Contents
- 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.
- 512.200 Basis and scope of subpart.
- 512.205 Definitions.
- 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.
- 512.230 Criteria for determining cancer types.
- 512.235 Included RT services.
- 512.240 Included modalities.
- 512.245 Included RO episodes.
- 512.250 Determination of national base rates.
- 512.255 Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts.
- 512.260 Billing.
- 512.265 Payment.
- 512.270 Treatment of add-on payments under existing Medicare payment systems.
- 512.275 Quality measures, clinical data, and reporting.
- 512.280 RO Model Medicare program waivers.
- 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.
- 512.300 Basis and scope.
- 512.310 Definitions.
- 512.320 Duration.
- 512.325 Participant selection and geographic areas.
- 512.330 Beneficiary notification.
- 512.340 Payments subject to the Facility HDPA.
- 512.345 Payments subject to the Clinician HDPA.
- 512.350 Schedule of home dialysis payment adjustments.
- 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.
- 512.395 Quality measures.
- 512.397 ETC Model Medicare program waivers and additional flexibilities.
- 512.400 Basis and scope.
- 512.402 Definitions.
- 512.412 Participant eligibility and selection.
- 512.414 Patient population.
- 512.422 Overview of performance assessment and scoring.
- 512.424 Achievement domain.
- 512.426 Efficiency domain.
- 512.428 Quality domain.
- 512.430 Upside risk payment, downside risk payment, and neutral zone.
- 512.434 Targeted review.
- 512.436 Extreme and uncontrollable circumstances.
- 512.440 Data sharing.
- 512.442 Transparency requirements.
- 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.
- 512.470 Waivers.
- 512.500 Basis and scope of subpart.
- 512.505 Definitions.
- 512.508 Mandatory participation.
- 512.510 Voluntary opt-in participation.
- 512.515 Geographic areas.
- 512.520 Participation tracks.
- 512.522 APM options.
- 512.525 Episodes.
- 512.535 Beneficiary inclusion criteria.
- 512.537 Determination of the episode.
- 512.540 Determination of preliminary target prices.
- 512.545 Determination of reconciliation target prices.
- 512.547 Quality measures, composite quality score, and display of quality measures.
- 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.
- 512.562 Data sharing with TEAM participants.
- 512.563 Health data reporting.
- 512.564 Referral to primary care services.
- 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.
- 512.580 TEAM Medicare Program Waivers.
- 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.
- 512.600 Basis and scope of subpart.
- 512.605 Definitions.
- 512.610 Mandatory participation.
- 512.615 CJR-X APM options.
- 512.620 Beneficiary inclusion criteria.
- 512.622 Beneficiary notifications.
- 512.625 Scope of episode.
- 512.630 Determination of the episode.
- 512.635 Quality measures, composite quality score, and display of quality measures.
- 512.640 Determination of preliminary target prices.
- 512.645 Determination of reconciliation target prices.
- 512.650 Reconciliation process and determination of the reconciliation payment or repayment amount.
- 512.652 Treatment of incentive programs or add-on payments under existing Medicare payment systems.
- 512.655 Proration of payments for items and services that extend beyond an episode.
- 512.660 Appeals process.
- 512.665 Data sharing with CJR-X participants.
- 512.670 Sharing arrangements.
- 512.675 Distribution arrangements.
- 512.680 Downstream distribution arrangements.
- 512.685 CJR-X beneficiary incentives.
- 512.690 Application of the CMS-sponsored Model Arrangements and Patient Incentives Safe Harbor.
- 512.695 CJR-X Medicare Program Waivers.
- 512.700 Basis and scope of subpart.
- 512.705 Definitions.
- 512.710 Participant eligibility and selection.
- 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.
- 512.750 Payment adjustment.
- 512.755 Timely error notice process.
- 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.
Contents
3,261 provisions, too many to show on one page. Open a part or section to read it with its history and connections, or search inside the text.
- 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.
- 512.200 · Basis and scope of subpart.
