feat(qpp): PY2027 registry + CMS-1848-P proposed changes (refs #613)

src/qpp/__init__.py

@@ -98,6 +98,89 @@ statement of the Medicare-option figure.  Rather than reuse that
 number under a different provision's field, ``benchmark_nominal_pct``
 is left ``None`` on every entry, with the gap documented in
 ``RiskStandards.notes``.
+
+CMS-1848-P (CY2027 PFS proposed rule) — QPP[2027]
+----------------------------------------------------
+
+CMS-1848-P (91 FR 43842, published July 16, 2026, transcribed from
+``data/fr_downloads/2026-14327.txt``) is captured on ``QPP[2027]``
+(QP Performance Period 2027, payment year 2029). Ingested into Zotero
+as :pincite:`5ITGVDJV`. No Final Rule (CMS-1848-F) had been published
+as of this transcription, so ``QPP[2027].proposed.changes`` states
+proposals only, with no finalized-disposition information available.
+
+QPP[2027] current-law thresholds are transcribed from two sources that
+agree: the RIA recital "The thresholds to achieve QP status in the
+2027 QP Performance Period (2029 payment year) are set to 75 percent
+for the payment amount, and 50 percent for the patient count." (91 FR
+44260, line 40311-40313), and the amendatory regulatory text at 42 CFR
+414.1430(a)(1)(v)/(a)(3)(v) "2029 and thereafter: 75 percent" /
+"50 percent" (91 FR 44285-44286, line 42551/42569) — the same
+amendatory text at (a)(2)(v)/(a)(4)(v) gives the Partial QP thresholds
+"2029 and thereafter: 50 percent" / "35 percent" (91 FR 44286, line
+42559/42576). No amendment to 42 CFR 414.1415 (nominal amount
+standard / CEHRT) or 414.1420 (Other Payer Advanced APM standard) is
+proposed in this NPRM — the amendatory-text item list runs "44. Sec.
+414.1400 ... 45. Sec. 414.1425 ..." (line 42368, 42504), skipping both
+sections — so ``risk_standards`` and ``cehrt_required`` are carried
+forward unchanged, corroborated indirectly by this NPRM's own
+statement that the Shared Savings Program ENHANCED track Level E loss
+recoupment limit — independently stated as "shall not exceed 8
+percent of total Medicare Parts A and B FFS revenue" (91 FR 44069,
+line 23890-23891) — equals "the revenue-based nominal amount standard
+under the Quality Payment Program (QPP) (42 CFR 414.1415(c)(3)(i)(A))"
+(line 23894-23896), consistent with the existing 8% figure.
+``qp_cf_applies`` is True: "eligible clinicians who are QPs for the
+2024 performance year/2026 payment year and beyond will receive an
+increased physician fee schedule update of 0.75 percent qualifying
+APM conversion factor" (91 FR 44217, line 30603-30606) confirms the
+split-CF policy is not time-limited and persists through payment year
+2029. ``apm_incentive_pct`` is None: the amendatory text at 42 CFR
+414.1450(b)(1) (91 FR 44286, line 42629-42632) lists applicable
+percentages only for payment years 2019-2024, 2025, 2026, and 2028 —
+no entry for payment year 2027 or 2029 — so under current law as
+restated by this NPRM, no lump-sum APM Incentive Payment is payable
+for payment year 2029 (the sunset already captured on QPP[2025]/
+QPP[2026] has a gap, not a clean cutoff — see next section).
+
+CMS-1848-P's substantive Advanced-APM-relevant proposals (see
+``QPP[2027].proposed.changes`` for full sourcing) are: (1) applying QP
+(and, by conforming amendment, Partial QP) status strictly at the
+TIN/NPI level rather than to the clinician across all TIN
+reassignments, beginning with the 2027 QP Performance Period (91 FR
+44215-44217, 44285); (2) a clerical fix to 42 CFR 414.1425(c)(5)(ii)
+removing an erroneously-included clause; (3) a clarification for APMs
+without a Participation List; (4) a restructuring/condensing of 42
+CFR 414.1430(a)/(b) to conform the regulation text to already-enacted
+statutory threshold levels (not a new CMS-set threshold change); and
+(5) codifying the CAA 2026's 3.1% APM Incentive Payment extension for
+payment year 2028 and restructuring 414.1450(b)(1) into a per-year
+list.
+
+**Concern — PY2026 (QPP[2026], payment year 2028) restatement
+discrepancy, NOT corrected here:** this NPRM's own amendatory text for
+42 CFR 414.1430(a)/(b) (91 FR 44285-44286) states, for payment year
+2028: QP payment amount threshold 50% (a)(1)(iv), QP patient count
+threshold 35% (a)(3)(iv), Partial QP payment amount threshold 40%
+(a)(2)(iv), Partial QP patient count threshold 25% (a)(4)(iv) — and
+for payment years 2021 through 2026 (covering QPP[2023]'s payment
+year 2025 and QPP[2024]'s payment year 2026): QP payment amount
+threshold 50% (a)(1)(ii), QP patient count threshold 35% (a)(3)(ii).
+These figures directly **contradict** the values currently coded on
+``QPP[2023]``, ``QPP[2024]``, and ``QPP[2026]`` (75%/50% QP,
+50%/35% Partial QP, uniformly), which were sourced from the CY2026
+Final Rule quote in this module's docstring ("The thresholds to
+achieve QP status in the 2026 QP Performance Period (2028 payment
+year) are set to 75 percent for the payment amount, and 50 percent
+for the patient count.", 90 FR 49980). This NPRM's amendatory text
+also directly states, for payment year 2028, an APM Incentive Payment
+of 3.1% (42 CFR 414.1450(b)(1)(iv), 91 FR 44286) — contradicting
+``QPP[2026].apm_incentive_pct = None``. Per task scope, these PY2023/
+PY2024/PY2026 values are **not modified** by this transcription; see
+task-7-report.md for the full cross-check and a recommendation that a
+follow-up task re-verify ``QPP[2023]``, ``QPP[2024]``, and
+``QPP[2026]`` directly against 42 CFR 414.1430/414.1450 (eCFR) rather
+than the FR-corpus narrative quotes.
 """
 
