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CMS-1403-FC
estimated total dollar amount each ESRD provider would have
received in CY 2008 (the 3 rd year of the 4-year transition).
The total of these payments became the target amount of
expenditures for all ESRD facilities for CY 2009. Next, we
computed the estimated dollar amount that would have been
paid to the same ESRD facilities using the proposed ESRD
wage index for CY 2009 (the 4 th year of the 4-year
transition). The total of these payments became the fourth
year new amount of wage-adjusted composite rate
expenditures for all ESRD facilities. Section 153(a) of
the MIPPA updated section 1881(b)(12)(G) of the Act and
revised payments to ESRD facilities. The revisions that
are effective January 1, 2009 include an update of
1 percent to the composite rate component of the payment
system, and the establishment of a site neutral composite
rate to hospital-based and independent dialysis facilities.
We note that when computing the 4 th year new amount, we did
not include the MIPPA provisions because they are not
budget neutral.
After comparing these two dollar amounts (target
amount divided by the 4 th year new amount), we calculated an
adjustment factor that, when multiplied by the applicable
CY 2009 ESRD wage index value, would result in aggregate
payments to ESRD facilities that will remain within the
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