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Incorporation By Reference

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Electronic Code of Federal Regulations

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e-CFR data is current as of February 23, 2021

Title 42 → Chapter IV → Subchapter H → Part 512

TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER H—HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS

PART 512—RADIATION ONCOLOGY MODEL AND END STAGE RENAL DISEASE TREATMENT CHOICES MODEL

Subpart A—GENERAL PROVISIONS RELATED TO INNOVATION CENTER MODELS

Basis and scope.

Definitions.

Beneficiary protections.

Cooperation in model evaluation and monitoring.

Audits and record retention.

Rights in data and intellectual property.

Monitoring and compliance.

Remedial action.

Innovation center model termination by CMS.

Limitations on review.

Miscellaneous provisions on bankruptcy and other notifications.

Subpart B—RADIATION ONCOLOGY MODEL

Basis and scope of subpart.

Definitions.

RO Model Participation

RO participants and geographic areas.

Beneficiary population.

Identification of individual practitioners.

RO participant compliance with RO Model requirements.

Beneficiary notification.

Scope of RO Episodes Being Tested

Criteria for determining cancer types.

Included RT services.

Included modalities.

Included RO episodes.

Pricing Methodology

Determination of national base rates.

Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts.

Billing and Payment

Billing.

Payment.

Treatment of add-on payments under existing Medicare payment systems.

Quality measures, clinical data, and reporting.

Medicare Program Waivers

RO Model Medicare program waivers.

Reconciliation and Review Process

Reconciliation process.

Timely error notice and reconsideration review process.

Subpart C—ESRD TREATMENT CHOICES MODEL

Basis and scope.

Definitions.

ESRD Treatment Choices Model Scope and Participants

Duration.

Participant selection and geographic areas.

Beneficiary notification.

Home Dialysis Payment Adjustment

Payments subject to the Facility HDPA.

Payments subject to the Clinician HDPA.

Schedule of home dialysis payment adjustments.

Performance Payment Adjustment

Schedule of performance assessment and performance payment adjustment.

Beneficiary population and attribution.

Performance assessment.

Benchmarking and scoring.

Payments subject to adjustment.

PPA Amounts and schedules.

PPA exclusions.

Notification and targeted review.

Quality Monitoring

Quality measures.

Medicare Program Waivers

ETC Model Medicare program waivers.

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