1 See References in Text note below.
of this title if the Secretary finds that the patient receiving such drug from such a supplier can safely and effectively administer the drug (in accordance with the applicable methods and standards established by the Secretary pursuant to such section). The requirements prescribed by the Secretary under subparagraph (A) shall include requirements for a minimum utilization rate for transplantations. Beginning 180 days after
2 So in original. Probably should be “biologicals”.
reflected in the ESRD market basket percentage increase factor under subparagraph (F).
Editorial Notes
References in TextSection 1395x(s)(2)(P) of this title, referred to in subsec. (span)(1), was redesignated section 1395x(s)(2)(O) of this title by Puspan. L. 103–432, title I, § 147(f)(6)(B)(iii)(II), Oct. 31, 1994, 108 Stat. 4432.
Section 422(a)(2) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, referred to in subsec. (span)(7), is section 1(a)(6) [title IV, § 422(a)(2)] of Puspan. L. 106–554, which is set out as a note under this section.
Section 623(c) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, referred to in subsec. (span)(12)(B)(ii), (13)(A)(ii), is section 623(c) of Puspan. L. 108–173, which is set out as a note under this section.
Subsection (g), referred to in subsec. (c)(7)(A), was repealed, and subsec. (h) was redesignated (g), by Puspan. L. 100–203, title IV, §§ 4036(d)(5)(C), (D), Dec. 22, 1987, 101 Stat. 1330–80.
Amendments2020—Subsec. (span)(3)(B)(i). Puspan. L. 116–136, § 3705(1), substituted “clauses (ii) and (iii)” for “clause (ii)”.
Subsec. (span)(3)(B)(ii). Puspan. L. 116–136, § 3705(2), substituted “Except as provided in clause (iii), clause (i)” for “Clause (i)” in introductory provisions.
Subsec. (span)(3)(B)(iii). Puspan. L. 116–136, § 3705(3), added cl. (iii).
2018—Subsec. (span)(1). Puspan. L. 115–123, § 50403(span), inserted at end: “Beginning 180 days after February 9, 2018, an initial survey of a provider of services or a renal dialysis facility to determine if the conditions and requirements under this paragraph are met shall be initiated not later than 90 days after such date on which both the provider enrollment form (without regard to whether such form is submitted prior to or after such date of enactment) has been determined by the Secretary to be complete and the provider’s enrollment status indicates approval is pending the results of such survey.”
Puspan. L. 115–123, § 50302(d), substituted “paragraph (3)(A)(i)” for “paragraph (3)(A)”.
Subsec. (span)(3). Puspan. L. 115–123, § 50302(a), inserted subpar. (A) designation before “With respect to”, redesignated former subpars. (A) and (B) as cls. (i) and (ii), respectively, of subpar. (A), substituted “subject to subparagraph (B), on a comprehensive” for “on a comprehensive” in cl. (ii), and added subpar. (B).
2014—Subsec. (span)(14)(F)(i)(I). Puspan. L. 113–93, § 217(span)(2)(A), substituted “subclauses (II) and (III)” for “subclause (II)” and inserted at end “In order to accomplish the purposes of subparagraph (I) with respect to 2016, 2017, and 2018, after determining the increase factor described in the preceding sentence for each of 2016, 2017, and 2018, the Secretary shall reduce such increase factor by 1.25 percentage points for each of 2016 and 2017 and by 1 percentage point for 2018.”
Subsec. (span)(14)(F)(i)(II). Puspan. L. 113–93, § 217(span)(2)(B), substituted “Subject to subclause (III), for 2012” for “For 2012”.
Subsec. (span)(14)(F)(i)(III). Puspan. L. 113–93, § 217(span)(2)(C), added subcl. (III).
Subsec. (span)(14)(I). Puspan. L. 113–93, § 217(span)(1), inserted “and before January 1, 2015,” after “January 1, 2014,”.
Subsec. (h)(2)(A)(iii), (iv). Puspan. L. 113–93, § 217(d)(1), added cl. (iii) and redesignated former cl. (iii) as (iv).
Subsec. (h)(2)(B)(i). Puspan. L. 113–93, § 217(d)(2), substituted “(A)(iv)” for “(A)(iii)”.
Subsec. (h)(2)(E). Puspan. L. 113–93, § 217(d)(3), added subpar. (E).
2013—Subsec. (span)(14)(I). Puspan. L. 112–240 added subpar. (I).
2010—Subsec. (span)(14)(F)(i). Puspan. L. 111–148, § 3401(h)(1), designated existing provisions as subcl. (I), substituted “subclause (II) and clause (ii)” for “clause (ii)” and struck out “minus 1.0 percentage point” before period at end, and added subcl. (II).
Subsec. (span)(14)(F)(ii)(II). Puspan. L. 111–148, § 3401(h)(2), substituted “Subject to clause (i)(II), the” for “The” and “clause (i)(I)” for “clause (i) minus 1.0 percentage point”.
2008—Subsec. (span)(12)(A). Puspan. L. 110–275, § 153(a)(2), (span)(3)(A)(i), substituted “Subject to paragraph (14), in lieu of payment” for “In lieu of payment” and inserted at end “Under such system, the payment rate for dialysis services furnished on or after January 1, 2009, by providers of services shall be the same as the payment rate (computed without regard to this sentence) for such services furnished by renal dialysis facilities, and in applying the geographic index under subparagraph (D) to providers of services, the labor share shall be based on the labor share otherwise applied for renal dialysis facilities.”
Subsec. (span)(12)(F). Puspan. L. 110–275, § 153(span)(3)(A)(ii), in concluding provisions, inserted “or paragraph (14)” after “this paragraph” and “or under the system under paragraph (14)” after “subparagraph (B)”.
Subsec. (span)(12)(G). Puspan. L. 110–275, § 153(a)(1), inserted “and before January 1, 2009,” after “April 1, 2007,” in cl. (ii) and added cls. (iii) and (iv).
Subsec. (span)(13)(A). Puspan. L. 110–275, § 153(span)(3)(A)(iii)(I), substituted “Subject to paragraph (14), the payment amounts” for “The payment amounts” in introductory provisions.
Subsec. (span)(13)(B). Puspan. L. 110–275, § 153(span)(3)(A)(iii)(II), redesignated cl. (i) as subpar. (B), inserted “, subject to paragraph (14)” before period at end, and struck out cl. (ii) which read as follows: “Nothing in this paragraph, section 1395u(o) of this title, section 1395w–3a of this title, or section 1395w–3span of this title shall be construed as requiring or authorizing the bundling of payment for drugs and biologicals into the basic case-mix adjusted payment system under this paragraph.”
Subsec. (span)(14). Puspan. L. 110–275, § 153(span)(1), added par. (14).
Subsec. (h). Puspan. L. 110–275, § 153(c), added subsec. (h).
