42 CFR Part 512
PART 512—STANDARD PROVISIONS FOR MANDATORY INNOVATION CENTER MODELS AND SPECIFIC PROVISIONS FOR CERTAIN MODELS
- PART 512—STANDARD PROVISIONS FOR MANDATORY INNOVATION CENTER MODELS AND SPECIFIC PROVISIONS FOR CERTAIN MODELS
- Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services › Subchapter H—Health Care Infrastructure and Model Programs
- Subpart A—Standard Provisions for Mandatory Innovation Center Models
- § 512.100 Basis and scope.
- § 512.110 Definitions.
- § 512.120 Beneficiary protections.
- § 512.130 Cooperation in model evaluation and monitoring.
- § 512.135 Audits and record retention.
- § 512.140 Rights in data and intellectual property.
- § 512.150 Monitoring and compliance.
- § 512.160 Remedial action.
- § 512.165 Innovation center model termination by CMS.
- § 512.170 Limitations on review.
- § 512.180 Miscellaneous provisions on bankruptcy and other notifications.
- § 512.190 Reconsideration review process.
- Subpart B—Radiation Oncology Model
- General
- § 512.200 Basis and scope of subpart.
- § 512.205 Definitions.
- RO Model Participation
- § 512.210 RO participants and geographic areas.
- § 512.215 Beneficiary population.
- § 512.217 Identification of individual practitioners.
- § 512.220 RO participant compliance with RO Model requirements.
- § 512.225 Beneficiary notification.
- Scope of RO Episodes Being Tested
- § 512.230 Criteria for determining cancer types.
- § 512.235 Included RT services.
- § 512.240 Included modalities.
- § 512.245 Included RO episodes.
- Pricing Methodology
- § 512.250 Determination of national base rates.
- § 512.255 Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts.
- Billing and Payment
- § 512.260 Billing.
- § 512.265 Payment.
- § 512.270 Treatment of add-on payments under existing Medicare payment systems.
- Data Reporting
- § 512.275 Quality measures, clinical data, and reporting.
- Medicare Program Waivers
- § 512.280 RO Model Medicare program waivers.
- Reconciliation and Review Process
- § 512.285 Reconciliation process.
- § 512.290 Timely error notice and reconsideration review process.
- § 512.292 Overlap with other models tested under Section 1115A and CMS programs.
- § 512.294 Extreme and uncontrollable circumstances.
- Subpart C—ESRD Treatment Choices Model
- General
- § 512.300 Basis and scope.
- § 512.310 Definitions.
- ESRD Treatment Choices Model Scope and Participants
- § 512.320 Duration.
- § 512.325 Participant selection and geographic areas.
- § 512.330 Beneficiary notification.
- Home Dialysis Payment Adjustment
- § 512.340 Payments subject to the Facility HDPA.
- § 512.345 Payments subject to the Clinician HDPA.
- § 512.350 Schedule of home dialysis payment adjustments.
- Performance Payment Adjustment
- § 512.355 Schedule of performance assessment and performance payment adjustment.
- § 512.360 Beneficiary population and attribution.
- § 512.365 Performance assessment.
- § 512.370 Benchmarking and scoring.
- § 512.375 Payments subject to adjustment.
- § 512.380 PPA Amounts and schedules.
- § 512.385 PPA exclusions.
- § 512.390 Notification, data sharing, and targeted review.
- Quality Monitoring
- § 512.395 Quality measures.
- Medicare Program Waivers
- § 512.397 ETC Model Medicare program waivers and additional flexibilities.
- Subpart D—Increasing Organ Transplant Access (IOTA) Model
- § 512.400 Basis and scope.
- § 512.402 Definitions.
- Increasing Organ Transplant Access Model Scope and Participation
- § 512.412 Participant eligibility and selection.
- § 512.414 Patient population.
- Performance Assessment and Scoring
- § 512.422 Overview of performance assessment and scoring.
- § 512.424 Achievement domain.
- § 512.426 Efficiency domain.
- § 512.428 Quality domain.
- Payment
- § 512.430 Upside risk payment, downside risk payment, and neutral zone.
