12 2 STA T . 2 5 5 8PUBLIC LA W 11 0– 2 7 5 —J UL Y 15 , 2008 ‘ ‘ (i i )AP P LICAT I ON.—Forp ro v i de r s o f servi c es an d rena l dial y sis facili t ies t h at do not m eet (or e x ceed) the total performance score esta b lished by the S ec - retary , the Secretary shall ens u re that the application of the methodolo g y developed under clause (i) results in an appropriate distribution of reductions in payment under paragraph ( 1 ) among providers and facilities achieving different levels of total performance scores, w ith providers and facilities achieving the lowest total performance scores receiving the largest reduction in payment under paragraph (1)(A). ‘‘(iii) WE I GH TING O FM EA SUR ES.— I n calculating the total performance score, the Secretary shall weight the scores with respect to individual measures cal- culated under subparagraph ( B ) to reflect priorities for q uality improvement, such as weighting scores to ensure that providers of services and renal dialysis facilities have strong incentives to meet or exceed anemia management and dialysis adequacy perform- ance standards, as determined appropriate by the Sec- retary. ‘‘(B) P ERFORMANCE SCORE W ITH RESPECT TO IN D I V IDUAL MEASURES.— T he Secretary shall also calculate separate performance scores for each measure, including for dialysis adequacy and anemia management. ‘‘( 4 ) PERFORMANCE STANDARDS.— ‘‘(A) E STA B LISHMENT.—Sub j ect to subparagraph (E), the Secretary shall establish performance standards with respect to measures selected under paragraph ( 2 )fora performance period with respect to a year (as established under subparagraph ( D )). ‘‘(B) ACHIEVEMENT AND IMPROVEMENT.—The perform- ance standards established under subparagraph (A) shall include levels of achievement and improvement, as deter- mined appropriate by the Secretary. ‘‘( C ) TIMING.—The Secretary shall establish the performance standards under subparagraph (A) prior to the beginning of the performance period for the year involved. ‘‘(D) PERFORMANCE PERIOD.—The Secretary shall estab- lish the performance period with respect to a year. Such performance period shall occur prior to the beginning of such year. ‘‘(E) SPECIAL RULE.—The Secretary shall initially use as the performance standard for the measures specified under paragraph (2)(A)(i) for a provider of services or a renal dialysis facility the lesser of— ‘‘(i) the performance of such provider or facility for such measures in the year selected by the Secretary under the second sentence of subsection (b)(14)(A)(ii)
or ‘‘(ii) a performance standard based on the national performance rates for such measures in a period deter- mined by the Secretary. ‘‘( 5 ) L IMITATION ON REVIEW.—There shall be no administra- tive or judicial review under section 1 869 , section 18 7 8, or otherwise of the following
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