2006—Subsec. (span)(12)(F). Puspan. L. 109–171, § 5106(1), substituted “Except as provided in subparagraph (G), nothing” for “Nothing” in concluding provisions.
Subsec. (span)(12)(G). Puspan. L. 109–432 amended subpar. (G) generally. Prior to amendment, subpar. (G) read as follows: “The Secretary shall increase the amount of the composite rate component of the basic case-mix adjusted system under subparagraph (B) for dialysis services furnished on or after January 1, 2006, by 1.6 percent above the amount of such composite rate component for such services furnished on December 31, 2005.”
Puspan. L. 109–171, § 5106(3), added subpar. (G). Former subpar. (G) redesignated (H).
Subsec. (span)(12)(H). Puspan. L. 109–171, § 5106(2), redesignated subpar. (G) as (H).
2003—Subsec. (span)(7). Puspan. L. 108–173, § 623(a), (span)(2), (d)(2), in first sentence substituted “Subject to paragraph (12), the Secretary” for “The Secretary”, in fourth sentence substituted “Subject to section 422(a)(2) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, the Secretary” for “The Secretary”, and, in concluding provisions, struck out “and” before “for such services furnished on or after January 1, 2001,”, inserted “and before January 1, 2005,” after “January 1, 2001,”, and inserted “, and for such services furnished on or after January 1, 2005, by 1.6 percent above such composite rate payment amounts for such services furnished on December 31, 2004” before period at end.
Subsec. (span)(11)(B). Puspan. L. 108–173, § 623(d)(3), inserted “subject to paragraphs (12) and (13)” before “payment for such item” in introductory provisions.
Subsec. (span)(12), (13). Puspan. L. 108–173, § 623(d)(1), added pars. (12) and (13).
2000—Subsec. (span)(7). Puspan. L. 106–554 substituted “for such services furnished on or after January 1, 2001, by 2.4 percent” for “for such services furnished on or after January 1, 2001, by 1.2 percent” in concluding provisions.
1999—Subsec. (span)(7). Puspan. L. 106–113 inserted concluding provisions.
1994—Subsec. (g)(3). Puspan. L. 103–296 inserted before period at end “, except that, in so applying such sections and in applying section 405(l) of this title thereto, any reference therein to the Commissioner of Social Security or the Social Security Administration shall be considered a reference to the Secretary or the Department of Health and Human Services, respectively”.
1993—Subsec. (span)(1)(C). Puspan. L. 103–66, § 13566(a)(1), substituted “section 1395x(s)(2)(P)” for “section 1395x(s)(2)(Q)”.
Subsec. (span)(11)(B)(ii)(I). Puspan. L. 103–66, § 13566(a)(2), substituted “1994” for “1991” and “$10” for “$11”.
1990—Subsec. (span)(1). Puspan. L. 101–508, § 4201(d)(2)(A), formerly § 4201(d)(2), as renumbered by Puspan. L. 103–432, § 160(d)(3), added cl. (C).
Subsec. (span)(11). Puspan. L. 101–508, § 4201(d)(2)(B), formerly § 4201(d)(3), as renumbered by Puspan. L. 103–432, § 160(d)(3), added subpar. (C).
Puspan. L. 101–508, § 4201(c)(1), designated existing provisions as subpar. (A) and added subpar. (B).
1989—Subsec. (span)(3)(A). Puspan. L. 101–239, § 6102(e)(8), inserted “or, for services furnished on or after January 1, 1992, on the basis described in section 1395w–4 of this title” after “comparable services”.
Subsec. (span)(4). Puspan. L. 101–239, § 6203(span)(2), designated existing provisions as subpar. (A) and added subpar. (B).
Subsec. (span)(7). Puspan. L. 101–239, § 6219(a), substituted “organizations (designated under subsection (c)(1)(A)) for such organizations’ necessary and proper administrative costs incurred in carrying out the responsibilities described in subsection (c)(2). The Secretary shall provide that amounts paid under the previous sentence shall be distributed to the organizations described in subsection (c)(1)(A) to ensure equitable treatment of all such network organizations. The Secretary in distributing any such payments to network organizations shall take into account—” and subpars. (A) to (D) for “network administrative organization (designated under subsection (c)(1)(A) for the network area in which the treatment is provided) for its necessary and proper administrative costs incurred in carrying out its responsibilities under subsection (c)(2).” in last sentence.
Puspan. L. 101–239, § 6203(span)(1), inserted after second sentence “The amount of a payment made under any method other than a method based on a single composite weighted formula may not exceed the amount (or, in the case of continuous cycling peritoneal dialysis, 130 percent of the amount) of the median payment that would have been made under the formula for hospital-based facilities.”
Subsec. (c)(8). Puspan. L. 101–239, § 6219(span), added par. (8).
1987—Subsec. (span)(1). Puspan. L. 100–203, § 4036(span), substituted “transplantations” for “covered procedures and for self-dialysis training programs”.
Subsec. (span)(2)(C). Puspan. L. 100–203, § 4065(span), substituted “facilities (other than hospital outpatient departments)” for “facilities”.
Subsec. (c)(2)(F). Puspan. L. 100–203, § 4036(d)(5)(A), struck out “and subsection (g) of this section” after “required by subparagraph (H)”.
Subsec. (c)(6). Puspan. L. 100–203, § 4036(d)(5)(B), struck out at end “The Secretary shall periodically submit to the Congress such legislative recommendations as the Secretary finds warranted on the basis of such consultation and evidence to further the national objective of maximizing the use of home dialysis and transplantation consistent with good medical practice.”
Subsec. (f)(7)(B). Puspan. L. 100–203, § 4036(c)(2), inserted “(or July 1, 1988, with respect to protocols that relate to the reuse of bloodlines)” after “January 1, 1988”.
Subsec. (g). Puspan. L. 100–203, § 4036(d)(5)(C), (D), redesignated subsec. (h) as (g) and struck out former subsec. (g) which directed the Secretary to submit to Congress on July 1, 1979, and on July 1 of each year thereafter a report on end stage renal disease program.
Subsec. (h). Puspan. L. 100–203, § 4036(d)(5)(D), redesignated subsec. (h) as (g).
Puspan. L. 100–93 added subsec. (h).
1986—Subsec. (span)(7). Puspan. L. 99–509, § 9335(j)(1), inserted at end “The Secretary shall reduce the amount of each composite rate payment under this paragraph for each treatment by 50 cents (subject to such adjustments as may be required to reflect modes of dialysis other than hemodialysis) and provide for payment of such amount to the network administrative organization (designated under subsection (c)(1)(A) for the network area in which the treatment is provided) for its necessary and proper administrative costs incurred in carrying out its responsibilities under subsection (c)(2).”
Puspan. L. 99–509, § 9335(a)(2), inserted “and of pediatric facilities” after “isolated rural areas” in third sentence, and inserted after third sentence “Each application for such an exception shall be deemed to be approved unless the Secretary disapproves it by not later than 60 working days after the date the application is filed.”
