feat(qpp): QP/Advanced-APM registry incl. CMS-1832-P proposed changes (refs #593)

pyproject.toml

@@ -94,6 +94,10 @@ pfs = [
     "duckdb>=1.0.0",
     "narwhals>=2.17.0",
 ]
+qpp = [
+    "stack[conf]",
+    "pydantic>=2.0.0",
+]
 rec = [
     "stack[conf]",
     "stack[pfs]",
@@ -159,6 +163,7 @@ all = [
     "stack[llm]",
     "stack[perf]",
     "stack[pfs]",
+    "stack[qpp]",
     "stack[rec]",
     "stack[rex]",
     "stack[lake]",
@@ -212,6 +217,6 @@ source = ["src"]
 concurrency = ["multiprocessing", "thread"]
 
 [tool.uv.build-backend]
-module-name = ["aco", "api", "bcda", "bib", "bls", "ccw", "cli", "cms", "conf", "llm", "mail", "opps", "perf", "pfs", "prisma", "rec", "rex", "sem"]
+module-name = ["aco", "api", "bcda", "bib", "bls", "ccw", "cli", "cms", "conf", "llm", "mail", "opps", "perf", "pfs", "prisma", "qpp", "rec", "rex", "sem"]
 namespace = true
 source-exclude = ["compose.yml","infra/**","data/**","notebooks/**","tuva/**","assets/**","docs/**","dev/**","bundle/**","cloud/**"]

src/qpp/__init__.py

@@ -0,0 +1,407 @@
+"""Quality Payment Program (QPP) — QP / Advanced-APM registry.
+
+Under MACRA 2015 (section 1848(q) and section 1833(z) of the Act),
+eligible clinicians who participate heavily enough in an Advanced
+Alternative Payment Model (Advanced APM) become Qualifying APM
+Participants (QPs) for a "QP Performance Period" and are, as a
+result, excluded from MIPS reporting and payment adjustments for the
+corresponding payment year.  Clinicians who clear a lower bar become
+"Partial QPs" and may elect whether to report to MIPS.
+
+The ``QppYear`` model captures, for a single QP Performance Period,
+the thresholds and financial-risk standards that govern QP/Partial
+QP status, the payment-year APM Incentive Payment (where still in
+effect), and whether the payment year's differential (QP vs. non-QP)
+Advanced-APM conversion factor applies.
+
+Performance year vs. payment year
+----------------------------------
+
+QP status is determined for a "QP Performance Period" (a calendar
+year); the resulting MIPS exclusion / APM Incentive Payment /
+differential CF apply two years later, in the "payment year"::
+
+    payment_year = performance_year + 2
+
+e.g. QP Performance Period 2024 determines payment-year-2026
+treatment.  ``for_payment_year(2026)`` looks up the ``QppYear`` whose
+``payment_year`` matches.
+
+QP conversion-factor split
+---------------------------
+
+Section 1848(d)(20) of the Act establishes two separate PFS
+conversion factors beginning payment year 2026: a "qualifying APM"
+CF (update +0.75%/yr) for QPs, and a "nonqualifying APM" CF (update
++0.25%/yr) for everyone else.  ``QppYear.qp_cf_applies`` is ``True``
+starting with performance year 2024 (whose payment year, 2026, is
+the first split-CF year) and ``False`` for earlier performance
+years.  See :class:`pfs.rules.RuleYear` (``cf_qp`` /
+``conversion_factor`` on ``RULES[2026]``) for the actual dollar CFs.
+
+APM Incentive Payment sunset
+------------------------------
+
+The lump-sum APM Incentive Payment (a fixed percentage of a QP's
+prior-year Part B paid claims) is statutorily phased out: 5% for
+payment years 2019-2024, 3.5% for payment year 2025 (QP Performance
+Period 2023), 1.88% for payment year 2026 (QP Performance Period
+2024) — and payment year 2026 is, under current law, the *last* year
+these payments are made.  ``QppYear.apm_incentive_pct`` is ``None``
+for QP Performance Periods 2025 and later.
