Part 512 — Standard Provisions for Mandatory Innovation Center Models and Specific Provisions for Certain Models
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
- § 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.
Subpart C — ESRD Treatment Choices Model
- § 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.
Subpart D — Increasing Organ Transplant Access (IOTA) Model
- § 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.
- § 512.446— Health equity plans.
- § 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.
Subpart E — Transforming Episode Accountability Model (TEAM)
- § 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.
Subpart G — Ambulatory Specialty Model (ASM)
- § 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.