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Electronic Code of Federal Regulations

e-CFR data is current as of December 9, 2019

Title 42Chapter IVSubchapter APart 403 → Subpart K

Title 42: Public Health

Subpart K—Access to Identifiable Data for the Center for Medicare and Medicaid Models

§403.1100   Purpose and scope.
§403.1105   Definitions.
§403.1110   Evaluation of models.

Source: 79 FR 68001, Nov. 13, 2014, unless otherwise noted.

§403.1100   Purpose and scope.

The regulations in this subpart implement section 1115A of the Act. The intent of that section is to enable CMS to test innovative payment and service delivery models to reduce program expenditures while preserving and/or enhancing the quality of care furnished to individuals under titles XVIII, XIX, and XXI of the Act. The Secretary is also required to conduct an evaluation of each model tested.

§403.1105   Definitions.

For purposes of this subpart—

Applicable titles means Titles XVIII, XIX, or XXI of the Act.

§403.1110   Evaluation of models.

(a) Evaluation. The Secretary conducts an evaluation of each model tested under section 1115A of the Act. Such evaluation must include an analysis of the following:

(1) The quality of care furnished under the model, including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the Secretary.

(2) The changes in spending under the applicable titles by reason of the model.

(b) Information. Any State or other entity participating in the testing of a model under section 1115A of the Act must collect and report such information, including “protected health information” as that term is defined at 45 CFR 160.103, as the Secretary determines is necessary to monitor and evaluate such model. Such data must be produced to the Secretary at the time and in the form and manner specified by the Secretary.

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