- § 512.434 Targeted review.
- § 512.436 Extreme and uncontrollable circumstances.
- Data Sharing
- § 512.440 Data sharing.
- § 512.442 Transparency requirements.
- Beneficiary Protections and Financial Arrangements, Beneficiary Incentives, and Compliance
- § 512.450 Required beneficiary notifications.
- § 512.452 Financial sharing arrangements and attributed patient engagement incentives.
- § 512.454 Distribution arrangements.
- § 512.455 Enforcement authority.
- § 512.456 Beneficiary incentive: Part B and Part D immunosuppressive drug cost sharing support.
- § 512.458 Attributed patient engagement incentives.
- § 512.459 Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
- § 512.460 Audit rights and records retention.
- § 512.462 Compliance and monitoring.
- § 512.464 Remedial action.
- § 512.466 Termination.
- § 512.468 Bankruptcy and other notifications.
- Waivers
- § 512.470 Waivers.
- Subpart E—Transforming Episode Accountability Model (TEAM)
- General
- § 512.500 Basis and scope of subpart.
- § 512.505 Definitions.
- TEAM Participation
- § 512.508 Mandatory participation.
- § 512.510 Voluntary opt-in participation.
- § 512.515 Geographic areas.
- § 512.520 Participation tracks.
- § 512.522 APM options.
- Scope of Episodes Being Tested
- § 512.525 Episodes.
- § 512.535 Beneficiary inclusion criteria.
- § 512.537 Determination of the episode.
- Pricing Methodology
- § 512.540 Determination of preliminary target prices.
- § 512.545 Determination of reconciliation target prices.
- Quality Measures and Composite Quality Score
- § 512.547 Quality measures, composite quality score, and display of quality measures.
- Reconciliation and Review Process
- § 512.550 Reconciliation process and determination of the reconciliation payment or repayment amount.
- § 512.552 Treatment of incentive programs or add-on payments under existing Medicare payment systems.
- § 512.555 Proration of payments for services that extend beyond an episode.
- § 512.560 Appeals process.
- § 512.561 Reconsideration review processes.
- Data Sharing and Other Requirements
- § 512.562 Data sharing with TEAM participants.
- § 512.563 Health data reporting.
- § 512.564 Referral to primary care services.
- Financial Arrangements and Beneficiary Incentives
- § 512.565 Sharing arrangements.
- § 512.568 Distribution arrangements.
- § 512.570 Downstream distribution arrangements.
- § 512.575 TEAM beneficiary incentives.
- § 512.576 Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
- Medicare Program Waivers
- § 512.580 TEAM Medicare Program Waivers.
- General Provisions
- § 512.582 Beneficiary protections.
- § 512.584 Cooperation in model evaluation and monitoring.
- § 512.586 Audits and record retention.
- § 512.588 Rights in data and intellectual property.
- § 512.590 Monitoring and compliance.
- § 512.592 Remedial action.
- § 512.594 Limitations on review.
- § 512.595 Bankruptcy and other notifications.
- § 512.596 Termination of TEAM or TEAM participant from model by CMS.
- Subpart F—XXX
- Subpart G—Ambulatory Specialty Model (ASM)
- General
- § 512.700 Basis and scope of subpart.
- § 512.705 Definitions.
- § 512.710 Participant eligibility and selection.
- Performance Categories and Scoring
- § 512.715 Overview of performance assessment.
- § 512.720 Data submission requirements.
- § 512.725 Quality ASM performance category.
- § 512.730 Cost ASM performance category.
- § 512.735 Improvement activities ASM performance category.
- § 512.740 Promoting Interoperability ASM performance category.
- § 512.745 Final scoring.
- Payment and Timely Error Notice Process
- § 512.750 Payment adjustment.
- § 512.755 Timely error notice process.
- Data Sharing, Waivers, Safe Harbor, and Compliance
- § 512.760 Data sharing with ASM participants.
- § 512.765 Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
- § 512.770 ASM beneficiary incentives.
- § 512.771 Collaborative care arrangements.
- § 512.775 Medicare program waivers.
- § 512.780 Extreme and uncontrollable circumstances.
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