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CMS-1403-FC
The fourth column shows the effect of all changes to
the ESRD wage index for CY 2009 as it affects the composite
rate payments to ESRD facilities. The fourth column
compares aggregate ESRD wage adjusted composite rate
payments in the fourth year of the transition (CY 2009) to
aggregate ESRD wage adjusted composite rate payments in the
third year of the transition (CY 2008). In the fourth year
of the transition (CY 2009), ESRD facilities receive
100 percent of the CBSA wage adjusted composite rate and
0 percent of the MSA wage adjusted composite rate. In the
third year of the transition, ESRD facilities receive
75 percent of the CBSA wage adjusted composite rate and
25 percent of the MSA wage adjusted composite rate. The
overall effect to all ESRD providers in aggregate is zero
because the CY 2009 ESRD wage index has been multiplied by
a BN adjustment factor to comply with the statutory
requirement that any wage index revisions be done in a
manner that results in the same aggregate amount of
expenditures as would have been made without any changes in
the wage index. The impacts are similar to those shown in
the proposed rule. (See the CY 2009 PFS proposed rule
(73 FR 38599) for a breakout of the effects associated with
the change in the wage index floor.)
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