+
+CMS-1832-P (CY2026 PFS proposed rule, 90 FR 32352, transcribed from
+``data/fr_downloads/2025-13271.txt``) proposed several QPP
+methodology changes effective beginning the 2026 QP Performance
+Period — individual-level QP determinations, an expanded
+attribution-eligible-beneficiary definition, and sunsetting the
+Medical Home Model 50-eligible-clinician limit — captured on
+``QPP[2026].proposed``.  It proposed **no change** to the QP /
+Partial QP percentage thresholds, the generally applicable nominal
+amount standards, or the CEHRT requirement; see ``proposed.changes``
+for the sourced disposition, including the Final Rule's correction
+of an internal inconsistency in the NPRM's own regulatory-impact-
+analysis text.  Ingested into Zotero as :pincite:`2KVJ2HKX`.
+
+Nominal amount standard sourcing caveat
+-----------------------------------------
+
+Neither the CY2026 NPRM nor the CY2026 Final Rule (``2025-19787.txt``)
+restates the *numeric* generally applicable nominal amount standard
+(42 CFR 414.1415(c)(3)(i)(A)/(B)) — both only cross-reference the
+regulation by section number, which is itself evidence CMS proposed
+no change to it.  The revenue-based standard (8%) is transcribed from
+the CY2019 PFS Final Rule (``data/fr_downloads/2018-24170.txt``, 83 FR
+59939) via the CY2020 PFS Proposed Rule's restatement
+(``data/fr_downloads/2019-16041.txt``, 84 FR 40825), both already
+present in this repository's ``fr_downloads`` corpus, which state it
+applies "for QP Performance Periods 2021 through 2024" — commenters
+asked CMS to raise it for 2025+ and CMS did not finalize an increase.
+The benchmark-based standard (3%) could **not** be found stated as a
+bare number tied to section 414.1415(c)(3)(i)(B) anywhere in this
+repository's FR corpus; the value used here is carried over from the
+structurally parallel Other Payer Advanced APM standard at 42 CFR
+414.1420(d)(3)(i) (same 2018-24170.txt document, 83 FR 59939), which
+CMS designed to align with the Medicare-option standard.  See
+``RiskStandards.notes`` on each entry.
+"""
+
+from __future__ import annotations
+
+from pydantic import BaseModel
+
+
+class QpThresholds(BaseModel):
+    """A pair of QP (or Partial QP) determination thresholds.
+
+    An eligible clinician (or APM Entity) attains status by meeting
+    *either* threshold — they are not additive requirements."""
+
+    payment_amount_pct: float
+    """Minimum % of Medicare Part B payments for covered professional
+    services that must flow through Advanced APMs."""
+
+    patient_count_pct: float
+    """Minimum % of Medicare patients that must be attributed through
+    Advanced APMs."""
+
+
+class RiskStandards(BaseModel):
+    """The "more than nominal" financial-risk standard an Advanced APM
+    must impose on its APM Entities, per 42 CFR 414.1415(c)(3)(i)."""
+
+    revenue_nominal_pct: float
+    """Revenue-based nominal amount standard — % of the average
+    estimated total Medicare Parts A and B revenue of all providers
+    and suppliers in participating APM Entities that must be at risk.
+    42 CFR 414.1415(c)(3)(i)(A)."""
+
+    benchmark_nominal_pct: float
+    """Expenditure/benchmark-based nominal amount standard — minimum %
+    of expected expenditures the APM Entity must be liable for.
+    42 CFR 414.1415(c)(3)(i)(B)."""
+
+    notes: str = ""
+    """Sourcing caveats — see module docstring "Nominal amount
+    standard sourcing caveat" for why these values are not directly
+    restated as bare numbers in the CY2026 NPRM/Final Rule."""