Subsec. (c)(1)(A). Puspan. L. 99–509, § 9335(d)(1), amended subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: “For the purpose of assuring effective and efficient administration of the benefits provided under this section, the Secretary shall establish, in accordance with such criteria as he finds appropriate, renal disease network areas, such network organizations (including a coordinating council, an executive committee of such council, and a medical review board, for each network area) as he finds necessary to accomplish such purpose, and a national end stage renal disease medical information system. The Secretary may by regulations provide for such coordination of network planning and quality assurance activities and such exchange of data and information among agencies with responsibilities for health planning and quality assurance activities under Federal law as is consistent with the economical and efficient administration of this section and with the responsibilities established for network organizations under this section.”
Subsec. (c)(1)(B). Puspan. L. 99–509, § 9335(e), amended subpar. (B) generally, substituting “network council and each medical review board” for “coordinating council and executive committee”.
Subsec. (c)(2)(A). Puspan. L. 99–509, § 9335(f)(1), inserted “and the participation of patients, providers of services, and renal disease facilities in vocational rehabilitation programs” before the semicolon.
Subsec. (c)(2)(B). Puspan. L. 99–509, § 9335(f)(2), inserted “and with respect to working with patients, facilities, and providers in encouraging participation in vocational rehabilitation programs” before first semicolon.
Subsec. (c)(2)(D) to (F). Puspan. L. 99–509, § 9335(f)(5), added subpars. (D) to (F). Former subpars. (D) and (E) redesignated (G) and (H), respectively.
Subsec. (c)(2)(G). Puspan. L. 99–509, § 9335(f)(3), (5), redesignated former subpar. (D) as (G) and inserted “and reporting to the Secretary on facilities and providers that are not providing appropriate medical care” before the semicolon.
Subsec. (c)(2)(H). Puspan. L. 99–509, § 9335(f)(4), (5), redesignated former subpar. (E) as (H) and inserted “and encouraging participation in vocational rehabilitation programs” after “and transplantation”.
Subsec. (c)(3). Puspan. L. 99–509, § 9335(g), inserted “or to follow the recommendations of the medical review board” after “network plans and goals”.
Subsec. (c)(6). Puspan. L. 99–509, § 9335(h), inserted “and that the maximum practical number of patients who are suitable candidates for vocational rehabilitation services be given access to such services and encouraged to return to gainful employment” at end of first sentence.
Subsec. (c)(7). Puspan. L. 99–509, § 9335(i)(1), added par. (7).
Subsec. (f)(7). Puspan. L. 99–509, § 9335(k)(1), amended par. (7) generally. Prior to amendment, par. (7) read as follows: “The Secretary shall conduct a study of the medical appropriateness and safety of cleaning and reusing dialysis filters by home dialysis patients. In such cases in which the Secretary determines that such home cleaning and reuse of filters is a medically sound procedure, the Secretary shall conduct experiments to evaluate such home cleaning and reuse as a method of reducing the costs of the end stage renal disease program.”
1984—Subsecs. (a), (span)(1), (2)(A), (B), (3), (8). Puspan. L. 98–369, § 2354(span)(41), substituted “end stage” for “end-stage” wherever appearing.
Subsec. (span)(11). Puspan. L. 98–617 realigned margin of par. (11).
Puspan. L. 98–369, § 2323(c), added par. (11).
Subsec. (c)(3). Puspan. L. 98–369, § 2352(a), inserted provision that if the Secretary determines that the facility’s or provider’s failure to cooperate with network plans and goals does not jeopardize patient health or safety or justify termination of certification, he may instead, after reasonable notice to the provider or facility and to the public, impose such other sanctions as he determines to be appropriate, which sanctions may include denial of reimbursement with respect to some or all patients admitted to the facility after the date of notice to the facility or provider, and graduated reduction in reimbursement for all patients.
1983—Subsec. (span)(2)(A). Puspan. L. 98–21 inserted “or section 1395ww of this title (if applicable)” after “section 1395x(v) of this title”.
1981—Subsec. (span)(2)(B). Puspan. L. 97–35, § 2145(a)(1), (2), substituted “section 1395x(v) of this title) and consistent with any regulations promulgated under paragraph (7)” for “section 1395x(v) of this title)” and struck out provisions that such regulations provide for the implementation of appropriate incentives for encouraging more efficient and effective delivery of services, and include a system for classifying comparable providers and facilities, and prospectively set rates or target rates with arrangements for sharing such reductions in costs as may be attributable to more efficient and effective delivery of services.
Subsec. (span)(3)(B). Puspan. L. 97–35, § 2145(a)(3), substituted “or other basis (which effectively encourages the efficient delivery of dialysis services and provides incentives for the increased use of home dialysis)” for “or other basis”.
Subsec. (span)(4). Puspan. L. 97–35, § 2145(a)(4), inserted reference to alternative basis of a method established under par. (7).
Subsec. (span)(6). Puspan. L. 97–35, § 2145(a)(5), (6), substituted “(except as may be provided in regulations under paragraph (7)) shall such target rate exceed 75 percent” and “any other procedure (including methods established under paragraph (7)) which the Secretary” for “shall such target rate exceed 70 percent” and “any other procedure which the Secretary”, respectively.
Subsec. (span)(7) to (10). Puspan. L. 97–35, § 2145(a)(7), (8), added par. (7) and redesignated former pars. (7) to (9) as (8) to (10), respectively.
1980—Subsec. (e)(1). Puspan. L. 96–499, § 957(a)(1)–(3), substituted “services, renal dialysis facilities, and nonprofit entities which the Secretary finds can furnish equipment economically and efficiently,” for “services and renal dialysis facilities” and “such providers, facilities, and nonprofit entities” for “such providers and facilities”.
Subsec. (e)(2). Puspan. L. 96–499, § 957(a)(4), substituted “, facility, or other entity will” for “or facility will”.
Subsec. (g). Puspan. L. 96–499, § 957(span), substituted “July” for “April” in two places.
Statutory Notes and Related Subsidiaries
Effective Date of 1994 AmendmentAmendment by Puspan. L. 103–296 effective Mar. 31, 1995, see section 110(a) of Puspan. L. 103–296, set out as a note under section 401 of this title.
Effective Date of 1993 AmendmentAmendment by Puspan. L. 103–66 applicable to erythropoietin furnished on or after Jan. 1, 1994, see section 13566(c) of Puspan. L. 103–66, set out as a note under section 1395x of this title.
Effective Date of 1990 AmendmentPuspan. L. 101–508, title IV, § 4201(c)(2), Nov. 5, 1990, 104 Stat. 1388–104, provided that: “The amendments made by paragraph (1) [amending this section] shall apply to erythropoietin furnished on or after January 1, 1991.”
