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Code of Federal Regulations (Last Updated: November 8, 2024) |
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Title 42 - Public Health |
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Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter H—Health Care Infrastructure and Model Programs |
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Part 512 - Standard Provisions for Innovation Center Models and Specific Provisions for Certain Models |
Part 512 - Standard Provisions for Innovation Center Models and Specific Provisions for Certain Models
| Subpart A - General Provisions Related to Innovation Center Models |
| § 512.1 - Basis and scope. |
| § 512.2 - Definitions. |
| § 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. |
| Subpart B - Radiation Oncology Model |
| § 512.105 - Geographic areas. |
| Reconciliation and Review Process |
| § 512.285 - Reconciliation process. |
| § 512.290 - Timely error notice and reconsideration review process. |
| § 512.292 - xxx |
| § 512.294 - xxx |
| 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. |
| General |
| § 512.200 - Basis and scope of subpart. |
| § 512.205 - Definitions. |
| 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. |
| Data Reporting |
| § 512.275 - Quality measures, clinical data, and reporting. |
| 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. |
| Medicare Program Waivers |
| § 512.280 - RO Model Medicare program waivers. |
| Subpart C - ESRD Treatment Choices Model |
| 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. |
| 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. |
| ESRD Treatment Choices Model Scope and Participants |
| § 512.320 - Duration. |
| § 512.325 - Participant selection and geographic areas. |
| § 512.330 - Beneficiary notification. |
| General |
| § 512.300 - Basis and scope. |
| § 512.310 - Definitions. |
| Subpart D - Pricing and Payment |
| § 512.305 - Determination of the NPRA and reconciliation process. |
| § 512.307 - Subsequent calculations. |
| § 512.315 - Composite quality scores for determining reconciliation payment eligibility and effective and applicable discount factors. |
| Subpart E - Transforming Episode Accountability Model (TEAM) |
| § 512.400 - Quality measures and reporting - general. |
| § 512.411 - Quality measures and reporting for AMI model. |
| § 512.412 - Quality measures and reporting for CABG model. |
| § 512.413 - Quality measures and reporting for SHFFT model. |
| § 512.450 - Beneficiary choice and beneficiary notification. |
| § 512.460 - Compliance enforcement. |
| 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. |
| Pricing Methodology |
| § 512.540 - Determination of preliminary target prices. |
| § 512.545 - Determination of reconciliation target prices. |
| General |
| § 512.500 - Basis and scope of subpart. |
| § 512.505 - Definitions. |
| 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. |
| Quality Measures and Composite Quality Score |
| § 512.547 - Quality measures, composite quality score, and display of quality measures. |
| 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. |
| § 512.598 - Decarbonization and resilience initiative. |
| Data Sharing and Other Requirements |
| § 512.562 - Data sharing with TEAM participants. |
| § 512.563 - Health equity reporting. |
| § 512.564 - Referral to primary care services. |
| Medicare Program Waivers |
| § 512.580 - TEAM Medicare Program Waivers |
| TEAM 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. |
| Subpart F - Financial Arrangements and Beneficiary Incentives |
| Subpart G - Waivers |
| § 512.600 - Waiver of direct supervision requirement for certain post-discharge home visits. |
| § 512.605 - Waiver of certain telehealth requirements. |
| § 512.610 - Waiver of SNF 3-day rule. |
| § 512.615 - Waiver of certain post-operative billing restrictions. |
| § 512.620 - Waiver of deductible and coinsurance that otherwise apply to reconciliation payments or repayments. |
| § 512.630 - Waiver of physician definition for furnishing cardiac rehabilitation and intensive cardiac rehabilitation services to an EPM beneficiary. |
| Subpart H - CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants |
| § 512.700 - Basis and scope. |
| § 512.703 - CR incentive payment model participants. |
| § 512.705 - CR/ICR services that count towards CR incentive payments. |
| § 512.710 - Determination of CR incentive payments. |
| Provisions for FFS-Cr Participants |
| § 512.715 - Access to records and retention for FFS-CR participants. |
| § 512.720 - Appeals process for FFS-CR participants. |
| § 512.725 - Data sharing for FFS-CR participants. |
| § 512.730 - Compliance enforcement for FFS-CR participants. |
| § 512.735 - Enforcement authority for FFS-CR participants. |
| § 512.740 - Beneficiary engagement incentives for FFS-CR participant use. |
| § 512.745 - Waiver of physician definition for furnishing CR and ICR services to a FFS-CR beneficiary. |
| Subparts I--J - XXX |
| Subpart K - Model Termination |
| § 512.900 - Termination of an episode payment model. |
| § 512.905 - Termination of the CR incentive payment model. |