Federal Register - November 8, 2021
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Source: Federal Register
Federal Register / Vol. 86, No. 213 / Monday, November 8, 2021 / Rules and Regulations Qualified staff in alphabetical order to read as follows:
512.310
Definitions.
Clinical staff means a licensed social worker or registered dietician/nutrition professional who furnishes services for which payment may be made under the physician fee schedule under the direction of and incident to the services of the Managing Clinician who is an ETC Participant.
Health Equity Incentive means the amount added to the ETC Participants improvement score, calculated as described in 512.370c1, if the ETC
Participants aggregation group demonstrated sufficient improvement on the home dialysis rate or transplant rate for attributed beneficiaries who are dual eligible or Medicare Low Income Subsidy LIS recipients between the Benchmark Year and the MY.
Qualified staff means both clinical staff and any qualified person as defined at 410.48a of this chapter who is an ETC Participant.
7. Section 512.360 is amended by revising paragraph c2ii introductory text and adding paragraph c2iii to read as follows:
512.360 Beneficiary population and attribution.
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512.365
c
2
ii For MY1 and MY2, a Pre-emptive LDT Beneficiary who is not excluded based on the criteria in paragraph b of this section is attributed to the Managing Clinician with whom the beneficiary has had the most claims between the start of the MY and the month in which the beneficiary received the transplant for all months between the start of the MY and the month of the transplant.
iii For MY3 through MY10, a Preemptive LDT Beneficiary who is not excluded based on the criteria in paragraph b of this section is attributed to the Managing Clinician who submitted the most claims for services furnished to the beneficiary in the 365
days preceding the date in which the beneficiary received the transplant.
A If no Managing Clinician has had the most claims for a given Pre-emptive LDT Beneficiary such that multiple Managing Clinicians each had the same number of claims for that beneficiary in the 365 days preceding the date of the
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transplant, the Pre-emptive LDT
Beneficiary is attributed to the Managing Clinician associated with the latest claim service date at the claim line through date during the 365 days preceding the date of the transplant.
B If no Managing Clinician had the most claims for a given Pre-emptive LDT Beneficiary such that multiple Managing Clinicians each had the same number of claims for that beneficiary in the 365 days preceding the date of the transplant, and more than one of those Managing Clinicians had the latest claim service date at the claim line through date during the 365 days preceding the date of the transplant, the Pre-emptive LDT Beneficiary is randomly attributed to one of these Managing Clinicians.
C The Pre-emptive LDT Beneficiary is considered eligible for attribution under this paragraph c2iii if the Pre-emptive LDT Beneficiary has at least 1-eligible month during the 12-month period that includes the month of the transplant and the 11 months prior to the month of the transplant. An eligible month refers to a month during which the Pre-emptive LDT Beneficiary not does not meet exclusion criteria in paragraph b of this section.
8. Section 512.365 is amended by revising paragraphs b1ii, b2ii, c1iA, c1iiA, c2iA, and c2iiA1 and 2 to read as follows:
Performance assessment.
b
1
ii For MY1 and MY2, the numerator is the total number of home dialysis treatment beneficiary years plus one half the total number of self dialysis treatment beneficiary years for attributed ESRD Beneficiaries during the MY. For MY3 through MY10, the numerator is the total number of home dialysis treatment beneficiary years, plus one half the total number of self dialysis treatment beneficiary years, plus one half the total number of nocturnal in center dialysis beneficiary years for attributed ESRD Beneficiaries during the MY.
A Home dialysis treatment beneficiary years included in the numerator are composed of those months during which attributed ESRD
Beneficiaries received maintenance dialysis at home, such that 1-beneficiary year is comprised of 12-beneficiary months. Months in which an attributed ESRD Beneficiary received maintenance dialysis at home are identified by claims with Type of Bill 072X and condition codes 74 or 76.
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B Self dialysis treatment beneficiary years included in the numerator are composed of those months during which attributed ESRD Beneficiaries received self dialysis in center, such that 1-beneficiary year is comprised of 12-beneficiary months. Months in which an attributed ESRD Beneficiary received self dialysis are identified by claims with Type of Bill 072X and condition code 72.
C Nocturnal in center dialysis beneficiary years included in the numerator are composed of those months during which attributed ESRD
Beneficiaries received nocturnal in center dialysis, such that 1-beneficiary year is comprised of 12-beneficiary months. Months in which an attributed ESRD Beneficiary received nocturnal in center dialysis are identified by claims with Type of Bill 072X and modifier UJ.
2
ii For MY1 and MY2, the numerator is the total number of home dialysis treatment beneficiary years for attributed ESRD Beneficiaries during the MY plus one half the total number of self dialysis treatment beneficiary years.
For MY3 through MY10, the numerator is the total number of home dialysis treatment beneficiary years, plus one half the total number of self dialysis treatment beneficiary years, plus one half the total number of nocturnal in center dialysis beneficiary years for attributed ESRD Beneficiaries during the MY.
A Home dialysis treatment beneficiary years included in the numerator are composed of those months during which attributed ESRD
Beneficiaries received maintenance dialysis at home, such that 1-beneficiary year is comprised of 12-beneficiary months. Months in which an attributed ESRD Beneficiary received maintenance dialysis at home are identified by claims with CPT codes 90965 or 90966.
B Self-dialysis treatment beneficiary years included in the numerator are composed of those months during which attributed ESRD Beneficiaries received self dialysis in center, such that 1-beneficiary year is comprised of 12-beneficiary months. Months in which an attributed ESRD Beneficiary received self dialysis are identified by claims with Type of Bill 072X and condition code 72.
C Nocturnal in center dialysis beneficiary years included in the numerator are composed of those months during which attributed ESRD
Beneficiaries received nocturnal in center dialysis, such that 1-beneficiary year is comprised of 12-beneficiary
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