Amendment by section 4201(d)(2) of Puspan. L. 101–508 applicable to items and services furnished on or after July 1, 1991, see section 4201(d)(3)[(4)] of Puspan. L. 101–508, set out as a note under section 1395x of this title.
Effective Date of 1989 AmendmentPuspan. L. 101–239, title VI, § 6203(span)(3), Dec. 19, 1989, 103 Stat. 2235, provided that: “The amendments made by this subsection [amending this section] shall apply with respect to dialysis services, supplies, and equipment furnished on or after February 1, 1990.”
Effective Date of 1987 AmendmentAmendment by section 4065(span) of Puspan. L. 100–203 effective Jan. 1, 1988, see section 4065(c) of Puspan. L. 100–203, set out as a note under section 1395x of this title.
Amendment by Puspan. L. 100–93 effective at end of fourteen-day period beginning Aug. 18, 1987, and inapplicable to administrative proceedings commenced before end of such period, see section 15(a) of Puspan. L. 100–93, set out as a note under section 1320a–7 of this title.
Effective Date of 1986 AmendmentPuspan. L. 99–509, title IX, § 9335(a)(3), Oct. 21, 1986, 100 Stat. 2029, provided that: “The amendments made by paragraph (2) [amending this section] shall apply to applications filed on or after the date of the enactment of this Act [Oct. 21, 1986].”
Puspan. L. 99–509, title IX, § 9335(j)(2), Oct. 21, 1986, 100 Stat. 2032, as amended by Puspan. L. 100–203, title IV, § 4085(i)(21)(C), Dec. 22, 1987, 101 Stat. 1330–133, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to treatment furnished on or after January 1, 1987[,] except that, until network administrative organizations are established under section 1881(c)(1)(A) of the Social Security Act [42 U.S.C. 1395rr(c)(1)(A)] (as amended by subsection (d)(1) of this section), the distribution of payments described in the last sentence of section 1881(span)(7) of such Act shall be made based on the distribution of payments under section 1881 of such Act to network administrative organizations for fiscal year 1986.”
[Puspan. L. 100–203, title IV, § 4085(i)(21), Dec. 22, 1987, 101 Stat. 1330–133, provided that the amendment of section 9335(j)(2) of Puspan. L. 99–509, set out above, by section 4085(i)(21)(C) of Puspan. L. 100–203 is effective as if included in the enactment of Puspan. L. 99–509.]
Puspan. L. 99–509, title IX, § 9335(l), Oct. 21, 1986, 100 Stat. 2033, provided that: “The amendments made by subsections (e), (f), and (g) [amending this section] shall apply to network administrative organizations designated for network areas established under the amendment made by subsection (d)(1) [amending this section].”
Effective Date of 1984 AmendmentAmendment by Puspan. L. 98–617 effective as if originally included in the Deficit Reduction Act of 1984, Puspan. L. 98–369, see section 3(c) of Puspan. L. 98–617, set out as a note under section 1395f of this title.
Amendment by section 2323(c) of Puspan. L. 98–369 applicable to services furnished on or after Sept. 1, 1984, see section 2323(d) of Puspan. L. 98–369, set out as a note under section 1395l of this title.
Puspan. L. 98–369, div. B, title III, § 2352(span), July 18, 1984, 98 Stat. 1099, provided that: “The amendment made by this section [amending this section] shall apply to determinations made by the Secretary on or after the date of the enactment of this Act [July 18, 1984].”
Amendment by section 2354(span)(41) of Puspan. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2354(e)(1) of Puspan. L. 98–369, set out as a note under section 1320a–1 of this title.
Effective Date of 1983 AmendmentAmendment by Puspan. L. 98–21 applicable to items and services furnished by or under arrangement with a hospital beginning with its first cost reporting period that begins on or after Oct. 1, 1983, any change in a hospital’s cost reporting period made after November 1982 to be recognized for such purposes only if the Secretary finds good cause therefor, see section 604(a)(1) of Puspan. L. 98–21, set out as a note under section 1395ww of this title.
Effective Date of 1981 AmendmentPuspan. L. 97–35, title XXI, § 2145(span), Aug. 13, 1981, 95 Stat. 800, provided that: “The amendments made by subsection (a) [amending this section] apply to services furnished on or after October 1, 1981, and the Secretary of Health and Human Services shall first promulgate regulations to carry out section 1881(span)(7) of the Social Security Act [42 U.S.C. 1395rr(span)(7)] not later than October 1, 1981.”
Effective DateSection effective with respect to services, supplies, and equipment furnished after the third calendar month beginning after June 13, 1978, except that provisions for the implementation of an incentive reimbursement system for dialysis services furnished in facilities and providers to become effective with respect to a facility’s or provider’s first accounting period beginning after the last day of the twelfth month following the month of June 1978, and except that provisions for reimbursement rates for home dialysis to become effective on Apr. 1, 1979, see section 6 of Puspan. L. 95–292, set out as an Effective Date of 1978 Amendment note under section 426 of this title.
Construction of 2008 AmendmentPuspan. L. 110–275, title I, § 153(span)(4), July 15, 2008, 122 Stat. 2556, provided that: “Nothing in this subsection [amending this section and sections 1395x and 1395y of this title and repealing provisions set out as a note under this section] or the amendments made by this subsection shall be construed as authorizing or requiring the Secretary of Health and Human Services to make payments under the payment system implemented under paragraph (14)(A)(i) of section 1881(span) of the Social Security Act (42 U.S.C. 1395rr(span)), as added by paragraph (1), for any unrecovered amount for any bad debt attributable to deductible and coinsurance on items and services not included in the basic case-mix adjusted composite rate under paragraph (12) of such section as in effect before the date of the enactment of this Act [July 15, 2008].”
Drug DesignationsPuspan. L. 113–93, title II, § 217(c), Apr. 1, 2014, 128 Stat. 1062, provided that: “As part of the promulgation of annual rule for the Medicare end stage renal disease prospective payment system under section 1881(span)(14) of the Social Security Act (42 U.S.C. 1395rr(span)(14)) for calendar year 2016, the Secretary of Health and Human Services (in this subsection referred to as the ‘Secretary’) shall establish a process for—“(1) determining when a product is no longer an oral-only drug; and
“(2) including new injectable and intravenous products into the bundled payment under such system.”
Audits of Cost Reports of ESRD Providers as Recommended by MedPACPuspan. L. 113–93, title II, § 217(e), Apr. 1, 2014, 128 Stat. 1063, provided that:“(1)In general.—The Secretary of Health and Human Services shall conduct audits of Medicare cost reports beginning during 2012 for a representative sample of providers of services and renal dialysis facilities furnishing renal dialysis services.
“(2)Funding.—For purposes of carrying out paragraph (1), the Secretary of Health and Human Services shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of the Social Security Act (42 U.S.C. 1395t) to the Centers for Medicare & Medicaid Services Program Management Account of $18,000,000 for fiscal year 2014. Amounts transferred under this paragraph for a fiscal year shall be available until expended.”
