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Federal Register / Vol. 86, No. 129 / Friday, July 9, 2021 / Proposed Rules
ESRD Beneficiary received maintenance dialysis are identified by claims with CPT codes 90957, 90958, 90959, 90960, 90961, 90962, 90965, or 90966, excluding claims for beneficiaries who were 75 years of age or older at any point during the month. For MY3
through MY10, months during which an attributed ESRD Beneficiary received maintenance dialysis are identified by claims with CPT codes 90957, 90958, 90959, 90960, 90961, 90962, 90965, or 90966, excluding claims for beneficiaries who were 75 years of age or older at any point during the month, or had a vital solid organ cancer diagnosis and were receiving treatment with chemotherapy or radiation for vital solid organ cancer during the MY.
Months in which an attributed ESRD
Beneficiary had a diagnosis of vital solid organ cancer are identified as described in paragraph c1iA1 of this section. Months in which an attributed ESRD Beneficiary received treatment with chemotherapy or radiation for vital solid organ cancer are identified as described in paragraph c1iA2 of this section.

ii
A
1 Dialysis treatment beneficiary years included in the denominator are composed of those months during which an attributed ESRD Beneficiary received maintenance dialysis at home or in an ESRD facility, such that 1beneficiary year is comprised of 12beneficiary months. For MY1 and MY2, months during which an attributed ESRD Beneficiary received maintenance dialysis are identified by claims with CPT codes 90957, 90958, 90959, 90960,
90961, 90962, 90965, or 90966, excluding claims for beneficiaries who were 75 years of age or older at any point during the month. For MY3
through MY10, months during which an attributed ESRD Beneficiary received maintenance dialysis are identified by claims with CPT codes 90957, 90958, 90959, 90960, 90961, 90962, 90965, or 90966, excluding claims for beneficiaries who were 75 years of age or older at any point during the month, or had a vital solid organ cancer diagnosis and were receiving treatment with chemotherapy or radiation for vital solid organ cancer during the MY.
Months in which an attributed ESRD
Beneficiary had a vital solid organ cancer diagnosis are identified as described in paragraph c1iA1 of this section. Months in which an attributed ESRD Beneficiary received treatment with chemotherapy or radiation for vital solid organ cancer are identified as described in paragraph c1iA2 of this section.
2 MY1 and MY2, Pre-emptive LDT
beneficiary years included in the denominator are composed of those months during which a Pre-emptive LDT Beneficiary is attributed to a Managing Clinician, from the beginning of the MY up to and including the month of the living donor transplant.
For MY3 through MY10, Pre-emptive LDT beneficiary years included in the denominator are composed of those months during which a Pre-emptive LDT Beneficiary is attributed to a Managing Clinician, from the beginning of the MY up to and including the month of the living donor transplant, excluding beneficiaries who had a vital solid organ cancer diagnosis and were
receiving treatment with chemotherapy or radiation for vital solid organ cancer during the MY. Months in which an attributed ESRD Beneficiary had a vital solid organ cancer diagnosis are identified as described in paragraph c1iA1 of this section. Months in which an attributed ESRD Beneficiary received treatment with chemotherapy or radiation for vital solid organ cancer are identified as described in paragraph c1iA2 of this section. Preemptive LDT Beneficiaries are identified using information about living donor transplants from the SRTR Database and Medicare claims data.

9. Section 512.370 is amended by revising paragraphs b, c, and d to read as follows:
512.370

Benchmarking and scoring.

b Achievement scoring. CMS
assesses ETC Participant performance at the aggregation group level on the home dialysis rate and transplant rate against achievement benchmarks constructed based on the home dialysis rate and transplant rate among aggregation groups of ESRD facilities and Managing Clinicians located in Comparison Geographic Areas during the Benchmark Year. Achievement benchmarks are calculated as described in paragraph b1 of this section and, for MY3
through MY10, are stratified as described in paragraph b2 of this section.
1 Achievement benchmarks. CMS
uses the following scoring methodology to assess an ETC Participants achievement score.

TABLE 1 TO 512.370B1ETC MODEL SCHEDULE OF PPA ACHIEVMENT BENCHMARKS BY MEASUREMENT YEAR
MY1 and MY2

MY3 and MY4

MY5 and MY6

MY7 and MY8

MY9 and MY10

90th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.

1.1 90th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.1 75th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.1 50th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.1 30th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.

1.2 90th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.2 75th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.2 50th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.2 30th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.

1.3 90th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.3 75th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.3 50th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.3 30th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.

1.4 90th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.4 75th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.4 50th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
1.4 30th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.

75th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.

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50th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.
30th+ Percentile of benchmark rates for Comparison Geographic Areas during the Benchmark Year.

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