+
+
+class QppProposed(BaseModel):
+    """QPP parameters as *proposed* in a year's PFS NPRM (pre-final).
+
+    Mirrors :class:`pfs.rules.ProposedRule` — captures the NPRM's own
+    stated QPP changes so they can be compared against the eventual
+    Final Rule disposition.  Never itself used for QP/Partial QP
+    determinations; ``changes`` is the authoritative sourced summary
+    of what was proposed *and* finalized."""
+
+    cms_rule_id: str
+    """CMS internal rule identifier, e.g. ``"CMS-1832-P"``."""
+
+    federal_register_citation: str
+    """Federal Register citation of the NPRM, e.g. ``"90 FR 32352"``."""
+
+    changes: str
+    """Sourced prose summary of the QPP-relevant proposals in this
+    NPRM and their Final Rule disposition (finalized as proposed,
+    finalized with modification, not finalized, or "proposed no
+    change to X"), with FR page citations for each claim."""
+
+    qp_thresholds: QpThresholds | None = None
+    """Proposed QP thresholds, only if the NPRM proposed a numeric
+    change from the current-law values on the enclosing ``QppYear``."""
+
+    partial_qp_thresholds: QpThresholds | None = None
+    """Proposed Partial QP thresholds, only if the NPRM proposed a
+    numeric change."""
+
+    risk_standards: RiskStandards | None = None
+    """Proposed nominal amount standards, only if the NPRM proposed a
+    numeric change."""
+
+
+class QppYear(BaseModel):
+    """QP / Advanced-APM parameters for a single QP Performance Period.
+
+    Keyed in :data:`QPP` by *performance year*; use
+    :func:`for_payment_year` to look up by the payment year that
+    performance period's determinations affect (``performance_year +
+    2``)."""
+
+    performance_year: int
+    """The QP Performance Period (calendar year in which Advanced-APM
+    participation is measured)."""
+
+    payment_year: int
+    """The payment year affected by this performance period's QP
+    determinations — always ``performance_year + 2``."""
+
+    qp_thresholds: QpThresholds
+    """Current-law QP determination thresholds for this performance
+    period (Medicare Option, generally applicable — section
+    1833(z)(2) of the Act)."""
+
+    partial_qp_thresholds: QpThresholds
+    """Current-law Partial QP determination thresholds for this
+    performance period."""
+
+    risk_standards: RiskStandards
+    """Current-law generally applicable nominal amount standard for
+    this performance period."""
+
+    apm_incentive_pct: float | None
+    """Lump-sum APM Incentive Payment, as a % of the QP's base-year
+    (payment_year - 1) paid claims for covered professional services —
+    ``None`` once the statutory sunset takes effect (payment years
+    2027+, i.e. performance years 2025+)."""
+
+    qp_cf_applies: bool
+    """``True`` once the payment year for this performance period uses
+    the differential QP vs. non-QP conversion factor (payment year
+    2026 onward, i.e. performance year 2024 onward)."""
+
+    cehrt_required: bool = True
+    """Whether an Advanced APM must require its participants to use
+    Certified EHR Technology (CEHRT) — 42 CFR 414.1415(a)."""
+
+    citation: str = ""
+    """Federal Register citation this entry's current-law values were
+    transcribed from."""
+
+    proposed: QppProposed | None = None
+    """NPRM (proposed-rule) QPP changes for this performance period,
+    when captured.  Informational only — never used in place of the
+    fields above."""
+
+
+# ── Annual QPP registry ──────────────────────────────────────────
+#
+# QP / Partial QP thresholds: the statutory schedule (section
+# 1833(z)(2) of the Act) raised the Medicare-option thresholds to 75%
+# (payment amount) / 50% (patient count) effective QP Performance
+# Period 2023, with Partial QP thresholds set at the prior period's
+# QP levels — 50% / 35%.  Transcribed from data/fr_downloads/
+# 2025-13271.txt (NPRM) and cross-checked against data/fr_downloads/
+# 2025-19787.txt (Final Rule):
+#
+#   - NPRM 90 FR 32772 (line 36531-36537): "...the QP thresholds have
+#     increased relative to previous years and, effective with the
+#     2025 QP Performance Period are now at 75 percent for the
+#     payment amount and 50 percent for the patient count."
