12 2 STA T . 2 5 5 4PUBLIC LA W 11 0– 2 7 5 —J UL Y 15 , 200 8usep e r p ati e n t uti l i z ati o n d ata f ro m20 0 7, 200 8 ,or200 9 , wh i c he v er has the lowest per patient utilization .‘ ‘ (B)F or purposes of this para g raph, the term ‘renal dial y sis services ’ includes — ‘‘(i) items and services included in the composite rate for renal dialysis services as of D ecem b er 31 , 2010
‘‘(ii) erythropoiesis stimulating agents and any oral form of such agents that are furnished to individuals for the treat - ment of end stage renal disease; ‘‘(iii) other drugs and biologicals that are furnished to individuals for the treatment of end stage renal disease and for which payment was (before the application of this para- graph) made separately under this title, and any oral e q uivalent form of such drug or biological; and ‘‘(iv) diagnostic laboratory tests and other items and serv- ices not described in clause (i) that are furnished to individuals for the treatment of end stage renal disease. S uch term does not include vaccines. ‘‘( C ) T he system under this paragraph may provide for payment on the basis of services furnished during a wee k or month or such other appropriate unit of payment as the Secretary specifies. ‘‘(D) Such system— ‘‘(i) shall include a payment ad j ustment based on case mi x that may take into account patient weight, body mass index, comorbidities, length of time on dialysis, age, race, eth- nicity, and other appropriate factors; ‘‘(ii) shall include a payment adjustment for high cost outliers due to unusual variations in the type or amount of medically necessary care, including variations in the amount of erythropoiesis stimulating agents necessary for anemia management; ‘‘(iii) shall include a payment adjustment that reflects the extent to which costs incurred by low-volume facilities (as defined by the Secretary) in furnishing renal dialysis services exceed the costs incurred by other facilities in furnishing such services, and for payment for renal dialysis services furnished on or after J anuary 1, 2011, and before January 1, 201 4 , such payment adjustment shall not be less than 10 percent; and ‘‘(iv) may include such other payment adjustments as the Secretary determines appropriate, such as a payment adjust- ment— ‘‘( I ) for pediatric providers of services and renal dialysis facilities; ‘‘(II) by a geographic index, such as the index referred to in paragraph (12)(D), as the Secretary determines to be appropriate; and ‘‘(III) for providers of services or renal dialysis facilities located in rural areas. The Secretary shall take into consideration the unique treatment needs of children and young adults in establishing such system. ‘‘( E )(i) The Secretary shall provide for a four-year phase-in (in equal increments) of the payment amount under the payment system under this paragraph, with such payment amount being fully implemented for renal dialysis services furnished on or after January 1, 2014. Ef f ectiv e da te .T i m e p e r i o d.
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