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CMS-1403-FC
CBSA-based geographic designations. Beginning
January 1, 2006, during each year of the transition, an
ESRD facility’s wage-adjusted composite rate (that is,
without regard to any case-mix adjustments) is a blend of
its old MSA-based wage-adjusted payment rate and its new
CBSA-based wage adjusted payment rate for the transition
year involved. In CY 2006, the first year of the
transition, we implemented a 75/25 blend. In CY 2007, the
second year of the transition, we implemented a 50/50
blend. In CY 2008, the third year of the transition, we
implemented a 25/75 blend. Consistent with the transition
blends announced in the CY 2006 PFS final rule with comment
period (70 FR 70170), in CY 2009, each ESRD facility’s
composite payment rate will be based entirely on the
CBSA-based wage index.
For CY 2009, we proposed to reduce the wage index
floor from 0.75 to 0.70. For this final year of the
transition (CY 2009), we believe that a reduction to 0.70
is appropriate as we continue to reassess the need for a
wage index floor in future years. We believe that a
gradual reduction in the floor is still needed to ensure
patient access to dialysis in areas that have low wage
index values, especially Puerto Rico, and to prevent sudden
adverse effects to the payment system. However, we note
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