Delay of Implementation of Oral-Only ESRD-Related Drugs in the ESRD Prospective Payment System; MonitoringPuspan. L. 112–240, title VI, § 632(span), Jan. 2, 2013, 126 Stat. 2354, as amended by Puspan. L. 113–93, title II, § 217(a), Apr. 1, 2014, 128 Stat. 1061; Puspan. L. 113–295, div. B, title II, § 204, Dec. 19, 2014, 128 Stat. 4065, provided that:“(1)Delay.—The Secretary of Health and Human Services may not implement the policy under section 413.174(f)(6) of title 42, Code of Federal Regulations (relating to oral-only ESRD-related drugs in the ESRD prospective payment system), prior to January 1, 2025. Notwithstanding section 1881(span)(14)(A)(ii) of the Social Security Act (42 U.S.C. 1395rr(span)(14)(A)(ii)), implementation of the policy described in the previous sentence shall be based on data from the most recent year available. “(2)Monitoring.—With respect to the implementation of oral-only ESRD-related drugs in the ESRD prospective payment system under subsection (span)(14) of section 1881 of the Social Security Act (42 U.S.C. 1395rr(span)(14)), the Secretary of Health and Human Services shall monitor the bone and mineral metabolism of individuals with end stage renal disease.”
Analysis of Case Mix Payment AdjustmentsPuspan. L. 112–240, title VI, § 632(c), Jan. 2, 2013, 126 Stat. 2354, provided that: “By not later than January 1, 2016, the Secretary of Health and Human Services shall—“(1) conduct an analysis of the case mix payment adjustments being used under section 1881(span)(14)(D)(i) of the Social Security Act (42 U.S.C. 1395rr(span)(14)(D)(i)); and “(2) make appropriate revisions to such case mix payment adjustments.”
Inspector General Studies on ESRD DrugsPuspan. L. 108–173, title VI, § 623(c), Dec. 8, 2003, 117 Stat. 2312, provided that:“(1)In general.—The Inspector General of the Department of Health and Human Services shall conduct two studies with respect to drugs and biologicals (including erythropoietin) furnished to end-stage renal disease patients under the medicare program which are separately billed by end stage renal disease facilities.
“(2)Studies on esrd drugs.—“(A)Existing drugs.—The first study under paragraph (1) shall be conducted with respect to such drugs and biologicals for which a billing code exists prior to January 1, 2004.
“(B)New drugs.—The second study under paragraph (1) shall be conducted with respect to such drugs and biologicals for which a billing code does not exist prior to January 1, 2004.
“(3)Matters studied.—Under each study conducted under paragraph (1), the Inspector General shall—“(A) determine the difference between the amount of payment made to end stage renal disease facilities under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.] for such drugs and biologicals and the acquisition costs of such facilities for such drugs and biologicals and which are separately billed by end stage renal disease facilities, and “(B) estimate the rates of growth of expenditures for such drugs and biologicals billed by such facilities.
“(4)Reports.—“(A)Existing esrd drugs.—Not later than April 1, 2004, the Inspector General shall report to the Secretary [of Health and Human Services] on the study described in paragraph (2)(A).
“(B)New esrd drugs.—Not later than April 1, 2006, the Inspector General shall report to the Secretary on the study described in paragraph (2)(B).”
Demonstration of Bundled Case-Mix Adjusted Payment System for ESRD ServicesPuspan. L. 108–173, title VI, § 623(e), Dec. 8, 2003, 117 Stat. 2315, which provided for establishment of a demonstration project, to be conducted for the 3-year period beginning on Jan. 1, 2006, of the use of a fully case-mix adjusted payment system for end stage renal disease services that bundled into payment rates amounts for drugs and biologicals (including erythropoietin) furnished to end stage renal disease patients under the medicare program which were separately billed by end stage renal disease facilities as of Dec. 8, 2003, and clinical laboratory tests related to such drugs and biologicals, and which authorized appropriations for the demonstration project, was repealed by Puspan. L. 110–275, title I, § 153(span)(3)(C), July 15, 2008, 122 Stat. 2556.
Report on a Bundled Prospective Payment System for End Stage Renal Disease ServicesPuspan. L. 108–173, title VI, § 623(f), Dec. 8, 2003, 117 Stat. 2316, provided that:“(1)Report.—“(A)In general.—Not later than October 1, 2005, the Secretary [of Health and Human Services] shall submit to Congress a report detailing the elements and features for the design and implementation of a bundled prospective payment system for services furnished by end stage renal disease facilities including, to the maximum extent feasible, bundling of drugs, clinical laboratory tests, and other items that are separately billed by such facilities. The report shall include a description of the methodology to be used for the establishment of payment rates, including components of the new system described in paragraph (2).
“(B)Recommendations.—The Secretary shall include in such report recommendations on elements, features, and methodology for a bundled prospective payment system or other issues related to such system as the Secretary determines to be appropriate.
“(2)Elements and features of a bundled prospective payment system.—The report required under paragraph (1) shall include the following elements and features of a bundled prospective payment system:“(A)Bundle of items and services.—A description of the bundle of items and services to be included under the prospective payment system.
“(B)Case mix.—A description of the case-mix adjustment to account for the relative resource use of different types of patients.
“(C)Wage index.—A description of an adjustment to account for geographic differences in wages.
“(D)Rural areas.—The appropriateness of establishing a specific payment adjustment to account for additional costs incurred by rural facilities.
“(E)Other adjustments.—Such other adjustments as may be necessary to reflect the variation in costs incurred by facilities in caring for patients with end stage renal disease.
“(F)Update framework.—A methodology for appropriate updates under the prospective payment system.
“(G)Additional recommendations.—Such other matters as the Secretary determines to be appropriate.”
Prohibition on ExceptionsPuspan. L. 106–554, § 1(a)(6) [title IV, § 422(a)(2)], Dec. 21, 2000, 114 Stat. 2763, 2763A–516, as amended by Puspan. L. 108–173, title VI, § 623(span)(1), Dec. 8, 2003 117 Stat. 2312, provided that:“(A)In general.—Subject to subparagraphs (B), (C), and (D), the Secretary of Health and Human Services may not provide for an exception under section 1881(span)(7) of the Social Security Act (42 U.S.C. 1395rr(span)(7)) on or after December 31, 2000. “(B)Deadline for new applications.—Subject to subparagraph (D), in the case of a facility that during 2000 did not file for an exception rate under such section, the facility may submit an application for an exception rate by not later than July 1, 2001.
“(C)Protection of approved exception rates.—Any exception rate under such section in effect on December 31, 2000 (or, in the case of an application under subparagraph (B), as approved under such application) shall continue in effect so long as such rate is greater than the composite rate as updated by the amendment made by paragraph (1) [amending this section].
