Home/CFR/Title 42/Part 512
FEDERAL · 42 CFR

Part 512 — Standard Provisions for Mandatory Innovation Center Models and Specific Provisions for Certain Models

133 sections · Title 42: Public Health

§ 512.100Basis and scope.
§ 512.110Definitions.
§ 512.120Beneficiary protections.
§ 512.130Cooperation in model evaluation and monitoring.
§ 512.135Audits and record retention.
§ 512.140Rights in data and intellectual property.
§ 512.150Monitoring and compliance.
§ 512.160Remedial action.
§ 512.165Innovation center model termination by CMS.
§ 512.170Limitations on review.
§ 512.180Miscellaneous provisions on bankruptcy and other notifications.
§ 512.190Reconsideration review process.
§ 512.200Basis and scope of subpart.
§ 512.205Definitions.
§ 512.210RO participants and geographic areas.
§ 512.215Beneficiary population.
§ 512.217Identification of individual practitioners.
§ 512.220RO participant compliance with RO Model requirements.
§ 512.225Beneficiary notification.
§ 512.230Criteria for determining cancer types.
§ 512.235Included RT services.
§ 512.240Included modalities.
§ 512.245Included RO episodes.
§ 512.250Determination of national base rates.
§ 512.255Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts.
§ 512.260Billing.
§ 512.265Payment.
§ 512.270Treatment of add-on payments under existing Medicare payment systems.
§ 512.275Quality measures, clinical data, and reporting.
§ 512.280RO Model Medicare program waivers.
§ 512.285Reconciliation process.
§ 512.290Timely error notice and reconsideration review process.
§ 512.292Overlap with other models tested under Section 1115A and CMS programs.
§ 512.294Extreme and uncontrollable circumstances.
§ 512.300Basis and scope.
§ 512.310Definitions.
§ 512.320Duration.
§ 512.325Participant selection and geographic areas.
§ 512.330Beneficiary notification.
§ 512.340Payments subject to the Facility HDPA.
§ 512.345Payments subject to the Clinician HDPA.
§ 512.350Schedule of home dialysis payment adjustments.
§ 512.355Schedule of performance assessment and performance payment adjustment.
§ 512.360Beneficiary population and attribution.
§ 512.365Performance assessment.
§ 512.370Benchmarking and scoring.
§ 512.375Payments subject to adjustment.
§ 512.380PPA Amounts and schedules.
§ 512.385PPA exclusions.
§ 512.390Notification, data sharing, and targeted review.
§ 512.395Quality measures.
§ 512.397ETC Model Medicare program waivers and additional flexibilities.
§ 512.400Basis and scope.
§ 512.402Definitions.
§ 512.412Participant eligibility and selection.
§ 512.414Patient population.
§ 512.422Overview of performance assessment and scoring.
§ 512.424Achievement domain.
§ 512.426Efficiency domain.
§ 512.428Quality domain.
§ 512.430Upside risk payment, downside risk payment, and neutral zone.
§ 512.434Targeted review.
§ 512.436Extreme and uncontrollable circumstances.
§ 512.440Data sharing.
§ 512.442Transparency requirements.
§ 512.446Health equity plans.
§ 512.450Required beneficiary notifications.
§ 512.452Financial sharing arrangements and attributed patient engagement incentives.
§ 512.454Distribution arrangements.
§ 512.455Enforcement authority.
§ 512.456Beneficiary incentive: Part B and Part D immunosuppressive drug cost sharing support.
§ 512.458Attributed patient engagement incentives.
§ 512.459Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
§ 512.460Audit rights and records retention.
§ 512.462Compliance and monitoring.
§ 512.464Remedial action.
§ 512.466Termination.
§ 512.468Bankruptcy and other notifications.
§ 512.470Waivers.
§ 512.500Basis and scope of subpart.
§ 512.505Definitions.
§ 512.508Mandatory participation.
§ 512.510Voluntary opt-in participation.
§ 512.515Geographic areas.
§ 512.520Participation tracks.
§ 512.522APM options.
§ 512.525Episodes.
§ 512.535Beneficiary inclusion criteria.
§ 512.537Determination of the episode.
§ 512.540Determination of preliminary target prices.
§ 512.545Determination of reconciliation target prices.
§ 512.547Quality measures, composite quality score, and display of quality measures.
§ 512.550Reconciliation process and determination of the reconciliation payment or repayment amount.
§ 512.552Treatment of incentive programs or add-on payments under existing Medicare payment systems.
§ 512.555Proration of payments for services that extend beyond an episode.
§ 512.560Appeals process.
§ 512.561Reconsideration review processes.
§ 512.562Data sharing with TEAM participants.
§ 512.563Health data reporting.
§ 512.564Referral to primary care services.
§ 512.565Sharing arrangements.
§ 512.568Distribution arrangements.
§ 512.570Downstream distribution arrangements.
§ 512.575TEAM beneficiary incentives.
§ 512.576Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
§ 512.580TEAM Medicare Program Waivers.
§ 512.582Beneficiary protections.
§ 512.584Cooperation in model evaluation and monitoring.
§ 512.586Audits and record retention.
§ 512.588Rights in data and intellectual property.
§ 512.590Monitoring and compliance.
§ 512.592Remedial action.
§ 512.594Limitations on review.
§ 512.595Bankruptcy and other notifications.
§ 512.596Termination of TEAM or TEAM participant from model by CMS.
§ 512.700Basis and scope of subpart.
§ 512.705Definitions.
§ 512.710Participant eligibility and selection.
§ 512.715Overview of performance assessment.
§ 512.720Data submission requirements.
§ 512.725Quality ASM performance category.
§ 512.730Cost ASM performance category.
§ 512.735Improvement activities ASM performance category.
§ 512.740Promoting Interoperability ASM performance category.
§ 512.745Final scoring.
§ 512.750Payment adjustment.
§ 512.755Timely error notice process.
§ 512.760Data sharing with ASM participants.
§ 512.765Application of the CMS-sponsored model arrangements and patient incentives safe harbor.
§ 512.770ASM beneficiary incentives.
§ 512.771Collaborative care arrangements.
§ 512.775Medicare program waivers.
§ 512.780Extreme and uncontrollable circumstances.