Electronic Code of Federal Regulations
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e-CFR data is current as of March 5, 2021 |
Amendment
42 CFR--PART 512
View Printed Federal Register page 85 FR 86304 in PDF format.Amendment(s) published December 29, 2020, in 85 FR 86304
Effective Dates: Dec. 4, 2021
26. Section 512.210 is amended, effective December 4, 2021, by revising paragraphs (a) and (c) to read as follows:
§512.210 RO participants and geographic areas.
(a) RO participants. Unless otherwise specified in paragraph (b) or (c) of this section, any RO participant that furnishes included RT services in a 5-digit ZIP Code linked to a CBSA selected for participation to an RO beneficiary for an RO episode that begins on or after July 1, 2021, and ends on or before December 31, 2025, must participate in the RO Model.
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(c) Low volume opt-out. A PGP, freestanding radiation therapy center, or HOPD, which would otherwise be required to participate in the RO Model may choose to opt-out of the RO Model for a given PY if it has fewer than 20 episodes of RT services across all CBSAs selected for participation in the most recent year with claims data available prior to the applicable PY. At least 30 days prior to the start of each PY, CMS notifies RO participants eligible for the low volume opt-out for the upcoming PY. The RO participant must attest to its intention of opting out of the RO Model prior to the start of the upcoming PY. Low volume opt-out eligibility is determined as follows:
(1) PY1. Episodes from January 1, 2019 through December 31, 2019 determine eligibility for the low volume opt-out for PY1.
(2) PY2. Episodes from January 1, 2020 through December 31, 2020 determine eligibility for the low volume opt-out for PY2.
(3) PY3. Episodes from January 1, 2021 through June 30, 2021 and RO episodes from July 1, 2021 through December 31, 2021 determine eligibility for the low volume opt-out for PY3.
(4) PY4. RO episodes from January 1, 2022 through December 31, 2022 determine low volume opt-out eligibility for PY4.
(5) PY5. RO episodes from January 1, 2023 through December 31, 2023 determine low volume opt-out eligibility for PY5.