Title 42

PART 512

Part 512 - Radiation Oncology Model And End Stage Renal Disease Treatment Choices Model

PART 512 - RADIATION ONCOLOGY MODEL AND END STAGE RENAL DISEASE TREATMENT CHOICES MODEL Authority:42 U.S.C. 1302, 1315a, and 1395hh. Source:85 FR 61362, Sept. 29, 2020, unless otherwise noted.

42:5.0.1.2.15.1SUBPART A
Subpart A - General Provisions Related to Innovation Center Models
42:5.0.1.2.15.1.55.1SECTION 512.100
   512.100 Basis and scope.
42:5.0.1.2.15.1.55.2SECTION 512.110
   512.110 Definitions.
42:5.0.1.2.15.1.55.3SECTION 512.120
   512.120 Beneficiary protections.
42:5.0.1.2.15.1.55.4SECTION 512.130
   512.130 Cooperation in model evaluation and monitoring.
42:5.0.1.2.15.1.55.5SECTION 512.135
   512.135 Audits and record retention.
42:5.0.1.2.15.1.55.6SECTION 512.140
   512.140 Rights in data and intellectual property.
42:5.0.1.2.15.1.55.7SECTION 512.150
   512.150 Monitoring and compliance.
42:5.0.1.2.15.1.55.8SECTION 512.160
   512.160 Remedial action.
42:5.0.1.2.15.1.55.9SECTION 512.165
   512.165 Innovation center model termination by CMS.
42:5.0.1.2.15.1.55.10SECTION 512.170
   512.170 Limitations on review.
42:5.0.1.2.15.1.55.11SECTION 512.180
   512.180 Miscellaneous provisions on bankruptcy and other notifications.
42:5.0.1.2.15.2SUBPART B
Subpart B - Radiation Oncology Model
42:5.0.1.2.15.2.55SUBJGRP 55
   General
42:5.0.1.2.15.2.55.1SECTION 512.200
   512.200 Basis and scope of subpart.
42:5.0.1.2.15.2.55.2SECTION 512.205
   512.205 Definitions.
42:5.0.1.2.15.2.56SUBJGRP 56
   RO Model Participation
42:5.0.1.2.15.2.56.3SECTION 512.210
   512.210 RO participants and geographic areas.
42:5.0.1.2.15.2.56.4SECTION 512.215
   512.215 Beneficiary population.
42:5.0.1.2.15.2.56.5SECTION 512.217
   512.217 Identification of individual practitioners.
42:5.0.1.2.15.2.56.6SECTION 512.220
   512.220 RO participant compliance with RO Model requirements.
42:5.0.1.2.15.2.56.7SECTION 512.225
   512.225 Beneficiary notification.
42:5.0.1.2.15.2.57SUBJGRP 57
   Scope of RO Episodes Being Tested
42:5.0.1.2.15.2.57.8SECTION 512.230
   512.230 Criteria for determining cancer types.
42:5.0.1.2.15.2.57.9SECTION 512.235
   512.235 Included RT services.
42:5.0.1.2.15.2.57.10SECTION 512.240
   512.240 Included modalities.
42:5.0.1.2.15.2.57.11SECTION 512.245
   512.245 Included RO episodes.
42:5.0.1.2.15.2.58SUBJGRP 58
   Pricing Methodology
42:5.0.1.2.15.2.58.12SECTION 512.250
   512.250 Determination of national base rates.
42:5.0.1.2.15.2.58.13SECTION 512.255
   512.255 Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts.
42:5.0.1.2.15.2.59SUBJGRP 59
   Billing and Payment
42:5.0.1.2.15.2.59.14SECTION 512.260
   512.260 Billing.
42:5.0.1.2.15.2.59.15SECTION 512.265
   512.265 Payment.
42:5.0.1.2.15.2.59.16SECTION 512.270
   512.270 Treatment of add-on payments under existing Medicare payment systems.
42:5.0.1.2.15.2.60SUBJGRP 60
   Data Reporting
42:5.0.1.2.15.2.60.17SECTION 512.275
   512.275 Quality measures, clinical data, and reporting.
42:5.0.1.2.15.2.61SUBJGRP 61
   Medicare Program Waivers
42:5.0.1.2.15.2.61.18SECTION 512.280
   512.280 RO Model Medicare program waivers.
42:5.0.1.2.15.2.62SUBJGRP 62
   Reconciliation and Review Process
42:5.0.1.2.15.2.62.19SECTION 512.285
   512.285 Reconciliation process.
42:5.0.1.2.15.2.62.20SECTION 512.290
   512.290 Timely error notice and reconsideration review process.
42:5.0.1.2.15.3SUBPART C
Subpart C - ESRD Treatment Choices Model
42:5.0.1.2.15.3.63SUBJGRP 63
   General
42:5.0.1.2.15.3.63.1SECTION 512.300
   512.300 Basis and scope.
42:5.0.1.2.15.3.63.2SECTION 512.310
   512.310 Definitions.
42:5.0.1.2.15.3.64SUBJGRP 64
   ESRD Treatment Choices Model Scope and Participants
42:5.0.1.2.15.3.64.3SECTION 512.320
   512.320 Duration.
42:5.0.1.2.15.3.64.4SECTION 512.325
   512.325 Participant selection and geographic areas.
42:5.0.1.2.15.3.64.5SECTION 512.330
   512.330 Beneficiary notification.
42:5.0.1.2.15.3.65SUBJGRP 65
   Home Dialysis Payment Adjustment
42:5.0.1.2.15.3.65.6SECTION 512.340
   512.340 Payments subject to the Facility HDPA.
42:5.0.1.2.15.3.65.7SECTION 512.345
   512.345 Payments subject to the Clinician HDPA.
42:5.0.1.2.15.3.65.8SECTION 512.350
   512.350 Schedule of home dialysis payment adjustments.
42:5.0.1.2.15.3.66SUBJGRP 66
   Performance Payment Adjustment
42:5.0.1.2.15.3.66.9SECTION 512.355
   512.355 Schedule of performance assessment and performance payment adjustment.
42:5.0.1.2.15.3.66.10SECTION 512.360
   512.360 Beneficiary population and attribution.
42:5.0.1.2.15.3.66.11SECTION 512.365
   512.365 Performance assessment.
42:5.0.1.2.15.3.66.12SECTION 512.370
   512.370 Benchmarking and scoring.
42:5.0.1.2.15.3.66.13SECTION 512.375
   512.375 Payments subject to adjustment.
42:5.0.1.2.15.3.66.14SECTION 512.380
   512.380 PPA Amounts and schedules.
42:5.0.1.2.15.3.66.15SECTION 512.385
   512.385 PPA exclusions.
42:5.0.1.2.15.3.66.16SECTION 512.390
   512.390 Notification and targeted review.
42:5.0.1.2.15.3.67SUBJGRP 67
   Quality Monitoring
42:5.0.1.2.15.3.67.17SECTION 512.395
   512.395 Quality measures.
42:5.0.1.2.15.3.68SUBJGRP 68
   Medicare Program Waivers
42:5.0.1.2.15.3.68.18SECTION 512.397
   512.397 ETC Model Medicare program waivers.