Page:United States Statutes at Large Volume 104 Part 2.djvu/511

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PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-103 patients provided under title XVIII of the Social Security Act. (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 pay- ments 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 freestanding 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. (c) PAYMENT RATES FOR ERYTHROPOIETIN. — (1) IN GENERAL.— Section 1881(b)(ll) of the Social Security Act (42 U.S.C. 1395rr(b)) is amended— (A) by striking "(H)" and inserting "(HXA)"; and (B) by adding at the end the following new subparagraph: "(B) Erythropoietin, when provided to a patient determined to have end stage renal disease, shall not be included as a dialysis service for purposes of payment under any prospective payment amount or comprehensive fee established under this section, and payment for such item shall be made separately— "(i) in the case of erj^hropoietin provided by a physician, in accordance with section 1833; and