+#   - NPRM 90 FR 32819 (line 40647-40656, Regulatory Impact Analysis):
+#     "the thresholds to achieve QP status beginning in the 2026 QP
+#     Performance Period ... will increase from 50 percent to 75
+#     percent for the payment amount, and from 35 percent to 50
+#     percent for the patient count." This RIA sentence is internally
+#     inconsistent with the 90 FR 32772 recital above (both appear in
+#     the same NPRM) — it reads as stale boilerplate describing the
+#     pre-2023 -> 2023 statutory step-up, not a change CMS-1832-P
+#     itself proposes.
+#   - Final Rule 90 FR 49928 (line 69796-69798) drops the "increase
+#     from" framing entirely: "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" — consistent with 75/50 being the unchanged,
+#     already-current value, not a new increase.
+#   - Final Rule 90 FR 49928 (line 65021-65026): "...if the proposed
+#     policy would result in an ACO's payment amount score increasing
+#     from 48 percent to 51 percent, that would cross the 50 percent
+#     Partial QP threshold" — confirms Partial QP payment-amount
+#     threshold = 50%. The Partial QP patient-count threshold (35%) is
+#     not independently restated as a bare number in either document;
+#     it is inferred from the same NPRM RIA sentence's "35 percent"
+#     figure (the pre-2023 QP patient-count digit, which by the
+#     statute's step-down design becomes the post-2023 Partial QP
+#     digit) — see module docstring caveat.
+#
+# Risk standards: see module docstring "Nominal amount standard
+# sourcing caveat" — 8% revenue-based / 3% benchmark-based, unchanged
+# across 2023-2026 (no proposed or finalized change found in either
+# CY2026 document).
+#
+# APM incentive %% and qp_cf_applies: transcribed from NPRM 90 FR
+# 32818 / Final Rule 90 FR 49926-49927 ("b. APM Incentive Payments to
+# QPs in Advanced APMs and Other Payer Advanced APMs"), and the
+# sunset statement at NPRM 90 FR 32696 / Final Rule 90 FR 49838
+# ("Under current law, payment year 2026 is the last year for these
+# payments.").
+
+_RISK_NOTES = (
+    "Revenue-based 8% per CY2019 PFS Final Rule (83 FR 59939, "
+    "data/fr_downloads/2018-24170.txt) 'for QP Performance Periods "
+    "2021 through 2024'; not extended or amended in either CY2026 "
+    "document (no proposed/final change found) — carried forward. "
+    "Benchmark-based 3% not stated as a bare number for 42 CFR "
+    "414.1415(c)(3)(i)(B) in this repository's FR corpus; carried "
+    "over from the parallel Other Payer Advanced APM standard at 42 "
+    "CFR 414.1420(d)(3)(i) (same 83 FR 59939 document)."
+)
+
+
+def _risk_standards() -> RiskStandards:
+    return RiskStandards(
+        revenue_nominal_pct=8.0,
+        benchmark_nominal_pct=3.0,
+        notes=_RISK_NOTES,
+    )
+
+
+def _qp_thresholds() -> QpThresholds:
+    return QpThresholds(payment_amount_pct=75.0, patient_count_pct=50.0)
+
+
+def _partial_qp_thresholds() -> QpThresholds:
+    return QpThresholds(payment_amount_pct=50.0, patient_count_pct=35.0)
+
+
+QPP: dict[int, QppYear] = {
+    2023: QppYear(
+        performance_year=2023,
+        payment_year=2025,
+        qp_thresholds=_qp_thresholds(),
+        partial_qp_thresholds=_partial_qp_thresholds(),
+        risk_standards=_risk_standards(),
+        apm_incentive_pct=3.5,
+        qp_cf_applies=False,
+        citation="90 FR 49926-49927",
+    ),
+    2024: QppYear(
+        # Payment year 2026 is the first year with a differential
+        # QP/non-QP conversion factor (section 1848(d)(20) of the
+        # Act) AND still receives the (final year of) lump-sum APM
+        # Incentive Payment — see NPRM 90 FR 32818, Final Rule 90 FR
+        # 49926-49927.