 from __future__ import annotations
@@ -432,6 +515,109 @@ QPP: dict[int, QppYear] = {
             ),
         ),
     ),
+    2027: QppYear(
+        # QP Performance Period 2027 / payment year 2029. Current-law
+        # thresholds transcribed from data/fr_downloads/2026-14327.txt
+        # (91 FR 43842, CMS-1848-P) -- see module docstring "CMS-1848-P
+        # (CY2027 PFS proposed rule) - QPP[2027]" for full sourcing:
+        #   - RIA recital, 91 FR 44260 (line 40311-40313): "The
+        #     thresholds to achieve QP status in the 2027 QP
+        #     Performance Period (2029 payment year) are set to 75
+        #     percent for the payment amount, and 50 percent for the
+        #     patient count."
+        #   - Amendatory text, 42 CFR 414.1430(a)(1)(v)/(a)(3)(v), 91 FR
+        #     44285-44286 (line 42551, 42569): "2029 and thereafter: 75
+        #     percent" / "50 percent" (QP); (a)(2)(v)/(a)(4)(v), 91 FR
+        #     44286 (line 42559, 42576): "2029 and thereafter: 50
+        #     percent" / "35 percent" (Partial QP).
+        # Risk standards / CEHRT: no amendment to 42 CFR 414.1415 or
+        # 414.1420 in this NPRM (amendatory-text item list skips both,
+        # 91 FR 44284-44285) -- carried forward unchanged; see
+        # module docstring for the indirect Shared Savings Program
+        # Level E cross-check (91 FR 44069).
+        # apm_incentive_pct: no payment-year-2029 entry in the
+        # amendatory text at 42 CFR 414.1450(b)(1), 91 FR 44286 (line
+        # 42629-42632) -- no APM Incentive Payment for this payment
+        # year under current law as restated by this NPRM.
+        # qp_cf_applies: "eligible clinicians who are QPs for the 2024
+        # performance year/2026 payment year and beyond will receive an
+        # increased physician fee schedule update of 0.75 percent
+        # qualifying APM conversion factor" (91 FR 44217, line
+        # 30603-30606) -- split CF persists through payment year 2029.
+        performance_year=2027,
+        payment_year=2029,
+        qp_thresholds=_qp_thresholds(),
+        partial_qp_thresholds=_partial_qp_thresholds(),
+        risk_standards=_risk_standards(),
+        apm_incentive_pct=None,
+        qp_cf_applies=True,
+        citation="91 FR 44260, 44285-44286",
+        # NPRM proposals per :pincite:`5ITGVDJV` -- CMS-1848-P, 91 FR
+        # 43842, transcribed from data/fr_downloads/2026-14327.txt. No
+        # Final Rule (CMS-1848-F) published as of this transcription --
+        # proposals only, no finalized disposition available.
+        proposed=QppProposed(
+            cms_rule_id="CMS-1848-P",
+            federal_register_citation="91 FR 43842",
+            changes=(
+                "TIN/NPI-level QP and Partial QP status determination: "
+                "proposed to apply QP status (and, via a conforming "
+                "amendment, Partial QP status) strictly to the "
+                "eligible clinician as a TIN/NPI combination, rather "
+                "than to the clinician (NPI) across all of their TIN "
+                "reassignments as under current policy, beginning with "
+                "the 2027 QP Performance Period (NPRM 91 FR "
+                "44215-44217, section 'Advanced APMs' > 'QP "
+                "Determination' > '(2) Applying QP Determinations at "
+                "the TIN/NPI Level'; amendatory text adding Sec. "
+                "414.1425(c)(8) and (d)(5), 91 FR 44285). "
+                "APM Entity Termination clerical fix: proposed to "
+                "remove an erroneously-included clause ('even if such "
+                "termination date occurs within such QP Performance "
+                "Period') from 42 CFR 414.1425(c)(5)(ii), correcting a "
+                "CY2020-PFS-final-rule clerical error that misaligned "
+                "the QP-status termination text from its Partial-QP "
+                "counterpart at 414.1425(d)(3)(ii) (NPRM 91 FR "
+                "44217-44218). "
+                "Participation List clarification: proposed to clarify "
+                "that APMs without a Participation List are not "
+                "thereby excluded from QP determinations or MIPS APM "
+                "scoring, addressing an interpretive gap for future "
+                "episode-based/mandatory APM designs (NPRM 91 FR "
+                "44218). "
+                "QP/Partial QP threshold regulatory-text conformance: "
+                "proposed to restructure and condense 42 CFR "
+                "414.1430(a)/(b) into a consolidated payment-year "
+                "schedule, conforming the regulation text to "
+                "already-enacted statutory changes (CAA 2024's "
+                "extension of payment-year-2025 thresholds through "
+                "payment year 2026, and subsequently legislated "
+                "payment-year 2027/2028/2029+ levels) rather than "
+                "proposing new CMS-set thresholds (NPRM 91 FR "
+                "44219-44220; amendatory text 91 FR 44285-44286). See "
+                "QPP[2027].qp_thresholds/partial_qp_thresholds for the "
+                "values as restated for payment year 2029. "
+                "APM Incentive Payment: proposed to codify the "
+                "Consolidated Appropriations Act, 2026's extension of "
+                "a 3.1 percent lump-sum APM Incentive Payment to "
+                "payment year 2028 (2026 QP Performance Period), and "
+                "to restructure 42 CFR 414.1450(b)(1) into a per-year "
+                "subparagraph list for readability, with no "
+                "substantive change to any other year's percentage "
+                "(NPRM 91 FR 44218-44219; RIA 91 FR 44260; amendatory "
+                "text 91 FR 44286). CONCERN: this amendatory text lists "
+                "no applicable percentage for payment years 2027 or "
+                "2029 (i.e., no incentive payment in those years) and "
+                "3.1 percent for payment year 2028 -- the latter "
+                "directly bears on QPP[2026].apm_incentive_pct "
+                "(payment year 2028), which is currently coded as "
+                "None; this transcription task is scoped not to "
+                "silently correct that entry -- see module docstring "
+                "'Concern - PY2026 ... restatement discrepancy' and "
+                "task-7-report.md."
+            ),
+        ),
+    ),
 }
 
