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 12 2 STA T . 2 5 5 3PUBLIC LA W 11 0– 2 7 5 —J UL Y 15, 200 8‘ ‘ (O)inthecas e ofk i d ne y disease ed u cation se rv ices (as defined in p ara g raph ( 1 ) of section 1 86 1(ggg)) ,w hich are fur - nished in e x cess of the nu mb er of sessions covered under para- graph ( 4 ) of such section ’ . ( 2 ) EF F ECTIV E DA TE. —T he amendments made by this sub- section sha l l apply to services furnished on or after J anuary 1,2 0 10. SEC.153 . R E NALDI AL Y SIS P R OV ISIONS. (a) COMP O S ITE R ATE.— (1) U PDATE.— S ection 1881(b)(12)( G ) of the Social Security A ct (42 U.S.C. 1 395 rr(b)(12)(G)) is amended— (A) in clause (i), by striking ‘‘and’’ at the end; ( B ) in clause (ii)— (i) by inserting ‘‘and before January 1, 2009,’’ after ‘‘April 1, 200 7 ,’’; and (ii) by striking the period at the end and inserting a semicolon; and (C) by adding at the end the following new clauses

‘‘(iii) furnished on or after January 1, 2009, and before January 1, 2010, by 1.0 percent above the amount of such composite rate component for such services furnished on D ecember 31, 2008; and ‘‘(iv) furnished on or after January 1, 2010, by 1.0 percent above the amount of such composite rate component for such services furnished on December 31, 2009.’’. (2) SITE N E U T R A L COMPOSITE RATE.—Section 1881(b)(12)(A) of the Social Security Act (42 U.S.C. 1395rr(b)(12)(A)) is amended by adding at the end the following new sentence: ‘‘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.’’. (b) DEVELOPMENT OF ESRD BUNDLED P A Y MENT SYSTEM.— (1) I N G ENERAL.—Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following new paragraph: ‘‘(14)(A)(i) Sub j ect to subparagraph (E), for services furnished on or after January 1, 2011, the Secretary shall implement a payment system under which a single payment is made under this title to a provider of services or a renal dialysis facility for renal dialysis services (as defined in subparagraph (B)) in lieu of any other payment (including a payment adjustment under para- graph (12)(B)(ii)) and for such services and items furnished pursu- ant to paragraph (4). ‘‘(ii) In implementing the system under this paragraph the Secretary shall ensure that the estimated total amount of payments under this title for 2011 for renal dialysis services shall e q ual 98 percent of the estimated total amount of payments for renal dialysis services, including payments under paragraph (12)(B)(ii), that would have been made under this title with respect to services furnished in 2011 if such system had not been implemented. In making the estimation under subclause (I), the Secretary shall Ef f ectiv e da te . Effective date. Effective date. T i m e p e r i o d. 42USC1395w– 4 n ote.

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