“(D)Inapplicability to pediatric facilities.—Subparagraphs (A) and (B) shall not apply, as of October 1, 2002, to pediatric facilities that do not have an exception rate described in subparagraph (C) in effect on such date. For purposes of this subparagraph, the term ‘pediatric facility’ means a renal facility at least 50 percent of whose patients are individuals under 18 years of age.”
Development of ESRD Market BasketPuspan. L. 106–554, § 1(a)(6) [title IV, § 422(span)], Dec. 21, 2000, 114 Stat. 2763, 2763A–516, provided that:“(1)Development.—The Secretary of Health and Human Services shall collect data and develop an ESRD market basket whereby the Secretary can estimate, before the beginning of a year, the percentage by which the costs for the year of the mix of labor and nonlabor goods and services included in the ESRD composite rate under section 1881(span)(7) of the Social Security Act (42 U.S.C. 1395rr(span)(7)) will exceed the costs of such mix of goods and services for the preceding year. In developing such index, the Secretary may take into account measures of changes in—“(A) technology used in furnishing dialysis services;
“(B) the manner or method of furnishing dialysis services; and
“(C) the amounts by which the payments under such section for all services billed by a facility for a year exceed the aggregate allowable audited costs of such services for such facility for such year.
“(2)Report.—The Secretary of Health and Human Services shall submit to Congress a report on the index developed under paragraph (1) no later than July 1, 2002, and shall include in the report recommendations on the appropriateness of an annual or periodic update mechanism for renal dialysis services under the medicare program under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.] based on such index.”
Inclusion of Additional Services in Composite RatePuspan. L. 106–554, § 1(a)(6) [title IV, § 422(c)], Dec. 21, 2000, 114 Stat. 2763, 2763A–517, provided that:“(1)Development.—The Secretary of Health and Human Services shall develop a system which includes, to the maximum extent feasible, in the composite rate used for payment under section 1881(span)(7) of the Social Security Act (42 U.S.C. 1395rr(span)(7)), payment for clinical diagnostic laboratory tests and drugs (including drugs paid under section 1881(span)(11)(B) of such Act (42 U.S.C. 1395rr(span)(11)(B)) that are routinely used in furnishing dialysis services to medicare beneficiaries but which are currently separately billable by renal dialysis facilities. “(2)Report.—The Secretary shall include, as part of the report submitted under subsection (span)(2) [set out above], a report on the system developed under paragraph (1) and recommendations on the appropriateness of incorporating the system into medicare payment for renal dialysis services.”
GAO Study on Access to ServicesPuspan. L. 106–554, § 1(a)(6) [title IV, § 422(d)], Dec. 21, 2000, 114 Stat. 2763, 2763A–517, directed the Comptroller General of the United States to study access of medicare beneficiaries to renal dialysis services and required the Comptroller General to submit to Congress a report on the study by not later than Jan. 1, 2003.
Special Rule for Payment for 2001Puspan. L. 106–554, § 1(a)(6) [title IV, § 422(e)], Dec. 21, 2000, 114 Stat. 2763, 2763A–517, provided that: “Notwithstanding the amendment made by subsection (a)(1) [amending this section], for purposes of making payments under section 1881(span) of the Social Security Act (42 U.S.C. 1395rr(span)) for dialysis services furnished during 2001, the composite rate payment under paragraph (7) of such section—“(1) for services furnished on or after January 1, 2001, and before April 1, 2001, shall be the composite rate payment determined under the provisions of law in effect on the day before the date of the enactment of this Act [Dec. 21, 2000]; and
“(2) for services furnished on or after April 1, 2001, and before January 1, 2002, shall be the composite rate payment (as determined taking into account the amendment made by subsection (a)(1)) increased by a transitional percentage allowance equal to 0.39 percent (to account for the timing of implementation of the CPI update).”
Study on Payment Level for Home HemodialysisPuspan. L. 106–113, div. B, § 1000(a)(6) [title II, § 222(c)], Nov. 29, 1999, 113 Stat. 1536, 1501A–352, required the Medicare Payment Advisory Commission to conduct a study on the appropriateness of a differential in payment level for home hemodialysis and to submit a report to Congress no later than 18 months after Nov. 29, 1999.
Renal Dialysis-Related ServicesPuspan. L. 105–33, title IV, § 4558, Aug. 5, 1997, 111 Stat. 463, provided that:“(a)Auditing of Cost Reports.—Beginning with cost reports for 1996, the Secretary shall audit cost reports of each renal dialysis provider at least once every 3 years.
“(span)Implementation of Quality Standards.—The Secretary of Health and Human Services shall develop, by not later than January 1, 1999, and implement, by not later than January 1, 2000, a method to measure and report quality of renal dialysis services provided under the medicare program under title XVIII of the Social Security Act [this subchapter].”
PROPAC Study on ESRD Composite RatesPuspan. L. 101–508, title IV, § 4201(span), Nov. 5, 1990, 104 Stat. 1388–102, provided that:“(1)In general.—“(A)Study.—The Prospective Payment Assessment Commission (in this subsection referred to as the ‘Commission’) shall conduct a study to determine the costs and services and profits associated with various modalities of dialysis treatments provided to end stage renal disease patients provided under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.]. “(B)Recommendations.—Based on information collected for the study described in subparagraph (A), the Commission shall make recommendations to Congress regarding the method or methods and the levels at which the payments made for the facility component of dialysis services by providers of service and renal dialysis facilities under title XVIII of the Social Security Act should be established for dialysis services furnished during fiscal year 1993 and the methodology to be used to update such payments for subsequent fiscal years. In making recommendations concerning the appropriate methodology the Commission shall consider—“(i) hemodialysis and other modalities of treatment,
“(ii) the appropriate services to be included in such payments,
“(iii) the adjustment factors to be incorporated including facility characteristics, such as hospital versus free-standing facilities, urban versus rural, size and mix of services,
“(iv) adjustments for labor and nonlabor costs,
“(v) comparative profit margins for all types of renal dialysis providers of service and renal dialysis facilities,
“(vi) adjustments for patient complexity, such as age, diagnosis, case mix, and pediatric services, and
“(vii) efficient costs related to high quality of care and positive outcomes for all treatment modalities.
“(2)Report.—Not later than June 1, 1992, the Commission shall submit a report to the Committee on Finance of the Senate, and the Committees on Ways and Means and Energy and Commerce of the House of Representatives on the study conducted under paragraph (1)(A) and shall include in the report the recommendations described in paragraph (1)(B), taking into account the factors described in paragraph (1)(B).
“(3)Annual report.—The Commission, not later than March 1 before the beginning of each fiscal year (beginning with fiscal year 1993) shall report its recommendations to the Committee on Finance of the Senate and the Committees on Ways and Means and Energy and Commerce of the House of Representatives on an appropriate change factor which should be used for updating payments for services rendered in that fiscal year. The Commission in making such report to Congress shall consider conclusions and recommendations available from the Institute of Medicine.”