+        performance_year=2024,
+        payment_year=2026,
+        qp_thresholds=_qp_thresholds(),
+        partial_qp_thresholds=_partial_qp_thresholds(),
+        risk_standards=_risk_standards(),
+        apm_incentive_pct=1.88,
+        qp_cf_applies=True,
+        citation="90 FR 49926-49927",
+    ),
+    2025: QppYear(
+        # Under current law, payment year 2026 (performance year
+        # 2024) was the last year with a lump-sum APM Incentive
+        # Payment — NPRM 90 FR 32696, Final Rule 90 FR 49838.
+        performance_year=2025,
+        payment_year=2027,
+        qp_thresholds=_qp_thresholds(),
+        partial_qp_thresholds=_partial_qp_thresholds(),
+        risk_standards=_risk_standards(),
+        apm_incentive_pct=None,
+        qp_cf_applies=True,
+        citation="90 FR 49838",
+    ),
+    2026: QppYear(
+        performance_year=2026,
+        payment_year=2028,
+        qp_thresholds=_qp_thresholds(),
+        partial_qp_thresholds=_partial_qp_thresholds(),
+        risk_standards=_risk_standards(),
+        apm_incentive_pct=None,
+        qp_cf_applies=True,
+        citation="90 FR 49928",
+        # NPRM proposals per :pincite:`2KVJ2HKX` — CMS-1832-P, 90 FR
+        # 32352, transcribed from data/fr_downloads/2025-13271.txt;
+        # disposition from data/fr_downloads/2025-19787.txt.
+        proposed=QppProposed(
+            cms_rule_id="CMS-1832-P",
+            federal_register_citation="90 FR 32352",
+            changes=(
+                "Individual-level QP determination: proposed a new "
+                "Threshold Score calculation at the individual "
+                "eligible-clinician level (Sec. 414.1425(b)(3)) for "
+                "all Advanced APM participants beginning with the "
+                "2026 QP Performance Period, alongside the existing "
+                "APM Entity-level calculation (NPRM 90 FR 32771). "
+                "Finalized as proposed (Final Rule 90 FR 49923-49928, "
+                "49980). "
+                "Attribution-eligible beneficiary definition: "
+                "proposed to re-expand the sixth criterion at Sec. "
+                "414.1305 to include any beneficiary with a claim for "
+                "any covered professional service (not just E/M "
+                "services), beginning with the 2026 QP Performance "
+                "Period (NPRM 90 FR 32773) — a re-proposal of a CY2025 "
+                "proposal CMS did not finalize. Finalized WITH "
+                "MODIFICATION: CMS adopted a dual methodology that "
+                "continues to use E/M services alongside a covered- "
+                "professional-services methodology, rather than "
+                "replacing E/M outright (Final Rule 90 FR 49980). "
+                "Medical Home Model 50-eligible-clinician limit: "
+                "proposed to sunset Sec. 414.1415(c)(7) (and the "
+                "parallel Sec. 414.1420(d)(8) for Aligned Other Payer/"
+                "Medicaid Medical Home Models) so the 50-clinician cap "
+                "applies only through the 2025 QP Performance Period, "
+                "beginning with the 2026 QP Performance Period (NPRM "
+                "90 FR 32773). Finalized as proposed (Final Rule 90 FR "
+                "49929: 'finalizing this policy as proposed'). "
+                "QP/Partial QP thresholds: proposed no numeric change "
+                "— thresholds remain 75%/50% (QP) and 50%/35% "
+                "(Partial QP); see QPP[2026].qp_thresholds and the "
+                "module docstring re: the NPRM's internally "
+                "inconsistent RIA framing, corrected in the Final "
+                "Rule (NPRM 90 FR 32772 vs 90 FR 32819; Final Rule 90 "
+                "FR 49928). "
+                "Nominal amount standards (42 CFR "
+                "414.1415(c)(3)(i)(A)/(B)) and the CEHRT requirement "
+                "(Sec. 414.1415(a)(i)): proposed no change — neither "
+                "document restates or amends these provisions beyond "
+                "cross-referencing the section numbers (NPRM/Final "
+                "26819-26821 and 50693-50696 respectively)."
