[Federal Register Volume 87, Number 68 (Friday, April 8, 2022)]
[Proposed Rules]
[Pages 20800-20805]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-07525]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 512

[CMS-5527-P2]
RIN 0938-AT89


Radiation Oncology (RO) Model

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services, (HHS).

ACTION: Proposed rule.

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SUMMARY: We are proposing to delay the current start date of the RO 
Model to a date to be determined through future rulemaking, and to 
modify the definition of the model performance period to provide that 
the start and end dates of the model performance period for the RO 
Model will be established in future rulemaking.

DATES: To be assured consideration, comments must be received at one of 
the addresses specified in the ADDRESSES section, by June 7, 2022.

ADDRESSES: In commenting, please refer to file code CMS-5527-P2.
    Comments, including mass comment submissions, must be submitted in 
one

[[Page 20801]]

of the following three ways (please choose only one of the ways 
listed):
    1. Electronically. You may submit electronic comments on this 
regulation to https://www.regulations.gov. Follow the ``Submit a 
comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address ONLY: Centers for Medicare & Medicaid Services, Department of 
Health and Human Services, Attention: CMS-5527-P2, P.O. Box 8013, 
Baltimore, MD 21244-8013.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the following address ONLY:
    Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-5527-P2, Mail Stop C4-26-05, 7500 
Security Boulevard, Baltimore, MD 21244-1850.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Rebecca Cole at Contact 
[email protected] or 1-844-711-2664, Option 5.

SUPPLEMENTARY INFORMATION:
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following 
website as soon as possible after they have been received: https://www.regulations.gov. Follow the search instructions on that website to 
view public comments. CMS will not post on Regulations.gov public 
comments that make threats to individuals or institutions or suggest 
that the individual will take actions to harm any individual. CMS 
continues to encourage individuals not to submit duplicative comments. 
We will post acceptable comments from multiple unique commenters even 
if the content is identical or nearly identical to other comments.

