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Federal Register / Vol. 86, No. 129 / Friday, July 9, 2021 / Proposed Rules
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TABLE 1 TO 512.370B1ETC MODEL SCHEDULE OF PPA ACHIEVMENT BENCHMARKS BY MEASUREMENT YEAR
Continued MY1 and MY2

MY3 and MY4

MY5 and MY6

MY7 and MY8

MY9 and MY10

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

2 Stratifying achievement benchmarks. For MY3 through MY10, CMS stratifies achievement benchmarks based on the proportion of beneficiary years attributed to the aggregation group for which attributed beneficiaries are dual eligible or LIS recipients during the MY. An ESRD Beneficiary or Preemptive LDT Beneficiary is considered to be dual eligible or an LIS recipient for a given month if at any point during the month the beneficiary was dual eligible 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
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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 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 an LIS recipient for a given month if at any point during the month the beneficiary was dual eligible or an LIS recipient. CMS determines whether a beneficiary was dual eligible or an 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 paragraph c2 of this section, is at least 5percentage points higher than the home dialysis rate for the Benchmark Year, calculated as specified in paragraph
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c2 of this section. 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 paragraph c2 of this section, is at least 5percentage points higher than the transplant rate for the Benchmark Year, calculated as specified in paragraph c2 of this section. 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 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
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