 

tests/qpp/test_rules.py

@@ -3,12 +3,13 @@
 Covers src/qpp/__init__.py:
 - QpThresholds / RiskStandards / QppProposed model construction
 - QppYear model construction with required and default fields
-- QPP dict: performance years 2023-2026, payment_year = performance_year + 2
+- QPP dict: performance years 2023-2027, payment_year = performance_year + 2
 - qp_cf_applies: False before performance year 2024, True from 2024 onward
 - Every entry has a non-empty citation
-- QPP[2026].proposed is CMS-1832-P
+- QPP[2026].proposed is CMS-1832-P; QPP[2027].proposed is CMS-1848-P
 - for_payment_year(year) lookup, including KeyError on miss
-- Exact-value asserts for transcribed thresholds (see task-6-report.md)
+- Exact-value asserts for transcribed thresholds (see task-6-report.md,
+  task-7-report.md)
 """
 
 from __future__ import annotations
@@ -110,10 +111,10 @@ class TestQppYear:
 
 
 class TestQppDict:
-    EXPECTED_YEARS = [2023, 2024, 2025, 2026]
+    EXPECTED_YEARS = [2023, 2024, 2025, 2026, 2027]
 
     def test_count(self):
-        assert len(QPP) == 4
+        assert len(QPP) == 5
 
     def test_keys(self):
         assert sorted(QPP.keys()) == self.EXPECTED_YEARS
@@ -150,6 +151,9 @@ class TestQpCfApplies:
     def test_2026_true(self):
         assert QPP[2026].qp_cf_applies is True
 