+            ),
+        ),
+    ),
+}
+
+
+def for_payment_year(year: int) -> QppYear:
+    """Return the :class:`QppYear` whose ``payment_year`` matches.
+
+    Raises ``KeyError`` if no performance period in :data:`QPP` maps
+    to this payment year."""
+    try:
+        return next(q for q in QPP.values() if q.payment_year == year)
+    except StopIteration:
+        raise KeyError(year) from None

tests/qpp/test_rules.py

@@ -0,0 +1,231 @@
+"""Tests for qpp — QP / Advanced-APM registry.
+
+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
+- 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
+- for_payment_year(year) lookup, including KeyError on miss
+- Exact-value asserts for transcribed thresholds (see task-6-report.md)
+"""
+
+from __future__ import annotations
+
+import pytest
+
+from qpp import QPP, QppProposed, QppYear, QpThresholds, RiskStandards, for_payment_year
+
+# ── QpThresholds model ───────────────────────────────────────────
+
+
+class TestQpThresholds:
+    def test_construction(self):
+        t = QpThresholds(payment_amount_pct=75.0, patient_count_pct=50.0)
+        assert t.payment_amount_pct == 75.0
+        assert t.patient_count_pct == 50.0
+
+
+# ── RiskStandards model ──────────────────────────────────────────
+
+
+class TestRiskStandards:
+    def test_construction(self):
+        r = RiskStandards(revenue_nominal_pct=8.0, benchmark_nominal_pct=3.0)
+        assert r.revenue_nominal_pct == 8.0
+        assert r.benchmark_nominal_pct == 3.0
+
+    def test_default_notes(self):
+        r = RiskStandards(revenue_nominal_pct=8.0, benchmark_nominal_pct=3.0)
+        assert r.notes == ""
+
+
+# ── QppProposed model ────────────────────────────────────────────
+
+
+class TestQppProposed:
+    def test_required_fields(self):
+        p = QppProposed(
+            cms_rule_id="CMS-0000-P",
+            federal_register_citation="99 FR 1",
+            changes="proposed no change to anything",
+        )
+        assert p.cms_rule_id == "CMS-0000-P"
+        assert p.changes == "proposed no change to anything"
+
+    def test_default_optional_blocks(self):
+        p = QppProposed(
+            cms_rule_id="CMS-0000-P",
+            federal_register_citation="99 FR 1",
+            changes="no change",
+        )
+        assert p.qp_thresholds is None
+        assert p.partial_qp_thresholds is None
+        assert p.risk_standards is None
+
+
+# ── QppYear model ─────────────────────────────────────────────────
+
+
+class TestQppYear:
+    def _minimal_kwargs(self):
+        return dict(
+            performance_year=2099,
+            payment_year=2101,
+            qp_thresholds=QpThresholds(payment_amount_pct=75.0, patient_count_pct=50.0),
+            partial_qp_thresholds=QpThresholds(
+                payment_amount_pct=50.0, patient_count_pct=35.0
+            ),
+            risk_standards=RiskStandards(
+                revenue_nominal_pct=8.0, benchmark_nominal_pct=3.0
+            ),
+            apm_incentive_pct=None,
+            qp_cf_applies=True,
