42 CFR § 512.535 - Beneficiary inclusion criteria.

---
identifier: "/us/cfr/t42/s512.535"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 512.535 - Beneficiary inclusion criteria."
title_number: 42
title_name: "Public Health"
section_number: "512.535"
section_name: "Beneficiary inclusion criteria."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "H"
subchapter_name: "HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS"
part_number: "512"
part_name: "STANDARD PROVISIONS FOR MANDATORY INNOVATION CENTER MODELS AND SPECIFIC PROVISIONS FOR CERTAIN MODELS"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302, 1315a, and 1395hh."
regulatory_source: "85 FR 61362, Sept. 29, 2020, unless otherwise noted."
cfr_part: "512"
---


# 512.535 Beneficiary inclusion criteria.

(a) Episodes tested in TEAM include only those in which care is furnished to beneficiaries who meet all of the following criteria upon admission for an anchor procedure or anchor hospitalization:

(1) Are enrolled in Medicare Parts A and B.

(2) Are not eligible for Medicare on the basis of having end stage renal disease, as described in § 406.13 of this chapter.

(3) Are not enrolled in any managed care plan (for example, Medicare Advantage, health care prepayment plans, or cost-based health maintenance organizations).

(4) Are not covered under a United Mine Workers of America health care plan.

(5) Have Medicare as their primary payer.

(b) The episode is canceled in accordance with § 512.537(b) if at any time during the episode a beneficiary no longer meets all criteria in this section.