I. Background

    We are committed to promoting higher quality of cancer care and 
improving outcomes for Medicare beneficiaries while reducing costs. As 
part of that effort, the Biden-Harris Administration has taken a number 
of steps to improve the care of Medicare cancer patients, most notably 
with the President's cancer agenda and the Cancer Moonshot. 
Additionally, the CMS Innovation Center's Oncology Care Model (OCM) 
focuses on patients with cancer who receive chemotherapy. In late 2019, 
the CMS Innovation Center released an informal Request for Information 
on a potential future oncology value-based model after OCM ends, and we 
look forward to providing additional information as soon as possible.
    In December 2015, Congress passed the Patient Access and Medicare 
Protection Act (Pub. L. 114-115) and section 3(b) of this legislation 
required the Secretary of the Department of Health and Human Services 
to submit to Congress a report, no later than 18 months after 
enactment, on ``the development of an episodic alternative payment 
model'' for payment under the Medicare program for radiation therapy 
(RT) services. We released the 2017 Report To Congress: ``Episodic 
Alternative Payment Model for Radiation Therapy Services,'' which laid 
out the potential for reforming the way Medicare pays for radiation 
oncology. Based on that work, using our authority under section 1115A 
of the Social Security Act, we published a proposed rule, titled 
``Medicare Program; Specialty Care Models to Improve Quality of Care 
and Reduce Expenditures'' (84 FR 34478), which included a proposal for 
implementing a mandatory model for radiation oncology services (the RO 
Model) (84 FR 34490 through 34535). The RO Model was designed to test 
whether making site-neutral, prospective, episode-based payments to 
hospital outpatient departments, physician group practices, and 
freestanding radiation therapy centers for RT episodes of care would 
preserve or enhance the quality of care furnished to Medicare 
beneficiaries while reducing or maintaining Medicare program spending.
    We published a final rule titled ``Medicare Program; Specialty Care 
Models to Improve Quality of Care and Reduce Expenditures'' that 
appeared in the September 29, 2020 Federal Register (85 FR 61114) 
(hereinafter referred to as the ``Specialty Care Models final rule''). 
In that final rule, we codified policies at 42 CFR part 512 subparts A 
and B that included a finalized RO Model with a model performance 
period that was to begin January 1, 2021 and end December 31, 2025 (85 
FR 61367). We finalized that each performance year (PY) would be the 
12-month period beginning on January 1 and ending on December 31 of 
each calendar year (CY) during the model performance period, and no new 
RO episodes may begin after October 3, 2025, in order for all RO 
episodes to end by December 31, 2025.
    Due to the public health emergency for the Coronavirus disease 2019 
(COVID-19) pandemic, we revised the RO Model's model performance period 
at 42 CFR 512.205 to begin on July 1, 2021, and to end December 31, 
2025 giving RO participants an additional 6 months to prepare for the 
RO Model. We implemented the revised model period via interim final 
regulations included in the final rule with comment period and interim 
final rule with comment period that appeared in the December 29, 2020 
Federal Register titled ``Medicare Program: Hospital Outpatient 
Prospective Payment and Ambulatory Surgical Center Payment Systems and 
Quality Reporting Programs; New Categories for Hospital Outpatient 
Department Prior Authorization Process; Clinical Laboratory Fee 
Schedule: Laboratory Date of Service Policy; Overall Hospital Quality 
Star Rating Methodology; Physician-owned Hospitals; Notice of Closure 
of Two Teaching Hospitals and Opportunity To Apply for Available Slots, 
Radiation Oncology Model; and Reporting Requirements for Hospitals and 
Critical Access Hospitals (CAHs) to Report COVID-19 Therapeutic 
Inventory and Usage and to Report Acute Respiratory Illness During the 
Public Health Emergency (PHE) for Coronavirus Disease 2019 (COVID-19)'' 
(85 FR 85866) (hereinafter referred to as ``CY 2021 OPPS/ASC IFC'').
    Section 133 of the Consolidated Appropriations Act (CAA), 2021 
(Pub. L. 116-260) (hereinafter referred to as ``CAA, 2021''), enacted 
on December 27, 2020, included a provision that prohibited 
implementation of the RO Model before January 1, 2022. This 
Congressional action superseded the start date of the model performance 
period of July 1, 2021 established in the CY 2021 OPPS/ASC IFC. To 
align the RO Model regulations with the requirements of the CAA, 2021, 
we proposed to modify the definition of ``model performance period'' in 
42 CFR 512.205 to provide for a 5-year model performance period 
starting on January 1, 2022, unless the RO Model is prohibited by law 
from starting on January 1, 2022, in which case the model performance 
period would begin on the earliest date permitted by law that is 
January 1, April 1, or July 1. We also proposed other modifications 
both related to and unrelated to the timing of the RO Model in the 
proposed rule that appeared in the August 4, 2021 Federal Register 
titled ``Medicare Program: Hospital Outpatient Prospective Payment and 
Ambulatory Surgical

[[Page 20802]]

Center Payment Systems and Quality Reporting Programs; Price 
Transparency of Hospital Standard Charges; Radiation Oncology Model; 
Request for Information on Rural Emergency Hospitals'' (86 FR 42018). 
These provisions were finalized in a final rule with comment period 
titled ``Medicare Program: Hospital Outpatient Prospective Payment and 
Ambulatory Surgical Center Payment Systems and Quality Reporting 
Programs; Price Transparency of Hospital Standard Charges; Radiation 
Oncology Model'' that appeared in the November 16, 2021 Federal 
Register (86 FR 63458) (hereinafter referred to as the ``CY 2022 OPPS/
ASC FC'').
    On December 10, 2021, the Protecting Medicare and American Farmers 
from Sequester Cuts Act (Pub. L. 117-71) was enacted, which included a 
provision that prohibits implementation of the RO Model prior to 
January 1, 2023. The November 2021 final rule with comment specified 
that the model performance period would begin on January 1, 2022 unless 
the RO Model was prohibited by law from beginning on January 1, 2022, 
in which case the model performance period would begin on the earliest 
date permitted by law that is January 1, April 1, or July 1. As a 
result, under the current definition for model performance period at 42 
CFR 512.205, the RO Model will start on January 1, 2023, because that 
date is the earliest date permitted by law. Given the multiple delays 
to date, and because both CMS and RO participants must invest 
operational resources in preparation for implementation of the RO 
Model, we have considered how best to proceed under these 
circumstances.