- 512.205 · Definitions.
- 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.
- 512.230 · Criteria for determining cancer types.
- 512.235 · Included RT services.
- 512.240 · Included modalities.
- 512.245 · Included RO episodes.
- 512.250 · Determination of national base rates.
- 512.255 · Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts.
- 512.260 · Billing.
- 512.265 · Payment.
- 512.270 · Treatment of add-on payments under existing Medicare payment systems.
- 512.275 · Quality measures, clinical data, and reporting.
- 512.280 · RO Model Medicare program waivers.
- 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.
- 512.300 · Basis and scope.
- 512.310 · Definitions.
- 512.320 · Duration.
- 512.325 · Participant selection and geographic areas.
- 512.330 · Beneficiary notification.
- 512.340 · Payments subject to the Facility HDPA.
- 512.345 · Payments subject to the Clinician HDPA.
- 512.350 · Schedule of home dialysis payment adjustments.
- 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.
- 512.395 · Quality measures.
- 512.397 · ETC Model Medicare program waivers and additional flexibilities.
- 512.400 · Basis and scope.
- 512.402 · Definitions.
- 512.412 · Participant eligibility and selection.
- 512.414 · Patient population.
- 512.422 · Overview of performance assessment and scoring.
- 512.424 · Achievement domain.
- 512.426 · Efficiency domain.
- 512.428 · Quality domain.
- 512.430 · Upside risk payment, downside risk payment, and neutral zone.
- 512.434 · Targeted review.
- 512.436 · Extreme and uncontrollable circumstances.
- 512.440 · Data sharing.
- 512.442 · Transparency requirements.
- 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.
- 512.470 · Waivers.
- 512.500 · Basis and scope of subpart.
- 512.505 · Definitions.
- 512.508 · Mandatory participation.
- 512.510 · Voluntary opt-in participation.
- 512.515 · Geographic areas.
- 512.520 · Participation tracks.
- 512.522 · APM options.
- 512.525 · Episodes.
- 512.535 · Beneficiary inclusion criteria.
- 512.537 · Determination of the episode.
- 512.540 · Determination of preliminary target prices.
- 512.545 · Determination of reconciliation target prices.
- 512.547 · Quality measures, composite quality score, and display of quality measures.
- 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.
- 512.562 · Data sharing with TEAM participants.
- 512.563 · Health data reporting.
- 512.564 · Referral to primary care services.
- 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.
- 512.580 · TEAM Medicare Program Waivers.
- 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.
- 512.600 · Basis and scope of subpart.
- 512.605 · Definitions.
- 512.610 · Mandatory participation.
- 512.615 · CJR-X APM options.
- 512.620 · Beneficiary inclusion criteria.
- 512.622 · Beneficiary notifications.
- 512.625 · Scope of episode.
- 512.630 · Determination of the episode.
- 512.635 · Quality measures, composite quality score, and display of quality measures.
- 512.640 · Determination of preliminary target prices.
- 512.645 · Determination of reconciliation target prices.
- 512.650 · Reconciliation process and determination of the reconciliation payment or repayment amount.
- 512.652 · Treatment of incentive programs or add-on payments under existing Medicare payment systems.
- 512.655 · Proration of payments for items and services that extend beyond an episode.
- 512.660 · Appeals process.
- 512.665 · Data sharing with CJR-X participants.
- 512.670 · Sharing arrangements.
- 512.675 · Distribution arrangements.
- 512.680 · Downstream distribution arrangements.
- 512.685 · CJR-X beneficiary incentives.
- 512.690 · Application of the CMS-sponsored Model Arrangements and Patient Incentives Safe Harbor.
- 512.695 · CJR-X Medicare Program Waivers.
- 512.700 · Basis and scope of subpart.
- 512.705 · Definitions.
- 512.710 · Participant eligibility and selection.
- 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.
- 512.750 · Payment adjustment.
- 512.755 · Timely error notice process.
- 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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