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Federal Register / Vol. 86, No. 213 / Monday, November 8, 2021 / Rules and Regulations
or an LIS recipient based on Medicare administrative data. CMS stratifies the achievement benchmarks into the following two strata:
i Stratum 1: 50 percent or more of attributed beneficiary years during the MY are for beneficiaries who are dual eligible or LIS recipients.
ii Stratum 2: Less than 50 percent of attributed beneficiary years during the MY are for beneficiaries who are dual eligible or LIS recipients.
c Improvement scoring. CMS
assesses ETC Participant improvement on the home dialysis rate and transplant rate against benchmarks constructed based on the ETC Participants aggregation groups historical performance on the home dialysis rate and transplant rate during the Benchmark Year to calculate the ETC
Participants improvement score, as specified in paragraph c1 of this section. For MY3 through MY10, CMS
assesses ETC Participant improvement on the home dialysis rate and transplant rate for ESRD Beneficiaries and, if applicable, Pre-emptive LDT
Beneficiaries, who are dual eligible or LIS recipients to determine whether to add the Health Equity Incentive to the ETC Participants improvement score, as specified in paragraph c2 of this section.
1 Improvement score calculation.
CMS uses the following scoring methodology to assess an ETC
Participants improvement score.
i Greater than 10 percent improvement relative to the Benchmark Year rate: 1.5 points ii Greater than 5 percent improvement relative to the Benchmark Year rate: 1 point iii Greater than 0 percent improvement relative to the Benchmark Year rate: 0.5 points iv Less than or equal to the Benchmark Year rate: 0 points v For MY3 through MY10, when calculating improvement benchmarks constructed based on the ETC
Participants aggregation groups historical performance on the home dialysis rate and transplant rate during the Benchmark Year, CMS adds one beneficiary month to the numerator of the home dialysis rate and adds one beneficiary month to the numerator of the transplant rate, such that the Benchmark Year rates cannot be equal to zero.
2 Health Equity Incentive. CMS
calculates the ETC Participants aggregation groups home dialysis rate and transplant rate as specified in 512.365b and 512.365c, respectively, using only attributed beneficiary years comprised of months
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during the MY in which ESRD
Beneficiaries and, if applicable, Preemptive LDT Beneficiaries, are dual eligible or LIS recipients. CMS also calculates the threshold for earning the Health Equity Incentive based on the ETC Participants aggregation groups historical performance on the home dialysis rate and transplant rate during the Benchmark Year, using only attributed beneficiary years comprised of months during the Benchmark Year in which ESRD Beneficiaries and, if applicable, Pre-emptive LDT
Beneficiaries, are dual eligible or LIS
recipients. An ESRD Beneficiary or Preemptive LDT Beneficiary is considered to be dual eligible or a LIS recipient for a given month if at any point during the month the beneficiary was dual eligible or a LIS recipient. CMS determines whether a beneficiary was dual eligible or a LIS recipient based on Medicare administrative data.
i The ETC Participant earns the Health Equity Incentive for the home dialysis rate improvement score if the home dialysis rate for the MY, calculated as specified in this paragraph c2, is at least 2.5-percentage points higher than the home dialysis rate for the Benchmark Year, calculated as specified in this paragraph c2. If the ETC Participant earns the Health Equity Incentive for the home dialysis rate improvement score, CMS adds 0.5
points to the ETC Participants home dialysis rate improvement score, calculated as specified in paragraph c1 of this section, unless the ETC
Participant is ineligible to receive the Home Equity Incentive as specified in paragraph c2iii of this section.
ii The ETC Participant earns the Health Equity Incentive for the transplant rate improvement score if the home dialysis rate for the MY, calculated as specified in this paragraph c2, is at least 2.5-percentage points higher than the transplant rate for the Benchmark Year, calculated as specified in this paragraph c2. If the ETC
Participant earns the Health Equity Incentive for the transplant rate improvement score, CMS adds 0.5
points to the ETC Participants transplant rate improvement score, calculated as specified in paragraph c1 of this section, unless the ETC
Participant is ineligible to receive the Home Equity Incentive as specified in paragraph c2iii of this section.
iii An ETC Participant in an aggregation group with fewer than 11attributed beneficiary years comprised of months in which ESRD Beneficiaries and, if applicable, Pre-emptive LDT
Beneficiaries, are dual eligible or LIS
recipients, during either the Benchmark
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Year or the MY is ineligible to earn the Health Equity Incentive.
d Modality Performance Score. 1
For MY1 and MY2, CMS calculates the ETC Participants MPS as the higher of ETC Participants achievement score or improvement score for the home dialysis rate, together with the higher of the ETC Participants achievement score or improvement score for the transplant rate, weighted such that the ETC
Participants score for the home dialysis rate constitutes 23 of the MPS and the ETC Participants score for the transplant rate constitutes 13 of the MPS. CMS uses the following formula to calculate the ETC Participants MPS for MY1 and MY2:
Modality Performance Score = 2
Higher of the home dialysis achievement or improvement score + Higher of the transplant achievement or improvement score 2 For MY3 through MY10, CMS
calculates the ETC Participants MPS as the higher of the ETC Participants achievement score for the home dialysis rate or the sum of the ETC Participants improvement score for the home dialysis rate calculated as specified in paragraph c1 of this section and, if applicable, the Health Equity Incentive, calculated as described in paragraph c2i of this section, together with the higher of the ETC Participants achievement score for the transplant rate or the sum of the ETC Participants improvement score for the transplant rate calculated as specified in paragraph c1 of this section and, if applicable, the Heath Equity Incentive, calculated as described in paragraph c2ii of this section, weighted such that the ETC
Participants score for the home dialysis rate constitutes 23 of the MPS and the ETC Participants score for the transplant rate constitutes 13 of the MPS. CMS uses the following formula to calculate the ETC Participants MPS for MY3 through MY10:
Modality Performance Score = 2
Higher of the home dialysis achievement or home dialysis improvement score + Health Equity Bonus + Higher of the transplant achievement or transplant improvement score +
Health Equity Bonus The Health Equity Incentive is applied to the home dialysis improvement score or transplant improvement score only if earned by the ETC Participant.
10. Section 512.390 is amended by revising the section heading, redesignating paragraph b as c and adding new paragraph b.
The revision and addition read as follows:

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