fix(qpp): correct risk-standard sourcing + FR citations (refs #593)
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kert
@@ -69,21 +69,35 @@ Nominal amount standard sourcing caveat
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Neither the CY2026 NPRM nor the CY2026 Final Rule (``2025-19787.txt``)
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restates the *numeric* generally applicable nominal amount standard
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(42 CFR 414.1415(c)(3)(i)(A)/(B)) — both only cross-reference the
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regulation by section number, which is itself evidence CMS proposed
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no change to it. The revenue-based standard (8%) is transcribed from
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the CY2019 PFS Final Rule (``data/fr_downloads/2018-24170.txt``, 83 FR
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59939) via the CY2020 PFS Proposed Rule's restatement
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(``data/fr_downloads/2019-16041.txt``, 84 FR 40825), both already
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present in this repository's ``fr_downloads`` corpus, which state it
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applies "for QP Performance Periods 2021 through 2024" — commenters
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asked CMS to raise it for 2025+ and CMS did not finalize an increase.
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The benchmark-based standard (3%) could **not** be found stated as a
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bare number tied to section 414.1415(c)(3)(i)(B) anywhere in this
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repository's FR corpus; the value used here is carried over from the
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structurally parallel Other Payer Advanced APM standard at 42 CFR
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414.1420(d)(3)(i) (same 2018-24170.txt document, 83 FR 59939), which
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CMS designed to align with the Medicare-option standard. See
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``RiskStandards.notes`` on each entry.
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regulation by section number (e.g. NPRM line 26819-26821, Final Rule
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line 50693-50696), which is itself evidence CMS proposed no change to
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it. The revenue-based standard, 42 CFR 414.1415(c)(3)(i)(A) (8%), is
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transcribed from the CY2019 PFS Final Rule
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(``data/fr_downloads/2018-24170.txt:47248-47252``, 83 FR 59923 —
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"we are finalizing our proposal to revise Sec. 414.1415(c)(3)(i)(A) to
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maintain the generally applicable revenue-based nominal amount
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standard at 8 percent ... for QP Performance Periods 2021 through
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2024"), already present in this repository's ``fr_downloads`` corpus —
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commenters asked CMS to raise it for 2025+ and CMS did not finalize an
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increase, so it is carried forward unchanged. This document also
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separately restates an **8 percent** standard for the *Other Payer*
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Advanced APM criterion (42 CFR 414.1420(d)(3)(i), same file, line
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48189-48192) — a different provision that happens to share the same
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number; do not conflate the two when re-verifying this citation.
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The benchmark-based standard, 42 CFR 414.1415(c)(3)(i)(B), could
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**not** be found stated as a bare percentage anywhere in this
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repository's FR corpus (``2025-13271.txt``, ``2025-19787.txt``,
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``2018-24170.txt``, and ``2019-16041.txt`` were all searched). The
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only nearby quoted figure — "at least 3 percent of the expected
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expenditures" — belongs to the textually distinct Other Payer Advanced
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APM standard at 42 CFR 414.1420(d)(3)(i)
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(``2018-24170.txt:48825-48827``, 83 FR 59939), which CMS designed to
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*align with* the Medicare-option standard but which is not itself a
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statement of the Medicare-option figure. Rather than reuse that
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number under a different provision's field, ``benchmark_nominal_pct``
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is left ``None`` on every entry, with the gap documented in
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``RiskStandards.notes``.
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"""
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from __future__ import annotations
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@@ -116,15 +130,21 @@ class RiskStandards(BaseModel):
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and suppliers in participating APM Entities that must be at risk.
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42 CFR 414.1415(c)(3)(i)(A)."""
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benchmark_nominal_pct: float
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benchmark_nominal_pct: float | None = None
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"""Expenditure/benchmark-based nominal amount standard — minimum %
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of expected expenditures the APM Entity must be liable for.
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42 CFR 414.1415(c)(3)(i)(B)."""
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42 CFR 414.1415(c)(3)(i)(B). ``None`` when this repository's FR
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corpus does not state the figure for this specific provision — see
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module docstring "Nominal amount standard sourcing caveat" and
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``notes``; do **not** assume it equals the numerically similar but
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textually distinct Other Payer Advanced APM standard at 42 CFR
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414.1420(d)(3)(i)."""
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notes: str = ""
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"""Sourcing caveats — see module docstring "Nominal amount
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standard sourcing caveat" for why these values are not directly
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restated as bare numbers in the CY2026 NPRM/Final Rule."""
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standard sourcing caveat" for why ``revenue_nominal_pct`` is not
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directly restated as a bare number in the CY2026 NPRM/Final Rule,
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and why ``benchmark_nominal_pct`` is ``None``."""
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class QppProposed(BaseModel):
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@@ -256,33 +276,44 @@ class QppYear(BaseModel):
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# digit) — see module docstring caveat.
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#
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# Risk standards: see module docstring "Nominal amount standard
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# sourcing caveat" — 8% revenue-based / 3% benchmark-based, unchanged
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# across 2023-2026 (no proposed or finalized change found in either
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# CY2026 document).