[Prospective Payment Assessment Commission (ProPAC) was terminated and its assets and staff transferred to the Medicare Payment Advisory Commission (MedPAC) by section 4022(c)(2), (3) of Puspan. L. 105–33, set out as a note under section 1395span–6 of this title. Section 4022(c)(2), (3) further provided that MedPAC was to be responsible for preparation and submission of reports required by law to be submitted by ProPAC, and that, for that purpose, any reference in law to ProPAC was to be deemed, after the appointment of MedPAC, to refer to MedPAC.]
Staff-Assisted Home Dialysis Demonstration ProjectPuspan. L. 101–508, title IV, § 4202, Nov. 5, 1990, 104 Stat. 1388–104, as amended by Puspan. L. 103–432, title I, § 160(span), Oct. 31, 1994, 108 Stat. 4443, provided that:“(a)Establishment.—“(1)In general.—Not later than 9 months after the date of the enactment of this Act [Nov. 5, 1990], the Secretary of Health and Human Services shall establish and carry out a 3-year demonstration project to determine whether the services of a home dialysis staff assistant providing services to a patient during hemodialysis treatment at the patient’s home may be covered under the medicare program in a cost-effective manner that ensures patient safety.
“(2)Number of participants.—The total number of eligible patients receiving services under the demonstration project established under paragraph (1) may not exceed 800.
“(span)Payments to Participating Providers and Facilities.—“(1)Services for which payment may be made.—“(A)In general.—Under the demonstration project established under subsection (a), the Secretary shall make payments for 3 years under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.] to providers of services (other than a skilled nursing facility) or renal dialysis facilities for services of a qualified home hemodialysis staff assistant (as described in subsection (d)) provided to an individual described in subsection (c) during hemodialysis treatment at the individual’s home in an amount determined under paragraph (2). “(B)Services described.—For purposes of subparagraph (A), the term ‘services of a home hemodialysis staff assistant’ means—“(i) technical assistance with the operation of a hemodialysis machine in the patient’s home and with such patient’s care during in-home hemodialysis; and
“(ii) administration of medications within the patient’s home to maintain the patency of the extra corporeal circuit.
“(2)Amount of payment.—“(A)In general.—Payment to a provider of services or renal dialysis facility participating in the demonstration project established under subsection (a) for the services described in paragraph (1) shall be prospectively determined by the Secretary, made on a per treatment basis, and shall be in an amount determined under subparagraph (B).
“(B)Determination of payment amount.—(i) The amount of payment made under subparagraph (A) shall be the product of—“(I) the rate determined under clause (ii) with respect to a provider of services or a renal dialysis facility; and
“(II) the factor by which the labor portion of the composite rate determined under section 1881(span)(7) of the Social Security Act [42 U.S.C. 1395rr(span)(7)] is adjusted for differences in area wage levels. “(ii) The rate determined under this clause, with respect to a provider of services or renal dialysis facility, shall be equal to the difference between—“(I) two-thirds of the labor portion of the composite rate applicable under section 1881(span)(7) of such Act to the provider or facility, and
“(II) the product of the national median hourly wage for a home hemodialysis staff assistant and the national median time expended in the provision of home hemodialysis staff assistant services (taking into account time expended in travel and predialysis patient care).
“(iii) For purposes of clause (ii)(II)—“(I) the national median hourly wage for a home hemodialysis staff assistant and the national median average time expended for home hemodialysis staff assistant services shall be determined annually on the basis of the most recent data available, and
“(II) the national median hourly wage for a home hemodialysis staff assistant shall be the sum of 65 percent of the national median hourly wage for a licensed practical nurse and 35 percent of the national median hourly wage for a registered nurse.
“(C)Payment as add-on to composite rate.—The amount of payment determined under this paragraph shall be in addition to the amount of payment otherwise made to the provider of services or renal dialysis facility under section 1881(span) of such Act.
“(c)Individuals Eligible to Receive Services Under Project.—“(1)In general.—An individual may receive services from a provider of services or renal dialysis facility participating in the demonstration project if—“(A) the individual is not a resident of a nursing facility;
“(B) the individual is an end stage renal disease patient entitled to benefits under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.]; “(C) the individual’s physician certifies that the individual is confined to a bed or wheelchair and cannot transfer themselves [sic] from a bed to a chair;
“(D) the individual has a serious medical condition (as specified by the Secretary) which would be exacerbated by travel to and from a dialysis facility;
“(E) the individual is eligible for ambulance transportation to receive routine maintenance dialysis treatments, and, based on the individual’s medical condition, there is reasonable expectation that such transportation will be used by the individual for a period of at least 6 consecutive months, such that the cost of ambulance transportation can reasonably be expected to meet or exceed the cost of home hemodialysis staff assistance as provided under subsection (span)(2); and
“(F) no family member or other individual is available to provide such assistance to the individual.
“(2)Coverage of individuals currently receiving services.—Any individual who, on the date of the enactment of this Act [Nov. 5, 1990], is receiving staff assistance under the experimental authority provided under section 1881(f)(2) of the Social Security Act [42 U.S.C. 1395rr(f)(2)] shall be deemed to be an eligible individual for purposes of this subsection. “(3)Continuation of coverage upon termination of project.—Notwithstanding any provision of title XVIII of the Social Security Act, any individual receiving services under the demonstration project established under subsection (a) as of the date of the termination of the project shall continue to be eligible for home hemodialysis staff assistance after such date under such title on the same terms and conditions as applied under the demonstration project.
“(d)Qualifications for Home Hemodialysis Staff Assistants.—For purposes of subsection (span), a home dialysis aide is qualified if the aide—“(1) meets minimum qualifications as specified by the Secretary; and
“(2) meets any applicable qualifications as specified under the law of the State in which the home hemodialysis staff assistant is providing services.
“(e)Reports.—“(1)Interim status report.—Not later than December 1, 1992, the Secretary shall submit to Congress a preliminary report on the status of the demonstration project established under subsection (a).
“(2)Final report.—Not later than December 31, 1995, the Secretary shall submit to Congress a final report evaluating the project, and shall include in such report recommendations regarding appropriate eligibility criteria and cost-control mechanisms for medicare coverage of the services of a home dialysis aide providing medical assistance to a patient during hemodialysis treatment at the patient’s home.
“(f)Authorization of Appropriations.—The Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund (established under section 1841 of the Social Security Act [42 U.S.C. 1395t]) of not more than the following amounts to carry out the demonstration project established under subsection (a) (without regard to amounts appropriated in advance in appropriation Acts):“(1) For fiscal year 1991, $4,000,000.
“(2) For fiscal year 1992, $4,000,000.
“(3) For fiscal year 1993, $3,000,000.
“(4) For fiscal year 1994, $2,000,000.
“(5) For fiscal year 1995, $1,000,000.”
