Payment for Renal Dialysis<br />

services Furnished by End-Stage Renal Disease (ESRD)<br />

Facilities<br />

The ESRD-related provisions are discussed in section<br />

II.H. of this final rule with comment period. To<br />

understand the impact of the changes affecting payments to<br />

different categories of ESRD facilities, it is necessary to<br />

compare estimated payments under the current year (CY 2008<br />

payments) to estimated payments under the revisions to the<br />

composite rate payment system (CY 2009 payments) as<br />

1053

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