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- 42 CFR 425.601 · Establishing, adjusting, and updating the benchmark for agreement periods beginning on or after July 1, 2019, and before January 1, 2024.
- 42 CFR 425.602 · Establishing, adjusting, and updating the benchmark for an ACO's first agreement period beginning on or before January 1, 2018.
- 42 CFR 425.603 · Resetting, adjusting, and updating the benchmark for a subsequent agreement period beginning on or before January 1, 2019.
- 42 CFR 425.604 · Calculation of savings under the one-sided model.
- 42 CFR 425.605 · Calculation of shared savings and losses under the BASIC track.
- 42 CFR 425.606 · Calculation of shared savings and losses under Track 2.
- 42 CFR 425.608 · Determining first year performance for ACOs beginning April 1 or July 1, 2012.
- 42 CFR 425.609 · Determining performance for 6-month performance years during CY 2019.
- 42 CFR 425.610 · Calculation of shared savings and losses under the ENHANCED track.
- 42 CFR 425.611 · Adjustments to Shared Savings Program calculations to address the COVID-19 pandemic.
- 42 CFR 425.612 · Waivers of payment rules or other Medicare requirements.
- 42 CFR 425.613 · Telehealth services.
- 42 CFR 425.614-425.629 · §§ 425.614-425.629 [Reserved]
- 42 CFR 425.630 · Option to receive advance investment payments.
- 42 CFR 425.631-425.639 · §§ 425.631-425.639 [Reserved]
- 42 CFR 425.640 · Option to receive prepaid shared savings.
- 42 CFR 425.641-425.649 · §§ 425.641-425.649 [Reserved]
- 42 CFR 425.650 · Benchmarking methodology.
- 42 CFR 425.652 · Establishing, adjusting, and updating the benchmark for agreement periods beginning on January 1, 2024, and in subsequent years.
- 42 CFR 425.654 · Calculating county expenditures and regional expenditures.
- 42 CFR 425.655 · Calculating the regional risk score growth cap adjustment factor.
- 42 CFR 425.656 · Calculating the regional adjustment to the historical benchmark.
- 42 CFR 425.658 · Calculating the prior savings adjustment to the historical benchmark.
- 42 CFR 425.659 · Calculating risk scores used in Shared Savings Program benchmark calculations.
- 42 CFR 425.660 · Accountable Care Prospective Trend (ACPT).
- 42 CFR 425.661 · [Reserved]
- 42 CFR 425.662 · Calculating the population adjustment to the historical benchmark.
- 42 CFR 425.663 · [Reserved]
- 42 CFR 425.664 · xxx
- 42 CFR 425.665-425.669 · -425.669 [Reserved]
- 42 CFR 425.670 · Adjustments to mitigate the impact of significant, anomalous, and highly suspect billing activity on Shared Savings Program financial calculations involving calendar year 2023.
- 42 CFR 425.672 · Adjustments to mitigate the impact of significant, anomalous, and highly suspect billing activity on Shared Savings Program financial calculations involving calendar year 2024 or subsequent calendar years.
- 42 CFR 425.674 · Accounting for the impact of improper payments on Shared Savings Program financial calculations.
- 42 CFR 425.700 · General rules.
- 42 CFR 425.702 · Aggregate reports.
- 42 CFR 425.704 · Beneficiary-identifiable claims data.
- 42 CFR 425.706 · Minimum necessary data.
- 42 CFR 425.708 · Beneficiaries may decline claims data sharing.
- 42 CFR 425.710 · Data use agreement.
- 42 CFR 425.800 · Preclusion of administrative and judicial review.
- 42 CFR 425.802 · Request for review.
- 42 CFR 425.804 · Reconsideration review process.
- 42 CFR 425.806 · On-the-record review of reconsideration official's recommendation by independent CMS official.
- 42 CFR 425.808 · Effect of independent CMS official's decision.
- 42 CFR 425.810 · Effective date of decision.
- 42 CFR 426.100 · Basis and scope.
- 42 CFR 426.110 · Definitions.
- 42 CFR 426.120 · Calculation of deadlines.
- 42 CFR 426.130 · Party submissions.
- 42 CFR 426.300 · Review of LCDs, NCDs, and deemed NCDs.
- 42 CFR 426.310 · LCD and NCD reviews and individual claim appeals.
- 42 CFR 426.320 · Who may challenge an LCD or NCD.
- 42 CFR 426.325 · What may be challenged.
- 42 CFR 426.330 · Burden of proof.
- 42 CFR 426.340 · Procedures for review of new evidence.
- 42 CFR 426.400 · Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD.
- 42 CFR 426.403 · Submitting new evidence once an acceptable complaint is filed.
- 42 CFR 426.405 · Authority of the ALJ.
- 42 CFR 426.406 · Ex parte contacts.
- 42 CFR 426.410 · Docketing and evaluating the acceptability of LCD complaints.
- 42 CFR 426.415 · CMS' role in the LCD review.
- 42 CFR 426.416 · Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.
- 42 CFR 426.417 · Contractor's statement regarding new evidence.
- 42 CFR 426.418 · LCD record furnished to aggrieved party.
- 42 CFR 426.419 · LCD record furnished to the ALJ.
- 42 CFR 426.420 · Retiring or revising an LCD under review.
- 42 CFR 426.423 · Withdrawing a complaint regarding an LCD under review.
- 42 CFR 426.425 · LCD review.
- 42 CFR 426.431 · ALJ's review of the LCD to apply the reasonableness standard.
- 42 CFR 426.432 · Discovery.
- 42 CFR 426.435 · Subpoenas.
- 42 CFR 426.440 · Evidence.
- 42 CFR 426.444 · Dismissals for cause.
- 42 CFR 426.445 · Witness fees.
- 42 CFR 426.446 · Record of hearing.
- 42 CFR 426.447 · Issuance and notification of an ALJ's decision.
- 42 CFR 426.450 · Mandatory provisions of an ALJ's decision.
- 42 CFR 426.455 · Prohibited provisions of an ALJ's decision.
- 42 CFR 426.457 · Optional provisions of an ALJ's decision.
- 42 CFR 426.458 · ALJ's LCD review record.
- 42 CFR 426.460 · Effect of an ALJ's decision.
- 42 CFR 426.462 · Notice of an ALJ's decision.
- 42 CFR 426.463 · Future new or revised LCDs.
- 42 CFR 426.465 · Appealing part or all of an ALJ's decision.
- 42 CFR 426.468 · Decision to not appeal an ALJ's decision.
- 42 CFR 426.470 · Board's role in docketing and evaluating the acceptability of appeals of ALJ decisions.
- 42 CFR 426.476 · Board review of an ALJ's decision.
- 42 CFR 426.478 · Retiring or revising an LCD during the Board's review of an ALJ's decision.
- 42 CFR 426.480 · Withdrawing an appeal of an ALJ's decision.
- 42 CFR 426.482 · Issuance and notification of a Board decision.
- 42 CFR 426.484 · Mandatory provisions of a Board decision.
- 42 CFR 426.486 · Prohibited provisions of a Board decision.
- 42 CFR 426.487 · Board's record on appeal of an ALJ's decision.
- 42 CFR 426.488 · Effect of a Board decision.
- 42 CFR 426.489 · Board remands.
- 42 CFR 426.490 · Board decision.
- 42 CFR 426.500 · Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD.
- 42 CFR 426.503 · Submitting new evidence once an acceptable complaint has been filed.
- 42 CFR 426.505 · Authority of the Board.
- 42 CFR 426.506 · Ex parte contacts.