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

The fifth column shows the effect of the MIPPA<br />

provisions on hospital-based and independent ESRD<br />

facilities. Section 153(a) of the MIPPA updated section<br />

1881(b)(12)(G) of the Act and revised payments to ESRD<br />

facilities. The revisions that are effective January 1,<br />

2009 include an update of 1 percent to the composite rate<br />

component of the payment system and the establishment of a<br />

site neutral composite rate to hospital-based and<br />

independent dialysis facilities.<br />

The sixth column shows the overall effect of the<br />

changes in the composite rate payments to ESRD providers<br />

excluding the drug add-on. <strong>This</strong> column shows the percent<br />

change between CY 2009 and CY 2008 composite rate payments<br />

to ESRD facilities. The sixth column combines the effects<br />

of changes in the wage index (column 4) with the effect of<br />

the MIPPA provisions (column 5). <strong>This</strong> column does not<br />

include the drug add-on to the composite rate.<br />

The seventh column shows the overall effect of the<br />

changes in composite rate payments to ESRD providers<br />

including the drug add-on. The overall effect is measured<br />

as the difference between the CY 2009 payment with all<br />

changes as proposed in this rule and current CY 2008<br />

payment. <strong>This</strong> payment amount is computed by multiplying<br />

the wage adjusted composite rate with the drug add-on for<br />

each provider times the number of dialysis treatments from<br />

1056

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