Federal Register/Vol. 84, No. 138/Thursday, July 18, 2019
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34478 Federal Register / Vol. 84, No. 138 / Thursday, July 18, 2019 / Proposed Rules DEPARTMENT OF HEALTH AND claims in the initial 3 years of the ETC website as soon as possible after they HUMAN SERVICES Model. have been received: http:// We believe that these two proposed www.regulations.gov. Follow the search Centers for Medicare & Medicaid models would test ways to further our instructions on that website to view Services goals of reducing Medicare expenditures public comments. while preserving or enhancing the 42 CFR Part 512 quality of care furnished to Electronic Access beneficiaries. This Federal Register document is [CMS–5527–P] DATES: Comment period: To be assured also available from the Federal Register consideration, comments must be online database through Federal Digital RIN 0938–AT89 received at one of the addresses System (FDsys), a service of the U.S. Medicare Program; Specialty Care provided below, no later than 5 p.m. Government Publishing Office. This Models To Improve Quality of Care and Eastern Standard Time on September database can be accessed via the Reduce Expenditures 16, 2019. internet at http://www.gpo.gov/fdsys/. ADDRESSES: In commenting, please refer Current Procedural Terminology (CPT) AGENCY: Centers for Medicare & to file code CMS–5527–P. Because of Copyright Notice Medicaid Services (CMS), HHS. staff and resource limitations, we cannot ACTION: Proposed rule. accept comments by facsimile (FAX) Throughout this proposed rule, we transmission. use CPT® codes and descriptions to SUMMARY: This proposed rule proposes Comments, including mass comment refer to a variety of services. We note to implement two new mandatory submissions, must be submitted in one that CPT® codes and descriptions are Medicare payment models under of the following three ways (please copyright 2019 American Medical section 1115A of the Social Security choose only one of the ways listed): Association. All Rights Reserved. CPT® Act—the Radiation Oncology Model 1. Electronically. You may submit is a registered trademark of the (RO Model) and the End-Stage Renal electronic comments on this regulation American Medical Association (AMA). Disease (ESRD) Treatment Choices to http://www.regulations.gov. Follow Applicable Federal Acquisition Model (ETC Model). The proposed RO the ‘‘Submit a comment’’ instructions. Regulations (FAR) and Defense Federal Model would promote quality and 2. By regular mail. You may mail Acquisition Regulations (DFAR) apply. financial accountability for providers written comments to the following and suppliers of radiotherapy (RT). The address ONLY: Centers for Medicare & I. Executive Summary RO Model would test whether making Medicaid Services, Department of A. Purpose prospective episode payments to Health and Human Services, Attention: hospital outpatient departments (HOPD) CMS–5527–P, P.O. Box 8013, Baltimore, The purpose of this proposed rule is and freestanding radiation therapy MD 21244–1850. to propose the implementation and centers for RT episodes of care preserves Please allow sufficient time for mailed testing of two new mandatory models or enhances the quality of care comments to be received before the under the authority of the Innovation furnished to Medicare beneficiaries close of the comment period. Center, as well as to propose certain while reducing Medicare program 3. By express or overnight mail. You general provisions that would be spending through enhanced financial may send written comments to the applicable to both the RO Model and the accountability for RO Model following address ONLY: Centers for ETC Model. Section 1115A of the Social participants. The proposed ETC Model Medicare & Medicaid Services, Security Act (the Act) authorizes the would be a mandatory payment model Department of Health and Human Innovation Center to test innovative focused on encouraging greater use of Services, Attention: CMS–5527–P, Mail payment and service delivery models home dialysis and kidney transplants, Stop C4–26–05, 7500 Security expected to reduce Medicare, Medicaid, in order to preserve or enhance the Boulevard, Baltimore, MD 21244–8013. and Children’s Health Insurance quality of care furnished to Medicare For information on viewing public Program (CHIP) expenditures while beneficiaries while reducing Medicare comments, see the beginning of the preserving or enhancing the quality of expenditures. The ETC Model would SUPPLEMENTARY INFORMATION section. care furnished to the beneficiaries of include ESRD facilities and certain FOR FURTHER INFORMATION CONTACT: such programs. Under the Medicare fee- clinicians caring for beneficiaries with Rebecca Cole (410) 786–1589. for-service (FFS) program, Medicare ESRD—or Managing Clinicians—located [email protected], for questions generally makes a separate payment to in selected geographic areas as related to General Provisions. providers and suppliers for each item or participants. CMS would assess the [email protected], for service furnished to a beneficiary during performance of participating Managing questions related to the Radiation the course of treatment. Because the Clinicians and ESRD facilities on their Oncology Model. ETC- amount of payments received by a rates of home dialysis and kidney and [email protected], for questions provider or supplier for such items and kidney-pancreas transplants during each related to the ESRD Treatment Choices services varies with the volume of items Measurement Year (MY), and would Model. and services furnished to a beneficiary, subsequently adjust certain of their SUPPLEMENTARY INFORMATION: some providers and suppliers may be Medicare payments upward or Inspection of Public Comments: All financially incentivized to downward during the corresponding comments received before the close of inappropriately increase the volume of performance payment adjustment the comment period are available for items and services to receive higher period based on their home dialysis rate viewing by the public, including any payments. Medicare FFS may also and transplant rate. CMS would also personally identifiable or confidential detract from a provider’s or supplier’s positively adjust certain Medicare business information that is included in incentive to invest in quality payments to participating ESRD a comment. We post all comments improvement and care coordination facilities and Managing Clinicians for received before the close of the activities if it means those activities will home dialysis and home dialysis-related comment period on the following result in a lower volume of items and VerDate Sep<11>2014 18:06 Jul 17, 2019 Jkt 247001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4702 E:\FR\FM\18JYP2.SGM 18JYP2 khammond on DSKBBV9HB2PROD with PROPOSALS2 Federal Register / Vol. 84, No. 138 / Thursday, July 18, 2019 / Proposed Rules 34479 services. As a result, care may be would result in a robust data set for Medicare expenditures while preserving fragmented, unnecessary, or duplicative. evaluating the models’ proposed or enhancing the quality of care for The goal for the proposed models is payment approaches and would Medicare beneficiaries. We anticipate to preserve or enhance the quality of stimulate the rapid development of new the proposed RO Model would benefit care furnished to beneficiaries while evidence-based knowledge. Testing the Medicare beneficiaries by encouraging reducing program spending through proposed models in this manner would more efficient care delivery and enhanced financial accountability for also allow us to learn more about incentivizing higher value care across model participants. We propose that the patterns of inefficient utilization of episodes of care. We propose that the performance period of the proposed RO health care services and how to RO Model would have a performance Model would begin in 2020, and end incentivize quality improvement for period of five calendar years, beginning December 31, 2024. We propose to beneficiaries receiving services for RT in 2020, and ending December 31, 2024. implement the proposed payment and ESRD, which could inform future We propose to test the RO Model to adjustments under the proposed ETC model design. capture all episodes that finish within Model over the course of 6 and a half We seek public comment on the the performance period, which means years, beginning January 1, 2020, and proposals contained in this proposed that the data collection, episode ending June 30, 2026. rule, and also on any alternatives payments, and reconciliation would The proposed models would offer considered. continue into calendar year 2025. participants the opportunity to examine and better understand their own care B. Summary of the Major Proposed a. Summary of Major Provisions processes and patterns with regard to Provisions (1) Proposed RO Model Overview beneficiaries receiving RT services for 1. General Provisions cancer, and beneficiaries with ESRD, RT is a common treatment for patients respectively. We chose these focus areas The proposed general provisions undergoing cancer treatment and is for the proposed models because, as would be applicable only to participants typically furnished by a physician at discussed in depth in sections III and IV in the RO Model and the ETC Model. either a HOPD or a freestanding of this proposed rule, we believe that We have identified the proposed general radiation therapy center. We are participants in these models would have provisions based on standardized proposing the RO Model to include significant opportunity to redesign care