II. Provisions of the Proposed Regulations

A. Proposed Model Performance Period

    We continue to believe that the RO Model would address long-
standing concerns related to RT delivery and payment, including the 
lack of site neutrality for payments, incentives that encourage volume 
of services over the value of services, and coding and payment 
challenges. We believe the RO Model would provide payment stability and 
promote high-quality care for Medicare beneficiaries. We note that we 
have heard that the RO Model is valuable and needed in the radiation 
oncology space from some stakeholders and that some RT providers and RT 
suppliers selected to be RO participants are dedicated to preparing for 
implementation of the RO Model.
    However, given that there have been two legislative delays of the 
RO Model, the operational resources required of CMS and RO participants 
to continue to prepare for the RO Model before it can be implemented, 
and some stakeholders' comments that they would not support the RO 
Model unless specific changes were made, we are proposing to delay the 
start of the RO Model to a date to be determined through future 
rulemaking and to modify the definition of model performance period at 
42 CFR 512.205 to reflect this policy. We would plan to propose a start 
date through rulemaking and modify the definition of model performance 
period at 42 CFR 512.205 to reflect this proposed start date no less 
than 6 months prior to that proposed start date.
    As noted previously, Congress has delayed the RO Model twice. There 
is a substantial cost to continue funding preparation for 
implementation of the RO Model in 2023. For example, funding is needed 
for CMS to prepare for participant onboarding, claims systems changes, 
and updates to the data used in the Model's design and participant-
specific payment amounts, among a number of other activities. The cost 
of the operational funding needed to continue to prepare to implement 
the RO Model takes resources away from the development of other 
alternative payment models, particularly when it is not known whether 
there may be further legislative delays to the start of the RO Model.
    Additionally, those entities selected to be RO participants 
continue to make good faith efforts to prepare to implement the RO 
Model, which may involve financial, operational, and administrative 
investment and resources. Given multiple delays and uncertainty about 
the timing of the RO Model, delaying the RO Model indefinitely will 
give RO participants the ability to pause their efforts to prepare for 
implementation of the RO Model. We welcome additional dialogue with RO 
participants and stakeholders about Medicare payment for RT services.
    Further, RO participants and stakeholders have requested additional 
changes to the RO Model's payment methodology and to other aspects of 
the RO Model design and participation requirements, such as lower 
discounts while keeping the geographic scope of the Model the same. In 
the CY 2022 OPPS/ASC FC, we summarized comments regarding the 
discounts. No commenters agreed with the proposed discounts, and many 
commenters recommended that the discounts be set to 3 percent or less. 
Those commenters, recommending discounts of 3 percent or less, argued 
that this would be more in line with other payment models and ensure 
that RO participants have sufficient capital to remain operational and 
invest in the necessary resources (human and equipment) to increase 
efficiency and enhance beneficiary care. As we have informed 
stakeholders, if the discounts are lowered below 3.5 percent for the 
professional component and 4.5 percent for the technical component, we 
would need to expand the geographic scope of the RO Model to be larger 
than 30 percent of Core Based Statistical Areas (CBSAs) (86 FR 63928 
and 63929). If the discount amounts are significantly smaller, all else 
equal, the projected savings will be smaller, and therefore, the number 
of CBSAs (and episodes) in the participant group may not be sufficient 
for CMS to detect an effect of the RO Model with statistical 
confidence. However, we believe that some stakeholders will not support 
the RO Model test moving forward with unchanged discounts and as noted 
previously, these stakeholders have also requested that we not increase 
the geographic scope of the Model.
    Thus, for these reasons, we are proposing to delay the current 
start date of the RO Model, and to establish the start and end dates 
for the model through future rulemaking, which may also involve 
modifications to the model design. We are proposing to modify the 
definition of the model performance period at 42 CFR 512.205 to reflect 
this proposed delay, by removing the provision that the RO Model begins 
on January 1, 2022 and ends on December 31, 2026, unless the RO Model 
is prohibited by law from starting on January 1, 2022, in which case 
the model performance period begins on the earliest date permitted by 
law that is January 1, April 1, or July 1. We are proposing to modify 
the definition of model performance period to instead specify that CMS 
will establish the start and end dates of the model performance period 
for the RO Model through future rulemaking. We note that if we do not 
finalize this proposal and instead proceed with a start date of January 
1, 2023, we do not plan to change the CBSAs selected for participation 
before that start date.
    We are soliciting comments on the proposed delay of the RO Model to 
a date to be determined through future rulemaking, as well as on our 
proposed amendments to the definition of the model performance period 
at 42 CFR 512.205 to reflect this proposed delay.