+    def test_2027_true(self):
+        assert QPP[2027].qp_cf_applies is True
+
 
 class TestApmIncentivePct:
     """Lump-sum APM Incentive Payment sunsets after payment year 2026."""
@@ -166,6 +170,13 @@ class TestApmIncentivePct:
     def test_2026_no_incentive(self):
         assert QPP[2026].apm_incentive_pct is None
 
+    def test_2027_no_incentive(self):
+        # Payment year 2029: 42 CFR 414.1450(b)(1) (as amended by
+        # CMS-1848-P, 91 FR 44286) lists applicable percentages only
+        # for payment years 2019-2024, 2025, 2026, and 2028 — no entry
+        # for 2029.
+        assert QPP[2027].apm_incentive_pct is None
+
 
 # ── QPP[2026].proposed — CMS-1832-P ──────────────────────────────
 
@@ -186,25 +197,53 @@ class TestProposed:
         assert QPP[2025].proposed is None
 
 
+# ── QPP[2027].proposed — CMS-1848-P ──────────────────────────────
+
+
+class TestProposed2027:
+    def test_2027_has_proposed(self):
+        p = QPP[2027].proposed
+        assert p is not None
+        assert p.cms_rule_id == "CMS-1848-P"
+        assert p.federal_register_citation == "91 FR 43842"
+
+    def test_2027_changes_non_empty(self):
+        assert len(QPP[2027].proposed.changes) > 0
+
+    def test_2027_no_numeric_change_blocks(self):
+        # CMS-1848-P's threshold/incentive amendments conform the
+        # regulation text to already-enacted statutory levels rather
+        # than proposing new CMS-set numeric values — see
+        # QppProposed.qp_thresholds docstring.
+        p = QPP[2027].proposed
+        assert p.qp_thresholds is None
+        assert p.partial_qp_thresholds is None
+        assert p.risk_standards is None
+
+
 # ── Exact transcribed threshold values ───────────────────────────
 
 
 class TestSpecificValues:
     """Verify transcribed QP/Partial QP thresholds and risk standards.
 
-    See task-6-report.md transcription table for sourcing per value."""
+    See task-6-report.md / task-7-report.md transcription tables for
+    sourcing per value. QPP[2027] (payment year 2029) values are
+    sourced from CMS-1848-P (91 FR 44260, 44285-44286) rather than the
+    CY2026-cycle documents underlying 2023-2026 — see module
+    docstring "CMS-1848-P (CY2027 PFS proposed rule) — QPP[2027]"."""
 
-    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026])
+    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026, 2027])
     def test_qp_thresholds(self, year):
         assert QPP[year].qp_thresholds.payment_amount_pct == 75.0
         assert QPP[year].qp_thresholds.patient_count_pct == 50.0
 
-    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026])
+    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026, 2027])
     def test_partial_qp_thresholds(self, year):
         assert QPP[year].partial_qp_thresholds.payment_amount_pct == 50.0
         assert QPP[year].partial_qp_thresholds.patient_count_pct == 35.0
 
-    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026])
+    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026, 2027])
     def test_risk_standards(self, year):
         # Revenue-based standard (42 CFR 414.1415(c)(3)(i)(A)) is
         # transcribed (8%); the benchmark-based standard (42 CFR
@@ -214,7 +253,7 @@ class TestSpecificValues:
         assert QPP[year].risk_standards.revenue_nominal_pct == 8.0
         assert QPP[year].risk_standards.benchmark_nominal_pct is None
 
-    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026])
+    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026, 2027])
     def test_cehrt_required(self, year):
         assert QPP[year].cehrt_required is True
 
@@ -235,6 +274,9 @@ class TestForPaymentYear:
     def test_2028_maps_to_performance_2026(self):
         assert for_payment_year(2028) is QPP[2026]
 
+    def test_2029_maps_to_performance_2027(self):
+        assert for_payment_year(2029) is QPP[2027]
+
     def test_unknown_payment_year_raises_keyerror(self):
         with pytest.raises(KeyError):
             for_payment_year(1999)