Title 42

SECTION 512.250

512.250 Determination of national base rates.

§ 512.250 Determination of national base rates.

CMS determines a national base rate for the PC and TC for each included cancer type.

(a) National base rates are the historical average cost for an episode of care for each of the included cancer types prior to the Model performance period.

(b) National base rates are determined in the following manner:

(1) CMS excludes claims from RT suppliers and RT providers in Maryland and Vermont and all inpatient and ASC claims from the construction of episodes and;

(2) CMS excludes the following:

(i) episodes with any RT services furnished by a CAH,

(ii) episodes that are not attributed to an RT provider or RT supplier, and

(iii) episodes in which either the PC or TC is attributed to an RT provider or RT supplier with a U.S. Territory service location.

(3) CMS calculates the episode amount CMS paid on average to RT providers and RT suppliers for the PC and TC for each of the included cancer types in the HOPD setting, creating the RO Model's national base rates.

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