Studies of End-Stage Renal Disease ProgramPuspan. L. 100–203, title IV, § 4036(d)(1)–(4), Dec. 22, 1987, 101 Stat. 1330–79, provided that:“(1) The Secretary of Health and Human Services (in this subsection referred to as the ‘Secretary’) shall arrange for a study of the end-stage renal disease program within the medicare program.
“(2) Among other items, the study shall address—“(A) access to treatment by both individuals eligible for medicare benefits and those not eligible for such benefits;
“(B) the quality of care provided to end-stage renal disease beneficiaries, as measured by clinical indicators, functional status of patients, and patient satisfaction;
“(C) the effect of reimbursement on quality of treatment;
“(D) major epidemiological and demographic changes in the end-stage renal disease population that may affect access to treatment, the quality of care, or the resource requirements of the program; and
“(E) the adequacy of existing data systems to monitor these matters on a continuing basis.
“(3) The Secretary shall submit to Congress, not later than 3 years after the date of the enactment of this Act [Dec. 22, 1987], a report on the study.
“(4) The Secretary shall request the National Academy of Sciences, acting through the Institute of Medicine, to submit an application to conduct the study described in this section. If the Academy submits an acceptable application, the Secretary shall enter into an appropriate arrangement with the Academy for the conduct of the study. If the Academy does not submit an acceptable application to conduct the study, the Secretary may request one or more appropriate nonprofit private entities to submit an application to conduct the study and may enter into an appropriate arrangement for the conduct of the study by the entity which submits the best acceptable application.”
Rates for Dialysis ServicesPuspan. L. 99–509, title IX, § 9335(a)(1), Oct. 21, 1986, 100 Stat. 2029, as amended by Puspan. L. 101–239, title VI, § 6203(a)(1), Dec. 19, 1989, 103 Stat. 2235; Puspan. L. 101–508, title IV, § 4201(a), Nov. 5, 1990, 104 Stat. 1388–102; Puspan. L. 106–113, div. B, § 1000(a)(6) [title II, § 222(span)], Nov. 29, 1999, 113 Stat. 1536, 1501A–352, provided that: “Effective with respect to dialysis services provided on or after October 1, 1986, and before December 31, 1990, the Secretary of Health and Human Services shall establish the base rate for routine dialysis treatment in a free-standing facility and in a hospital-based facility under section 1881(span)(7) of the Social Security Act [42 U.S.C. 1395rr(span)(7)] at a level equal to the respective rate in effect as of May 13, 1986, reduced by $2.00. With respect to services furnished on or after January 1, 1991, and before January 1, 2000, such base rate shall be equal to the respective rate in effect as of September 30, 1990 (determined without regard to any reductions imposed pursuant to section 6201 of the Omnibus Budget Reconciliation Act of 1989 [Puspan. L. 101–239, set out as a note under section 904 of Title 2, The Congress]), increased by $1.00. No change may be made in the base rate in effect as of September 30, 1990, unless the Secretary makes such change in accordance with notice and comment requirements set forth in section 1871(span)(1) of such Act [42 U.S.C. 1395rr(span)(1)].”
[Puspan. L. 101–239, title VI, § 6203(a)(2), Dec. 19, 1989, 103 Stat. 2235, provided that: “The amendment made by paragraph (1) [amending section 9335(a)(1) of Puspan. L. 99–509, set out above] shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1986 [Puspan. L. 99–509].”]
Study and Report on Medicare Payment Rate Reductions for Patients With End Stage Renal DiseasePuspan. L. 99–509, title IX, § 9335(span), Oct. 21, 1986, 100 Stat. 2029, directed Secretary of Health and Human Services to provide for a study to evaluate the effects of reductions in the rates of payment for facility and physicians’ services under the medicare program for patients with end stage renal disease on their access to care or on the quality of care, and a report to Congress on results of the study by not later than Jan. 1, 1988, with Secretary to enter into an appropriate arrangement with the National Academy of Sciences or other appropriate nonprofit private entity for the conduct of the study.
Deadline for Establishing New End Stage Renal Disease Network Areas; TransitionPuspan. L. 99–509, title IX, § 9335(d)(2), (3), Oct. 21, 1986, 100 Stat. 2031, as amended by Puspan. L. 100–203, title IV, § 4009(j)(6)(E), Dec. 22, 1987, 101 Stat. 1330–59, provided that:“(2)Deadline for establishing new areas.—The Secretary of Health and Human Services shall establish end stage renal disease network areas, pursuant to the amendment made by paragraph (1) [amending this section], not later than May 1, 1987. The Secretary shall designate network administrative organizations for such areas by not later than July 1, 1987.
“(3)Transition.—If, under the amendment made by paragraph (1), the Secretary designates a network administrative organization for an area which was not previously designated for that area, the Secretary shall offer to continue to fund the previously designated organization for that area for a period of 30 days after the first date the newly designated organization assumes the duties of a network administrative organization for that area.”
Report on Establishment of National End Stage Renal Disease RegistryPuspan. L. 99–509, title IX, § 9335(i)(2), Oct. 21, 1986, 100 Stat. 2032, provided that: “The Secretary of Health and Human Services shall submit to the Congress, no later than April 1, 1987, a full report on the progress made in establishing the national end stage renal disease registry under the amendment made by paragraph (1) [amending this section] and shall establish such registry by not later than January 1, 1988.”
Deadline for Establishment of Protocols on Reuse of Dialyzer FiltersPuspan. L. 99–509, title IX, § 9335(k)(2), Oct. 21, 1986, 100 Stat. 2033, as amended by Puspan. L. 100–203, title IV, § 4036(c)(1)(A), Dec. 22, 1987, 101 Stat. 1330–79, provided that: “The Secretary of Health and Human Services shall establish the protocols described in section 1881(f)(7)(A) of the Social Security Act [42 U.S.C. 1395rr(f)(7)(A)] by not later than October 1, 1987 (or July 1, 1988, with respect to protocols that relate to the reuse of bloodlines).”
[Puspan. L. 100–203, title IV, § 4036(c)(1)(B), Dec. 22, 1987, 101 Stat. 1330–79, provided that: “The amendment made by subparagraph (A) [amending section 9335(k)(2) of Puspan. L. 99–509, set out above] shall be effective as if included in the enactment of section 9335(k)(2) of the Omnibus Budget Reconciliation Act of 1986 [Puspan. L. 99–509].”]
Limitation on Merger of End Stage Renal Disease NetworksPuspan. L. 99–272, title IX, § 9214, Apr. 7, 1986, 100 Stat. 180, provided that: “The Secretary of Health and Human Services shall maintain renal disease network organizations as authorized under section 1881(c) of the Social Security Act [42 U.S.C. 1395rr(c)], and may not merge the network organizations into other organizations or entities. The Secretary may consolidate such network organizations, but only if such consolidation does not result in fewer than 14 such organizations being permitted to exist.”
