365 
‘‘(i) QUALITY INCENTIVE PAYMENTS IN THE END- 
STAGE RENAL DISEASE PROGRAM.— 
‘‘(1) QUALITY INCENTIVE PAYMENTS FOR SERV-
ICES FURNISHED IN 2008, 2009, AND 2010.— 
‘‘(A) IN GENERAL.—With respect to renal 
dialysis services furnished during a performance 
period (as defined in subparagraph (B)) by a 
provider of services or renal dialysis facility that 
the Secretary determines meets the applicable 
performance standard for the period under sub-
paragraph (C) and reports on measures for 2009 
and 2010 under subparagraph (D) for such serv-
ices, in addition to the amount otherwise paid 
under this section, subject to subparagraph (G), 
there also shall be paid to the provider or facility 
an amount equal to the applicable percentage 
(specified in subparagraph (E) for the period) of 
the Secretary’s estimate (based on claims sub-
mitted not later than two months after the end 
of the performance period) of the amount speci-
fied in subparagraph (F) for such period. 
‘‘(B) 
PERFORMANCE
PERIOD.—In 
this 
paragraph, the term ‘performance period’ means 
each of the following: 
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‘‘(i) The period beginning on July 1, 
2008, and ending on December 31, 2008. 
‘‘(ii) 2009. 
‘‘(iii) 2010. 
‘‘(C) PERFORMANCE STANDARD.— 
‘‘(i) 2008.—For the performance pe-
riod occurring in 2008, the applicable per-
formance standards for a provider or facil-
ity under this subparagraph are— 
‘‘(I) 92 percent or more of indi-
viduals with end stage renal disease re-
ceiving erythopoetin stimulating agents 
who have an average hematocrit of 
33.0 percent or more; and 
‘‘(II) less than a percentage, speci-
fied by the Secretary, of individuals 
with end stage renal disease receiving 
erythopoetin stimulating agents who 
have an average hematocrit of 39.0 
percent or more. 
‘‘(ii) 2009 AND
2010.—For the 2009 
and 2010 performance periods, the applica-
ble performance standard for a provider or 
facility under this subparagraph is success-
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ful performance (relative to national aver-
age) on— 
‘‘(I) such measures of anemia 
management as the Secretary shall 
specify, including measures of hemo-
globin levels or hematocrit levels for 
erythropoietin stimulating agents that 
are consistent with the labeling for dos-
age 
of 
erythropoietin 
stimulating 
agents approved by the Food and Drug 
Administration for treatment of ane-
mia in patients with end stage renal 
disease, taking into account variations 
in hemoglobin ranges or hematocrit 
levels of patients; and 
‘‘(II) such other measures, relat-
ing to subjects described in subpara-
graph (D)(i), as the Secretary may 
specify. 
‘‘(D) REPORTING
PERFORMANCE
MEAS-
URES.—The performance measures under this 
subparagraph to be reported shall include— 
‘‘(i) such measures as the Secretary 
specifies, before the beginning of the per-
formance period involved and taking into 
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account measures endorsed by the National 
Quality Forum, including, to the extent fea-
sible measures on— 
‘‘(I) iron management; 
‘‘(II) dialysis adequacy; and 
‘‘(III) vascular access, including 
for maximizing the placement of arte-
rial venous fistula; and 
‘‘(ii) to the extent feasible, such meas-
ure (or measures) of patient satisfaction as 
the Secretary shall specify. 
The provider or facility submitting information 
on such measures shall attest to the completeness 
and accuracy of such information. 
‘‘(E) APPLICABLE PERCENTAGE.—The ap-
plicable percentage specified in this subpara-
graph for— 
‘‘(i) the performance period occurring 
in 2008, is 1.0 percent; 
‘‘(ii) the 2009 performance period, is 
2.0 percent; and 
‘‘(iii) the 2010 performance period, is 
3.0 percent. 