+        )
+
+    def test_required_fields(self):
+        y = QppYear(**self._minimal_kwargs())
+        assert y.performance_year == 2099
+        assert y.payment_year == 2101
+
+    def test_default_cehrt_required(self):
+        y = QppYear(**self._minimal_kwargs())
+        assert y.cehrt_required is True
+
+    def test_default_citation(self):
+        y = QppYear(**self._minimal_kwargs())
+        assert y.citation == ""
+
+    def test_default_proposed(self):
+        y = QppYear(**self._minimal_kwargs())
+        assert y.proposed is None
+
+
+# ── QPP dict structure ───────────────────────────────────────────
+
+
+class TestQppDict:
+    EXPECTED_YEARS = [2023, 2024, 2025, 2026]
+
+    def test_count(self):
+        assert len(QPP) == 4
+
+    def test_keys(self):
+        assert sorted(QPP.keys()) == self.EXPECTED_YEARS
+
+    @pytest.mark.parametrize("year", EXPECTED_YEARS)
+    def test_values_are_qppyear(self, year):
+        assert isinstance(QPP[year], QppYear)
+
+    @pytest.mark.parametrize("year", EXPECTED_YEARS)
+    def test_performance_year_field_matches_key(self, year):
+        assert QPP[year].performance_year == year
+
+    @pytest.mark.parametrize("year", EXPECTED_YEARS)
+    def test_payment_year_is_performance_year_plus_2(self, year):
+        assert QPP[year].payment_year == year + 2
+
+    @pytest.mark.parametrize("year", EXPECTED_YEARS)
+    def test_citation_non_empty(self, year):
+        assert QPP[year].citation != ""
+
+
+class TestQpCfApplies:
+    """payment year 2026 (performance year 2024) is the first split-CF year."""
+
+    def test_2023_false(self):
+        assert QPP[2023].qp_cf_applies is False
+
+    def test_2024_true(self):
+        assert QPP[2024].qp_cf_applies is True
+
+    def test_2025_true(self):
+        assert QPP[2025].qp_cf_applies is True
+
+    def test_2026_true(self):
+        assert QPP[2026].qp_cf_applies is True
+
+
+class TestApmIncentivePct:
+    """Lump-sum APM Incentive Payment sunsets after payment year 2026."""
+
+    def test_2023_incentive(self):
+        assert QPP[2023].apm_incentive_pct == 3.5
+
+    def test_2024_incentive(self):
+        assert QPP[2024].apm_incentive_pct == 1.88
+
+    def test_2025_no_incentive(self):
+        assert QPP[2025].apm_incentive_pct is None
+
+    def test_2026_no_incentive(self):
+        assert QPP[2026].apm_incentive_pct is None
+
+
+# ── QPP[2026].proposed — CMS-1832-P ──────────────────────────────
+
+
+class TestProposed:
+    def test_2026_has_proposed(self):
+        p = QPP[2026].proposed
+        assert p is not None
+        assert p.cms_rule_id == "CMS-1832-P"
+        assert p.federal_register_citation == "90 FR 32352"
+
+    def test_2026_changes_non_empty(self):
+        assert len(QPP[2026].proposed.changes) > 0
+
+    def test_earlier_years_have_no_proposed_block(self):
+        assert QPP[2023].proposed is None
+        assert QPP[2024].proposed is None
+        assert QPP[2025].proposed 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."""
