I 

108TH CONGRESS 

1ST SESSION H. R. 1784

To amend title XVIII of the Social Security Act to update the renal dialysis 

composite rate. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 11, 2003

Mr. CAMP (for himself, Mr. KLECZKA, Mr. SAM JOHNSON of Texas, Mr. 

ISRAEL, Mr. MCNULTY, Mr. ROGERS of Michigan, Mr. PAUL, Mr. 

HAYWORTH, Mr. ENGLISH, Mr. WHITFIELD, and Mr. LEWIS of Georgia) 

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and 

Means, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL

To amend title XVIII of the Social Security Act to update 

the renal dialysis composite rate.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Renal Dialy5 sis Payment Fairness Act of 2003’’. 
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1 SEC. 2. UPDATE IN RENAL DIALYSIS COMPOSITE RATE. 

2 (a) IN GENERAL.—The last sentence of section 

3 1881(b)(7) of the Social Security Act (42 U.S.C. 

4 1395rr(b)(7)) is amended—

5 (1) by striking ‘‘and’’ before ‘‘for such serv6 ices’’; 

7 (2) by inserting ‘‘and before January 1, 2004,’’ 

8 after ‘‘January 1, 2001,’’; and 

9 (3) by inserting before the period at the end the 

10 following: ‘‘, and for such services furnished during 

11 all subsequent years (beginning with 2004), by the 

12 ESRD market basket percentage increase (as de13 fined in paragraph (12)(A) and including any addi14 tional factors that may increase costs described in 

15 paragraph (12)(B)) above such composite rate pay16 ment amounts for such services furnished on Decem17 ber 31 of the previous year’’. 

18 (b) ESRD MARKET BASKET PERCENTAGE INCREASE

19 DEFINED.—Section 1881(b) of the Social Security Act 

20 (42 U.S.C. 1395rr(b)) is amended by adding at the end 

21 the following new paragraph: 

22 ‘‘(12)(A) For purposes of this title, the term ‘ESRD 

23 market basket percentage increase’ means, with respect to 

24 a calendar year, the percentage (estimated by the Sec25 retary before the beginning of such year) by which—
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1 ‘‘(i) the cost of the mix of goods and services 

2 included in the provision of dialysis services (includ3 ing the costs described in subparagraph (D)) that is 

4 determined based on an index of appropriately 

5 weighted indicators of changes in wages and prices 

6 which are representative of the mix of goods and 

7 services included in such dialysis services for the cal8 endar year; exceeds 

9 ‘‘(ii) the cost of such mix of goods and services 

10 for the preceding calendar year. 

11 ‘‘(B) In addition to determining the percentage up12 date under subparagraph (A), the Secretary shall also take 

13 into account any increase in the costs of furnishing the 

14 mix of goods and services described in such subparagraph 

15 resulting from—

16 ‘‘(i) the adoption of scientific and technological 

17 innovations used to provide dialysis services; 

18 ‘‘(ii) changes in the manner or method of deliv19 ering dialysis services; 

20 ‘‘(iii) productivity improvements in the provi21 sion of dialysis services; and 

22 ‘‘(iv) any other relevant factor. 

23 ‘‘(C) The Secretary shall periodically review and up24 date (as necessary) the items and services included in the 
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1 mix of goods and services used to determine the percent2 age under subparagraph (A). 

3 ‘‘(D) The costs described in this subparagraph in4 clude—

5 ‘‘(i) labor, including direct patient care costs 

6 and administrative labor costs, vacation and holiday 

7 pay, payroll taxes, and employee benefits; 

8 ‘‘(ii) other direct costs, including drugs, sup9 plies, and laboratory fees; 

10 ‘‘(iii) overhead, including medical director fees, 

11 temporary services, general and administrative costs, 

12 interest expenses, and bad debt; 

13 ‘‘(iv) capital, including rent, real estate taxes, 

14 depreciation, utilities, repairs, and maintenance; and 

15 ‘‘(v) such other allowable costs as the Secretary 

16 may specify.’’.

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