In the case of any performance period which is 
less than an entire year, the applicable percent-
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age specified in this subparagraph shall be mul-
tiplied by the ratio of the number of months in 
the year to the number of months in such per-
formance period. In the case of 2010, the appli-
cable percentage specified in this subparagraph 
shall be multiplied by the Secretary’s estimate of 
the ratio of the aggregate payment amount de-
scribed in subparagraph (F)(i) that would apply 
in 2010 if paragraph (14) did not apply, to the 
aggregate payment base under subparagraph 
(F)(ii) for 2010. 
‘‘(F) PAYMENT BASE.—The payment base 
described in this subparagraph for a provider or 
facility is— 
‘‘(i) for performance periods before 
2010, the payment amount determined 
under paragraph (12) for services furnished 
by the provider or facility during the per-
formance period, including the drug pay-
ment adjustment described in subparagraph 
(B)(ii) of such paragraph; and 
‘‘(ii) for the 2010 performance period 
is the amount determined under paragraph 
(14) for services furnished by the provider 
or facility during the period. 
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‘‘(G) LIMITATION ON FUNDING.— 
‘‘(i) IN GENERAL.—If the Secretary de-
termines that the total payments under this 
paragraph for a performance period is pro-
jected to exceed the dollar amount specified 
in clause (ii) for such period, the Secretary 
shall reduce, in a pro rata manner, the 
amount of such payments for each provider 
or facility for such period to eliminate any 
such projected excess for the period. 
‘‘(ii) DOLLAR
AMOUNT.—The dollar 
amount specified in this clause— 
‘‘(I) for the performance period 
occurring in 2008, is $50,000,000; 
‘‘(II) for the 2009 performance pe-
riod is $100,000,000; and 
‘‘(III) for the 2010 performance 
period is $150,000,000. 
‘‘(H) FORM
OF
PAYMENT.—The payment 
under this paragraph shall be in the form of a 
single consolidated payment. 
‘‘(2) QUALITY INCENTIVE PAYMENTS FOR FACILI-
TIES AND PROVIDERS FOR 2011.— 
‘‘(A) INCREASED PAYMENT.—For 2011, in 
the case of a provider or facility that, for the 
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performance period (as defined in subparagraph 
(B))— 
‘‘(i) meets (or exceeds) the performance 
standard for anemia management specified 
in paragraph (1)(C)(ii)(I); 
‘‘(ii) has substantially improved per-
formance or exceeds a performance standard 
(as determined under subparagraph (E)); 
and 
‘‘(iii) reports measures specified in 
paragraph (1)(D), 
with respect to renal dialysis services furnished 
by the provider or facility during the quality 
bonus payment period (as specified in subpara-
graph (C)) the payment amount otherwise made 
to such provider or facility under subsection 
(b)(14) shall be increased, subject to subpara-
graph (F), by the applicable percentage specified 
in subparagraph (D). Payment amounts under 
paragraph (1) shall not be counted for purposes 
of applying the previous sentence. 
‘‘(B) 
PERFORMANCE
PERIOD.—In 
this 
paragraph, the term ‘performance period’ means 
a multi-month period specified by the Secretary 
. 
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‘‘(C) QUALITY BONUS PAYMENT PERIOD.— 
In this paragraph, the term ‘quality bonus pay-
ment period’ means, with respect to a perform-
ance period, a multi-month period beginning on 
January 1, 2011, specified by the Secretary that 
begins at least 3 months (but not more than 9 
months) after the end of the performance period. 
‘‘(D) APPLICABLE PERCENTAGE.—The ap-
plicable percentage specified in this subpara-
graph is a percentage, not to exceed the 4.0 per-
cent, specified by the Secretary consistent with 
subparagraph (F). Such percentage may vary 
based on the level of performance and improve-
ment. The applicable percentage specified in this 
subparagraph shall be multiplied by the ratio 
applied under the third sentence of paragraph 
(1)(E) for 2010. 
‘‘(E) PERFORMANCE STANDARD.—Based on 
performance of a provider of services or a renal 
dialysis facility on performance measures de-
scribed in paragraph (1)(D) for a performance 
period, the Secretary shall determine a composite 
score for such period. 
‘‘(F) LIMITATION ON FUNDING.—If the Sec-
retary determines that the total amount to be 
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