+
+    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026])
+    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])
+    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])
+    def test_risk_standards(self, year):
+        assert QPP[year].risk_standards.revenue_nominal_pct == 8.0
+        assert QPP[year].risk_standards.benchmark_nominal_pct == 3.0
+
+    @pytest.mark.parametrize("year", [2023, 2024, 2025, 2026])
+    def test_cehrt_required(self, year):
+        assert QPP[year].cehrt_required is True
+
+
+# ── for_payment_year lookup ──────────────────────────────────────
+
+
+class TestForPaymentYear:
+    def test_2025_maps_to_performance_2023(self):
+        assert for_payment_year(2025) is QPP[2023]
+
+    def test_2026_maps_to_performance_2024(self):
+        assert for_payment_year(2026) is QPP[2024]
+
+    def test_2027_maps_to_performance_2025(self):
+        assert for_payment_year(2027) is QPP[2025]
+
+    def test_2028_maps_to_performance_2026(self):
+        assert for_payment_year(2028) is QPP[2026]
+
+    def test_unknown_payment_year_raises_keyerror(self):
+        with pytest.raises(KeyError):
+            for_payment_year(1999)

uv.lock

@@ -4083,6 +4083,11 @@ prisma = [
     { name = "pyyaml" },
     { name = "resend" },
 ]
+qpp = [
+    { name = "duckdb" },
+    { name = "httpx" },
+    { name = "pydantic" },
+]
 rec = [
     { name = "duckdb" },
     { name = "fsspec" },
@@ -4182,6 +4187,7 @@ requires-dist = [
     { name = "pydantic", marker = "extra == 'ccw'", specifier = ">=2.0.0" },
     { name = "pydantic", marker = "extra == 'cms'", specifier = ">=2.0.0" },
     { name = "pydantic", marker = "extra == 'conf'", specifier = ">=2.0.0" },
+    { name = "pydantic", marker = "extra == 'qpp'", specifier = ">=2.0.0" },
     { name = "pydo", marker = "extra == 'mail'", specifier = ">=0.29.0" },
     { name = "pydo", marker = "extra == 'prisma'", specifier = ">=0.29.0" },
     { name = "pyjwt", marker = "extra == 'api'", specifier = ">=2.13.0" },
@@ -4216,6 +4222,7 @@ requires-dist = [
     { name = "stack", extras = ["conf"], marker = "extra == 'perf'" },
     { name = "stack", extras = ["conf"], marker = "extra == 'pfs'" },
     { name = "stack", extras = ["conf"], marker = "extra == 'prisma'" },
+    { name = "stack", extras = ["conf"], marker = "extra == 'qpp'" },
     { name = "stack", extras = ["conf"], marker = "extra == 'rec'" },
     { name = "stack", extras = ["conf"], marker = "extra == 'rex'" },
     { name = "stack", extras = ["lake"], marker = "extra == 'all'" },
@@ -4225,6 +4232,7 @@ requires-dist = [
     { name = "stack", extras = ["perf"], marker = "extra == 'all'" },
     { name = "stack", extras = ["pfs"], marker = "extra == 'all'" },
     { name = "stack", extras = ["pfs"], marker = "extra == 'rec'" },
+    { name = "stack", extras = ["qpp"], marker = "extra == 'all'" },
     { name = "stack", extras = ["rec"], marker = "extra == 'all'" },
     { name = "stack", extras = ["rex"], marker = "extra == 'all'" },
     { name = "stack", extras = ["rex"], marker = "extra == 'opps'" },
@@ -4236,7 +4244,7 @@ requires-dist = [
     { name = "uvicorn", marker = "extra == 'llm'", specifier = ">=0.41.0" },
     { name = "xlrd", specifier = ">=2.0.2" },
 ]
-provides-extras = ["conf", "aco", "api", "bcda", "bib", "bls", "llm", "ccw", "cli", "mail", "cms", "opps", "pfs", "rec", "rex", "prisma", "perf", "sem", "lake", "aws", "gcp", "azure", "all"]
+provides-extras = ["conf", "aco", "api", "bcda", "bib", "bls", "llm", "ccw", "cli", "mail", "cms", "opps", "pfs", "qpp", "rec", "rex", "prisma", "perf", "sem", "lake", "aws", "gcp", "azure", "all"]
 
 [package.metadata.requires-dev]
 dev = [