[[Page 20803]]

III. Collection of Information Requirements

    As stated in section 1115A(d)(3) of the Social Security Act, 
Chapter 35 of title 44, United States Code, shall not apply to the 
testing, evaluation, and expansion of CMS Innovation Center Models. 
Consequently, there is no need for review by the Office of Management 
and Budget under the authority of the Paperwork Reduction Act of 1995 
(44 U.S.C. 3501 et seq.).

IV. Regulatory Impact Analysis

A. Statement of Need

    The purpose of this proposed rule is to propose to delay the start 
of the RO Model to a date yet to be determined, and to modify the 
definition of model performance period at 42 CFR 512.205. Delaying the 
start of the RO Model to a date yet to be determined does not change 
the statement of need for the RO Model as described in the Specialty 
Care Models final rule (85 FR 61347) and the CY 2021 OPPS/ASC IFC (85 
FR 86296) and again in the CY 2022 OPPS/ASC FC (86 FR 63458).

B. Overall Impact

    We have examined the impact of this rule as required by Executive 
Order 12866 on Regulatory Planning and Review (September 30, 1993), 
Executive Order 13563 on Improving Regulation and Regulatory Review 
(January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, 
1980, Pub. L. 96-354), section 1102(b) of the Act, section 202 of the 
Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), 
Executive Order 13132 on Federalism (August 4, 1999), and the 
Congressional Review Act (5 U.S.C. 804(2)).
    Executive Orders 12866 and 13563 direct agencies to assess all 
costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). Section 
3(f) of Executive Order 12866 defines a ``significant regulatory 
action'' as an action that is likely to result in a rule: (1) Having an 
annual effect on the economy of $100 million or more in any 1 year, or 
adversely and materially affecting a sector of the economy, 
productivity, competition, jobs, the environment, public health or 
safety, or state, local or tribal governments or communities (also 
referred to as ``economically significant''); (2) creating a serious 
inconsistency or otherwise interfering with an action taken or planned 
by another agency; (3) materially altering the budgetary impacts of 
entitlement grants, user fees, or loan programs or the rights and 
obligations of recipients thereof; or (4) raising novel legal or policy 
issues arising out of legal mandates, the President's priorities, or 
the principles set forth in the Executive Order.
    A regulatory impact analysis (RIA) must be prepared for major rules 
with significant regulatory actions or with economically significant 
effects ($100 million or more in any 1 year). Based on our estimates, 
OMB's Office of Information and Regulatory Affairs has determined this 
rulemaking is ``significant''. Accordingly, we have prepared an RIA 
that to the best of our ability presents the costs and benefits of the 
rulemaking.

