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Title 42, Part 512 — Standard Provisions for Mandatory Innovation Center Models and Specific Provisions for Certain Models

133 sections

Section 512.100
Basis and scope.
Section 512.110
Definitions.
Section 512.120
Beneficiary protections.
Section 512.130
Cooperation in model evaluation and monitoring.
Section 512.135
Audits and record retention.
Section 512.140
Rights in data and intellectual property.
Section 512.150
Monitoring and compliance.
Section 512.160
Remedial action.
Section 512.165
Innovation center model termination by CMS.
Section 512.170
Limitations on review.
Section 512.180
Miscellaneous provisions on bankruptcy and other notifications.
Section 512.190
Reconsideration review process.
Section 512.200
Basis and scope of subpart.
Section 512.205
Definitions.
Section 512.210
RO participants and geographic areas.
Section 512.215
Beneficiary population.
Section 512.217
Identification of individual practitioners.
Section 512.220
RO participant compliance with RO Model requirements.
Section 512.225
Beneficiary notification.
Section 512.230
Criteria for determining cancer types.
Section 512.235
Included RT services.
Section 512.240
Included modalities.
Section 512.245
Included RO episodes.
Section 512.250
Determination of national base rates.
Section 512.255
Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts.
Section 512.260
Billing.
Section 512.265
Payment.
Section 512.270
Treatment of add-on payments under existing Medicare payment systems.
Section 512.275
Quality measures, clinical data, and reporting.
Section 512.280
RO Model Medicare program waivers.
Section 512.285
Reconciliation process.
Section 512.290
Timely error notice and reconsideration review process.
Section 512.292
Overlap with other models tested under Section 1115A and CMS programs.
Section 512.294
Extreme and uncontrollable circumstances.
Section 512.300
Basis and scope.
Section 512.310
Definitions.
Section 512.320
Duration.
Section 512.325
Participant selection and geographic areas.
Section 512.330
Beneficiary notification.
Section 512.340
Payments subject to the Facility HDPA.
Section 512.345
Payments subject to the Clinician HDPA.
Section 512.350
Schedule of home dialysis payment adjustments.
Section 512.355
Schedule of performance assessment and performance payment adjustment.
Section 512.360
Beneficiary population and attribution.
Section 512.365
Performance assessment.
Section 512.370
Benchmarking and scoring.
Section 512.375
Payments subject to adjustment.
Section 512.380
PPA Amounts and schedules.
Section 512.385
PPA exclusions.
Section 512.390
Notification, data sharing, and targeted review.
Section 512.395
Quality measures.
Section 512.397
ETC Model Medicare program waivers and additional flexibilities.
Section 512.400
Basis and scope.
Section 512.402
Definitions.
Section 512.412
Participant eligibility and selection.
Section 512.414
Patient population.
Section 512.422
Overview of performance assessment and scoring.
Section 512.424
Achievement domain.
Section 512.426
Efficiency domain.
Section 512.428
Quality domain.
Section 512.430
Upside risk payment, downside risk payment, and neutral zone.
Section 512.434
Targeted review.
Section 512.436
Extreme and uncontrollable circumstances.
Section 512.440
Data sharing.
Section 512.442
Transparency requirements.
Section 512.446
Health equity plans.
Section 512.450
Required beneficiary notifications.
Section 512.452
Financial sharing arrangements and attributed patient engagement incentives.
Section 512.454
Distribution arrangements.
Section 512.455
Enforcement authority.
Section 512.456
Beneficiary incentive: Part B and Part D immunosuppressive drug cost sharing support.
Section 512.458
Attributed patient engagement incentives.
Section 512.459
Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
Section 512.460
Audit rights and records retention.
Section 512.462
Compliance and monitoring.
Section 512.464
Remedial action.
Section 512.466
Termination.
Section 512.468
Bankruptcy and other notifications.
Section 512.470
Waivers.
Section 512.500
Basis and scope of subpart.
Section 512.505
Definitions.
Section 512.508
Mandatory participation.
Section 512.510
Voluntary opt-in participation.
Section 512.515
Geographic areas.
Section 512.520
Participation tracks.
Section 512.522
APM options.
Section 512.525
Episodes.
Section 512.535
Beneficiary inclusion criteria.
Section 512.537
Determination of the episode.
Section 512.540
Determination of preliminary target prices.
Section 512.545
Determination of reconciliation target prices.
Section 512.547
Quality measures, composite quality score, and display of quality measures.
Section 512.550
Reconciliation process and determination of the reconciliation payment or repayment amount.
Section 512.552
Treatment of incentive programs or add-on payments under existing Medicare payment systems.
Section 512.555
Proration of payments for services that extend beyond an episode.
Section 512.560
Appeals process.
Section 512.561
Reconsideration review processes.
Section 512.562
Data sharing with TEAM participants.
Section 512.563
Health data reporting.
Section 512.564
Referral to primary care services.
Section 512.565
Sharing arrangements.
Section 512.568
Distribution arrangements.
Section 512.570
Downstream distribution arrangements.
Section 512.575
TEAM beneficiary incentives.
Section 512.576
Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
Section 512.580
TEAM Medicare Program Waivers.
Section 512.582
Beneficiary protections.
Section 512.584
Cooperation in model evaluation and monitoring.
Section 512.586
Audits and record retention.
Section 512.588
Rights in data and intellectual property.
Section 512.590
Monitoring and compliance.
Section 512.592
Remedial action.
Section 512.594
Limitations on review.
Section 512.595
Bankruptcy and other notifications.
Section 512.596
Termination of TEAM or TEAM participant from model by CMS.
Section 512.700
Basis and scope of subpart.
Section 512.705
Definitions.
Section 512.710
Participant eligibility and selection.
Section 512.715
Overview of performance assessment.
Section 512.720
Data submission requirements.
Section 512.725
Quality ASM performance category.
Section 512.730
Cost ASM performance category.
Section 512.735
Improvement activities ASM performance category.
Section 512.740
Promoting Interoperability ASM performance category.
Section 512.745
Final scoring.
Section 512.750
Payment adjustment.
Section 512.755
Timely error notice process.
Section 512.760
Data sharing with ASM participants.
Section 512.765
Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
Section 512.770
ASM beneficiary incentives.
Section 512.771
Collaborative care arrangements.
Section 512.775
Medicare program waivers.
Section 512.780
Extreme and uncontrollable circumstances.