42 C.F.R. § 414.1430

Current through September 30, 2024
Section 414.1430 - Qualifying APM participant determination: QP and partial QP thresholds
(a)Medicare Option -
(1)QP payment amount threshold. The QP payment amount thresholds are the following values for the indicated payment years:
(i) 2019 and 2020: 25 percent.
(ii) 2021 and 2022: 50 percent.
(iii) 2023 and 2024: 50 percent.
(iv) 2025: 50 percent.
(v) 2026 and later: 75 percent.
(2)Partial QP payment amount threshold. The Partial QP payment amount thresholds are the following values for the indicated payment years:
(i) 2019 and 2020: 20 percent.
(ii) 2021 and 2022: 40 percent.
(iii) 2023 and 2024: 40 percent.
(iv) 2025: 40 percent.
(v) 2026 and later: 50 percent.
(3)QP patient count threshold. The QP patient count thresholds are the following values for the indicated payment years:
(i) 2019 and 2020: 20 percent
(ii) 2021 and 2022: 35 percent
(iii) 2023 and 2024: 35 percent.
(iv) 2025: 35 percent.
(v) 2026 and later: 50 percent.
(4)Partial QP patient count threshold. The Partial QP patient count thresholds are the following values for the indicated payment years:
(i) 2019 and 2020: 10 percent
(ii) 2021 and 2022: 25 percent
(iii) 2023 and 2024: 25 percent.
(iv) 2025: 25 percent.
(v) 2026 and later: 35 percent.
(b)All-Payer Combination Option -
(1)QP payment amount threshold.
(i) The QP payment amount thresholds are the following values for the indicated payment years:
(A) 2021 through 2025: 50 percent.
(B) 2026 and later: 75 percent.
(ii) To meet the QP payment amount threshold under this option, the eligible clinician must also meet a 25 percent QP payment amount threshold under the Medicare Option.
(2)Partial QP payment amount threshold.
(i) The Partial QP payment amount thresholds are the following values for the indicated payment years:
(A) 2021 through 2025:40 percent.
(B) 2026 and later: 50 percent.
(ii) To meet the QP payment amount threshold under this option, the eligible clinician must also meet a 20 percent Partial QP payment amount threshold under the Medicare Option.
(3)QP patient count threshold.
(i) The QP patient count thresholds are the following values for the indicated payment years:
(A) 2021 through 2025: 35 percent.
(B) 2026 and later: 50 percent.
(ii) To meet the QP patient count threshold under this option, the eligible clinician must also meet a 20 percent QP patient count threshold under the Medicare Option.
(4)Partial QP patient count threshold.
(i) The Partial QP patient count thresholds are the following values for the indicated payment years:
(A) 2021 through 2025: 25 percent.
(B) 2026 and later: 35 percent.
(ii) To meet the Partial QP patient count threshold under this option, the eligible clinician group or eligible clinician must also meet a 10 percent QP patient count threshold under the Medicare Option.

42 C.F.R. §414.1430

81 FR 77537, Nov. 4, 2016, as amended at 86 FR 65681, Nov. 19, 2021; 87 FR 70230, Nov. 18, 2022; 88 FR 79539, Nov. 16, 2023
81 FR 77537, 1/1/2017; 86 FR 65524, 1/1/2022; 87 FR 70230, 1/1/2023; 88 FR 79539, 1/1/2024