On February 20, CMS issued a report to Congress outlining its recommendations for implementation of a fully-bundled Medicare payment system for end-stage renal disease (ESRD) services (see ). Under the plan, which would require Congressional action, ESRD facilities would be paid a base treatment rate encompassing all services in the current “composite rate” along with those serves now separately billable (e.g., drugs, laboratory services, supplies, and blood products). The base rate would be adjusted for certain patient characteristics and comorbidities, and outlier payments could be provided for particularly expensive cases.  CMS acknowledges that it would take several years to implement a fully-bundled ESRD PPS; the President’s budget calls for implementation by January 1, 2011.