C. Detailed Economic Analysis

    Delaying the start of the RO Model to a later undetermined date and 
modifying the regulatory text at 42 CFR 512.205 to reflect this would 
mean that the annualized/monetarized estimates of costs and transfers 
policy for the RO Model presented in the CY 2022 OPPS/ASC FC (86 FR 
63986) would not be realized at this time.
    Similarly, the burden estimates related to implementation of the RO 
Model presented in the Specialty Care Models final rule (85 FR 61358), 
the CY 2021 OPPS/ASC IFC (85 FR 86297), and the CY 2022 OPPS/ASC FC (86 
FR 63987) would not be realized at this time.
    The regulatory impact analysis of the CY 2022 OPPS/ASC FC estimated 
that on net the RO Model would reduce Medicare spending by $150 million 
over the 5-year model performance period. This amount is the net 
Medicare Part B impact that includes both Part B premium and Medicare 
Advantage United States Per Capita Costs (MA USPCC) rate financing 
interaction effects. This estimate excludes changes in beneficiary cost 
sharing liability to the extent it is not a Federal outlay under the 
policy. These potential impacts were estimated to occur beginning on 
January 1, 2022 through December 31, 2026, in alignment with a January 
1, 2022 model start. Table 1 summarizes the estimated impact of the RO 
Model with a model performance period that would have begun January 1, 
2022, and ended December 31, 2026. Table 2 provides additional 
information about those expected impacts by year. However, because the 
RO Model was not implemented on January 1, 2022, as contemplated in the 
CY 2022 OPPS/ASC FC, such effects have yet not occurred.

                                Table 1--Estimates of Medicare Program Savings (Millions $) for Radiation Oncology Model
                                                               [Starting January 1, 2022]
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                                                                                                   Year of model
                                                         -----------------------------------------------------------------------------------------------
                                                               2022            2023            2024            2025            2026           Total *
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Net Impact to Medicare Program Spending.................             -20             -30             -20             -40             -40            -150
Changes to Incurred FFS Spending........................             -20             -20             -20             -30             -30            -120
Changes to MA Capitation Payments.......................               0             -20             -20             -20             -30             -80
Part B Premium Revenue Offset...........................               0              10              10              10              10              50
Total APM Incentive Payments............................               0               0              10               0               0              10
Episode Allowed Charges.................................             830             860             900             930             970           4,490
Episode Medicare Payment................................             650             670             700             730             750           3,500
Total Number of Episodes................................          53,300          54,900          56,400          58,000          59,600         282,200
Total Number of Beneficiaries...........................          51,900          53,500          54,900          56,500          58,100         250,200
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* Negative spending reflects a reduction in Medicare spending, while positive spending reflects an increase.
* Totals may not sum due to rounding and from beneficiaries that have cancer treatment spanning multiple years.


[[Page 20804]]


   Table 2--Radiation Oncology Model PGP (Including Freestanding Radiation Therapy Centers) vs Hopd Allowed Charge Impacts 2022 to 2026 as Compared to
                                                         Those Not Participating in the RO Model
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                                                               2022            2023            2024            2025            2026        2022 to 2026
                        % Impact                             (percent)       (percent)       (percent)       (percent)       (percent)       (percent)
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PGP (including freestanding radiation therapy centers)..             3.1             4.5             6.0             7.4             8.9             6.3
HOPD....................................................            -7.8            -8.8            -9.6           -10.6           -11.6            -9.9
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    Nevertheless, and notwithstanding the RO Model delay, the analysis 
uses a baseline in which the RO Model provisions of the CY 2022 OPPS/
ASC FC were effective on January 1, 2022, to calculate the monetized 
estimates of the effects of this proposed rule. We maintain the 
analytical approach described in the regulatory impact analysis of the 
CY 2022 OPPS/ASC FC, and, for the purposes of quantifying the effects 
of this proposed rule, we assume that the regulations at 42 CFR part 
512 subpart B as amended by the CY 2022 OPPS/ASC FC will be in full 
effect if this proposed rule is not finalized. As a result of the delay 
of the start of the RO Model to a date yet to be determined, this 
proposed rule would, if finalized, prevent the occurrence of the 
estimated savings presented in Table 90 of the CY 2022 OPPS/ASC FC at 
this time. We summarize this result in Table 1 in this section, which 
illustrates, inversely, the net monetized estimates contained in Table 
90 of the CY 2022 OPPS/ASC FC. The period covered shown in Table 1 
begins January 2022 in alignment with Table 90 of the CY 2022 OPPS/ASC 
FC.
    As required by OMB Circular A-4 (available at the Office of 
Management and Budget website at: https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf), we have prepared an 
accounting statement in Table 3 showing the classification of the 
impact associated with the provisions of this proposed rule.

