1. (a) Basis. This subpart implements section 1848(p) of the Act by establishing a payment modifier that provides for differential payment starting in 2015 to a group of physicians and starting in 2017 to a group and a solo practitioner under the Medicare Physician Fee Schedule based on the quality of care furnished compared to cost during a performance period.

2. (b) Scope. This subpart sets forth the following:

   1. (1) The application of the value-based payment modifier.
   2. (2) Performance and payment adjustment periods.
   3. (3) Reporting mechanisms for the value-based payment modifier.
   4. (4) Alignment of PQRS quality of care measures with the quality measures for the value-based payment modifier.
   5. (5) Additional measures for groups and solo practitioners.
   6. (6) Cost measures.
   7. (7) Attribution for quality of care and cost measures.
   8. (8) Scoring methods for the value-based payment modifier.
   9. (9) Benchmarks for quality of care measures.
   10. (10) Benchmarks for cost measures.
   11. (11) Composite scores.
   12. (12) Reliability of measures.
   13. (13) Payment adjustments.
   14. (14) Value-based payment modifier quality-tiering scoring methodology.
   15. (15) Limitation of review.
   16. (16) Inquiry process.

[77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68005, Nov. 13, 2014]