42 CFR 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.