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# sourcing caveat" — 8% revenue-based (42 CFR 414.1415(c)(3)(i)(A)),
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# unchanged across 2023-2026 (no proposed or finalized change found in
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# either CY2026 document). Benchmark-based standard (42 CFR
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# 414.1415(c)(3)(i)(B)) left None — not stated as a bare number
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# anywhere in this repository's FR corpus.
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#
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# APM incentive %% and qp_cf_applies: transcribed from NPRM 90 FR
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# 32818 / Final Rule 90 FR 49926-49927 ("b. APM Incentive Payments to
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# 32818 / Final Rule 90 FR 49979-49980 ("b. APM Incentive Payments to
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# QPs in Advanced APMs and Other Payer Advanced APMs"), and the
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# sunset statement at NPRM 90 FR 32696 / Final Rule 90 FR 49838
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# ("Under current law, payment year 2026 is the last year for these
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# payments.").
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_RISK_NOTES = (
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"Revenue-based 8% per CY2019 PFS Final Rule (83 FR 59939, "
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"data/fr_downloads/2018-24170.txt) 'for QP Performance Periods "
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"2021 through 2024'; not extended or amended in either CY2026 "
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"Revenue-based 8% per CY2019 PFS Final Rule (83 FR 59923, "
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"data/fr_downloads/2018-24170.txt:47248-47252) 'to maintain the "
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"generally applicable revenue-based nominal amount standard at 8 "
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"percent ... for QP Performance Periods 2021 through 2024' (Sec. "
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"414.1415(c)(3)(i)(A)); not extended or amended in either CY2026 "
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"document (no proposed/final change found) — carried forward. "
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"Benchmark-based 3% not stated as a bare number for 42 CFR "
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"414.1415(c)(3)(i)(B) in this repository's FR corpus; carried "
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"over from the parallel Other Payer Advanced APM standard at 42 "
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"CFR 414.1420(d)(3)(i) (same 83 FR 59939 document)."
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"(This document separately restates 8% for the *different* Other "
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"Payer Advanced APM standard, Sec. 414.1420(d)(3)(i), at line "
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"48189-48192 — do not conflate the two.) "
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"Benchmark-based standard (Sec. 414.1415(c)(3)(i)(B)) is left "
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"None: not stated as a bare percentage anywhere in this "
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"repository's FR corpus (2025-13271.txt, 2025-19787.txt, "
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"2018-24170.txt, 2019-16041.txt all searched). The only nearby "
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"quoted figure, 'at least 3 percent of the expected expenditures' "
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"(2018-24170.txt:48825-48827, 83 FR 59939), is for the textually "
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"distinct Other Payer Advanced APM standard at Sec. "
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"414.1420(d)(3)(i), not this provision."
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)
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def _risk_standards() -> RiskStandards:
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return RiskStandards(
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revenue_nominal_pct=8.0,
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benchmark_nominal_pct=3.0,
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benchmark_nominal_pct=None,
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notes=_RISK_NOTES,
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)
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@@ -304,14 +335,14 @@ QPP: dict[int, QppYear] = {
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risk_standards=_risk_standards(),
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apm_incentive_pct=3.5,
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qp_cf_applies=False,
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citation="90 FR 49926-49927",
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citation="90 FR 49979-49980",
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),
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2024: QppYear(
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# Payment year 2026 is the first year with a differential
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# QP/non-QP conversion factor (section 1848(d)(20) of the
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# Act) AND still receives the (final year of) lump-sum APM
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# Incentive Payment — see NPRM 90 FR 32818, Final Rule 90 FR
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# 49926-49927.
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# 49979-49980.
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performance_year=2024,
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payment_year=2026,
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qp_thresholds=_qp_thresholds(),
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@@ -319,7 +350,7 @@ QPP: dict[int, QppYear] = {
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risk_standards=_risk_standards(),
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apm_incentive_pct=1.88,
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qp_cf_applies=True,
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citation="90 FR 49926-49927",
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citation="90 FR 49979-49980",
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),
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2025: QppYear(
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# Under current law, payment year 2026 (performance year
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@@ -40,6 +40,10 @@ class TestRiskStandards:
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r = RiskStandards(revenue_nominal_pct=8.0, benchmark_nominal_pct=3.0)
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assert r.notes == ""
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def test_default_benchmark_nominal_pct(self):
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r = RiskStandards(revenue_nominal_pct=8.0)
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assert r.benchmark_nominal_pct is None
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# ── QppProposed model ────────────────────────────────────────────
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@@ -202,8 +206,13 @@ class TestSpecificValues:
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@pytest.mark.parametrize("year", [2023, 2024, 2025, 2026])
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def test_risk_standards(self, year):
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# Revenue-based standard (42 CFR 414.1415(c)(3)(i)(A)) is
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# transcribed (8%); the benchmark-based standard (42 CFR
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# 414.1415(c)(3)(i)(B)) is not stated as a bare number in this
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# repository's FR corpus and is left None — see
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# RiskStandards.notes / module docstring.
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assert QPP[year].risk_standards.revenue_nominal_pct == 8.0
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assert QPP[year].risk_standards.benchmark_nominal_pct == 3.0
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assert QPP[year].risk_standards.benchmark_nominal_pct is None
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@pytest.mark.parametrize("year", [2023, 2024, 2025, 2026])
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def test_cehrt_required(self, year):
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