Subpart E. Subpart E—Transforming Episode Accountability Model (TEAM)

• General

  • SECTION § 512.500 - Basis and scope of subpart.
  • SECTION § 512.505 - Definitions.

• TEAM Participation

  • SECTION § 512.510 - Voluntary opt-in participation.
  • SECTION § 512.515 - Geographic areas.
  • SECTION § 512.520 - Participation tracks.
  • SECTION § 512.522 - APM options.

• Scope of Episodes Being Tested

  • SECTION § 512.525 - Episodes.
  • SECTION § 512.535 - Beneficiary inclusion criteria.
  • SECTION § 512.537 - Determination of the episode.

• Pricing Methodology

  • SECTION § 512.540 - Determination of preliminary target prices.
  • SECTION § 512.545 - Determination of reconciliation target prices.

• Quality Measures and Composite Quality Score

  • SECTION § 512.547 - Quality measures, composite quality score, and display of quality measures.

• Reconciliation and Review Process

  • SECTION § 512.550 - Reconciliation process and determination of the reconciliation payment or repayment amount.
  • SECTION § 512.552 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.
  • SECTION § 512.555 - Proration of payments for services that extend beyond an episode.
  • SECTION § 512.560 - Appeals process.
  • SECTION § 512.561 - Reconsideration review processes.

• Data Sharing and Other Requirements

  • SECTION § 512.562 - Data sharing with TEAM participants.
  • SECTION § 512.563 - Health equity reporting.
  • SECTION § 512.564 - Referral to primary care services.

• Financial Arrangements and Beneficiary Incentives

  • SECTION § 512.565 - Sharing arrangements.
  • SECTION § 512.568 - Distribution arrangements.
  • SECTION § 512.570 - Downstream distribution arrangements.
  • SECTION § 512.575 - TEAM beneficiary incentives.
  • SECTION § 512.576 - Application of the CMS-sponsored model arrangements and patient incentives safe harbor.

• Medicare Program Waivers

  • SECTION § 512.580 - TEAM Medicare Program Waivers

• General Provisions

  • SECTION § 512.582 - Beneficiary protections.
  • SECTION § 512.584 - Cooperation in model evaluation and monitoring.
  • SECTION § 512.586 - Audits and record retention.
  • SECTION § 512.588 - Rights in data and intellectual property.
  • SECTION § 512.590 - Monitoring and compliance.
  • SECTION § 512.592 - Remedial action.
  • SECTION § 512.594 - Limitations on review.
  • SECTION § 512.595 - Bankruptcy and other notifications.
  • SECTION § 512.596 - Termination of TEAM or TEAM participant from model by CMS.
  • SECTION § 512.598 - Decarbonization and resilience initiative.