   Table 3--Accounting Statement: Estimated Impacts From CY 2022 to CY 2026 as a Result of Provisions of This
                                                  Proposed Rule
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                                                                                       Units
                                                     Estimates   -----------------------------------------------
                    Category                         (million)                     Discount rate      Period
                                                                   Year  dollar      (percent)        covered
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Transfers:
    Annualized Monetized ($million/year)........             $27            2020               7       2022-2026
                                                              29            2020               3       2022-2026
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From Whom to Whom...............................  From the Federal Government to healthcare providers.
----------------------------------------------------------------------------------------------------------------

D. Regulatory Flexibility Act (RFA)

    The RFA requires agencies to analyze options for regulatory relief 
of small entities. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other health care providers and 
suppliers are small entities, either by nonprofit status or by having 
revenues of less than $8 million to $41.5 million in any 1 year. 
Individuals and states are not included in the definition of a small 
entity. For details, see the Small Business Administration's ``Table of 
Small Business Size Standards'' at https://www.sba.gov/document/support--table-size-standards.
    As its measure of significant economic impact on a substantial 
number of small entities, HHS uses a change in revenue of more than 3 
to 5 percent. If finalized, the impact in this proposed rule as 
described the CY 2022 OPPS/ASC FC would not occur. Instead, payment for 
submitted claims would be made under the applicable Medicare payment 
methodology. As a result, the Secretary has determined that this 
proposed rule will not have a significant impact on a substantial 
number of small entities.
    In addition, section 1102(b) of the Act requires us to prepare an 
RIA if a rule may have a significant impact on the operations of a 
substantial number of small rural hospitals. This analysis must conform 
to the provisions of section 603 of the RFA. For purposes of section 
1102(b) of the Act, we define a small rural hospital as a hospital that 
is located outside of a Metropolitan Statistical Area for Medicare 
payment regulations and has fewer than 100 beds. We are not preparing 
an analysis for section 1102(b) of the Act because we have determined, 
and the Secretary certifies, that the RO Model will not have a 
significant impact on the operations of a substantial number of small 
rural hospitals.
    We welcome comments on our estimate of significantly affected 
providers and suppliers and the magnitude of estimated effects for this 
proposed rule.

E. Unfunded Mandates Reform Act (UMRA)

    Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA) also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any 1 year of $100 
million in 1995 dollars, updated annually for inflation. In 2022, that 
threshold is approximately $165 million. This proposed rule does not 
mandate any requirements for State, local, or tribal governments, or 
for the private sector.

F. Federalism

    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. This rule would not have a substantial direct effect on 
state or local governments, preempt state law, or otherwise have a 
Federalism

[[Page 20805]]

implication because the RO Model is a Federal payment model impacting 
Federal payments only and does not implicate local governments or state 
law. Therefore, the requirements of Executive Order 13132 are not 
applicable.

V. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this proposed 
rule, and, when we proceed with a subsequent document, we will respond 
to the comments in the preamble to that document.
    Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & 
Medicaid Services, approved this document on March 31, 2022.

List of Subjects in 42 CFR 512

    Administrative practice and procedure, Health facilities, Medicare, 
Reporting and recordkeeping requirements.

    For the reasons set forth in the preamble and under the authority 
at 42 U.S.C. 1302, 1315a, and 1395hh, the Centers for Medicare & 
Medicaid Services proposes to amend 42 CFR chapter IV part 512 as set 
forth below:

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

0
1. The authority citation for part 512 continues to read as follows:

    Authority:  42 U.S.C. 1302, 1315a, and 1395hh.

0
2. Section 512.205 is amended by revising the definition of ``model 
performance period'' to read as follows:


Sec.  512.205   Definitions

* * * * *
    Model performance period means the 5 performance years (PYs) during 
which RO episodes initiate and terminate. CMS will establish the start 
and end dates of the model performance period for the RO Model through 
future rulemaking.
* * * * *

    Dated: April 5, 2022.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2022-07525 Filed 4-6-22; 4:15 pm]
BILLING CODE 4120-01-P