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Code of Federal Regulations (Last Updated: May 6, 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 - Radiation Oncology Model and End Stage Renal Disease Treatment Choices Model |
| 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 - Quality Measures, Beneficiary Protections, and Compliance Enforcement |
| § 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. |
| Subpart F - Financial Arrangements and Beneficiary Incentives |
| § 512.500 - Sharing arrangements under the EPM. |
| § 512.505 - Distribution arrangements under the EPM. |
| § 512.510 - Downstream distribution arrangements under the EPM. |
| § 512.520 - Enforcement authority under the EPM. |
| § 512.525 - Beneficiary engagement incentives under the EPM. |
| 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. |