United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2019_register executive 2019-07-18 article Part II Proposed Rules D09002ee1c7cfea80 D09002ee1c7cfec55 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This proposed rule proposes to implement two new mandatory Medicare payment models under section 1115A of the Social Security Act--the Radiation Oncology Model (RO Model) and the End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model). The proposed RO Model would promote quality and financial accountability for providers and suppliers of radiotherapy (RT). The RO Model would test whether making prospective episode payments to hospital outpatient departments (HOPD) and freestanding radiation therapy centers for RT episodes of care preserves or enhances the quality of care furnished to Medicare beneficiaries while reducing Medicare program spending through enhanced financial accountability for RO Model participants. The proposed ETC Model would be a mandatory payment model focused on encouraging greater use of home dialysis and kidney transplants, in order to preserve or enhance the quality of care furnished to Medicare beneficiaries while reducing Medicare expenditures. The ETC Model would include ESRD facilities and certain clinicians caring for beneficiaries with ESRD-- or Managing Clinicians--located in selected geographic areas as participants. CMS would assess the performance of participating Managing Clinicians and ESRD facilities on their rates of home dialysis and kidney and kidney-pancreas transplants during each Measurement Year (MY), and would subsequently adjust certain of their Medicare payments upward or downward during the corresponding performance payment adjustment period based on their home dialysis rate and transplant rate. CMS would also positively adjust certain Medicare payments to participating ESRD facilities and Managing Clinicians for home dialysis and home dialysis-related claims in the initial 3 years of the ETC Model. We believe that these two proposed models would test ways to further our goals of reducing Medicare expenditures while preserving or enhancing the quality of care furnished to beneficiaries. 84 FR 34478 https://www.govinfo.gov/app/details/FR-2019-07-18/2019-14902 2019-14902 fr18jy19-18 RIN 0938-AT89 P CMS-5527-P https://www.govinfo.gov/app/details/FR-2019-07-18/2019-14902 https://www.govinfo.gov/content/pkg/FR-2019-07-18/html/2019-14902.htm https://www.govinfo.gov/content/pkg/FR-2019-07-18/pdf/2019-14902.pdf Administrative Practice and Procedure Health Facilities Medicare Reporting and Recordkeeping Requirements 118 p. 34478 34595 84 FR 34478 Title 42 Part 512 42 CFR Part 512 RIN 0938-AT89 Medicare Program; Specialty Care Models To Improve Quality of Care and Reduce Expenditures; Federal Register Vol. 84, Issue PRORULE 2019-14902 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2019-09-16 CMS-5527-P P 2019-14902 Proposed rule.

This proposed rule proposes to implement two new mandatory Medicare payment models under section 1115A of the Social Security Act--the Radiation Oncology Model (RO Model) and the End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model). The proposed RO Model would promote quality and financial accountability for providers and suppliers of radiotherapy (RT). The RO Model would test whether making prospective episode payments to hospital outpatient departments (HOPD) and freestanding radiation therapy centers for RT episodes of care preserves or enhances the quality of care furnished to Medicare beneficiaries while reducing Medicare program spending through enhanced financial accountability for RO Model participants. The proposed ETC Model would be a mandatory payment model focused on encouraging greater use of home dialysis and kidney transplants, in order to preserve or enhance the quality of care furnished to Medicare beneficiaries while reducing Medicare expenditures. The ETC Model would include ESRD facilities and certain clinicians caring for beneficiaries with ESRD-- or Managing Clinicians--located in selected geographic areas as participants. CMS would assess the performance of participating Managing Clinicians and ESRD facilities on their rates of home dialysis and kidney and kidney-pancreas transplants during each Measurement Year (MY), and would subsequently adjust certain of their Medicare payments upward or downward during the corresponding performance payment adjustment period based on their home dialysis rate and transplant rate. CMS would also positively adjust certain Medicare payments to participating ESRD facilities and Managing Clinicians for home dialysis and home dialysis-related claims in the initial 3 years of the ETC Model. We believe that these two proposed models would test ways to further our goals of reducing Medicare expenditures while preserving or enhancing the quality of care furnished to beneficiaries.

Comment period: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. Eastern Standard Time on September 16, 2019. Rebecca Cole (410) 786-1589. Megan.Hyde@cms.hhs.gov, for questions related to General Provisions. RadiationTherapy@cms.hhs.gov, for questions related to the Radiation Oncology Model. ETC-CMMI@cms.hhs.gov, for questions related to the ESRD Treatment Choices Model. 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Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2019-07-18 P0b002ee1a228b666 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr18jy19 https://www.govinfo.gov/app/details/FR-2019-07-18 https://www.govinfo.gov/content/pkg/FR-2019-07-18/pdf/FR-2019-07-18.pdf https://www.govinfo.gov/content/pkg/FR-2019-07-18/xml/FR-2019-07-18.xml fdlp 34255 34768 DGPO 2019-07-18 2024-05-31 FR-2019-07-18 machine generated eng FR FR-2019-07-18 84 138