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qpp: correct QPP[2023]/[2024]/[2026] thresholds — payment-year keying error + CAA 2026 supersession #620

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opened 2026-08-14 02:07:28 +00:00 by kert · 1 comment
kert commented 2026-08-14 02:07:28 +00:00
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Found by #613's implementer, adjudicated by the P37 Task-7 review against both captured rules + current CFR. Two distinct root causes:

  1. Keying error (P36): 42 CFR 414.1430(a) and section 1833(z)(2) key QP thresholds to payment years; P36 read the 75% step-up as effective performance period 2023. Operative law: payment years 2021–2026 = QP 50%/35% (Partial 40%/25%); 75%/50% starts payment year 2027. So QPP[2023] (pay 2025) and QPP[2024] (pay 2026) must be corrected from 75/50 & 50/35 to 50/35 & 40/25 (citation: 42 CFR 414.1430(a), 89 FR 98564; restated 91 FR 44285-44286; CAA 2024 §304 at 91 FR 44219).
  2. Supersession (not P36's error): QPP[2026] (pay 2028) was accurate per the CY2026 final rule narrative (90 FR 49980) but CAA 2026 legislatively restored pay-2028 to 50/35 (Partial 40/25) and added a 3.1% APM incentive (91 FR 44218-44220, 44260, 44286). Note: eCFR still shows the old schedule — the statute is self-executing and controls; the reg conformance is only proposed in CMS-1848-P.

QPP[2025] (pay 2027: 75/50) and QPP[2027] (pay 2029: 75/50) are correct. Also fix: the P36-era header comment in src/qpp/__init__.py (~L323-327), QPP[2026].proposed.changes prose, the shared threshold helpers (values now differ by year), TestApmIncentivePct docstring ('sunsets after 2026' — revived at 3.1% for pay 2028), and add one docstring note re CMS's internal drafting error at 414.1430(b)(2)(i)(D) (91 FR 44220/…:42589). Blocks #616 (notebooks render this table).

Found by #613's implementer, adjudicated by the P37 Task-7 review against both captured rules + current CFR. Two distinct root causes: 1. **Keying error (P36)**: 42 CFR 414.1430(a) and section 1833(z)(2) key QP thresholds to **payment years**; P36 read the 75% step-up as effective *performance period* 2023. Operative law: payment years 2021–2026 = QP 50%/35% (Partial 40%/25%); 75%/50% starts payment year 2027. So `QPP[2023]` (pay 2025) and `QPP[2024]` (pay 2026) must be corrected from 75/50 & 50/35 to **50/35 & 40/25** (citation: 42 CFR 414.1430(a), 89 FR 98564; restated 91 FR 44285-44286; CAA 2024 §304 at 91 FR 44219). 2. **Supersession (not P36's error)**: `QPP[2026]` (pay 2028) was accurate per the CY2026 final rule narrative (90 FR 49980) but **CAA 2026 legislatively restored** pay-2028 to 50/35 (Partial 40/25) and added a **3.1% APM incentive** (91 FR 44218-44220, 44260, 44286). Note: eCFR still shows the old schedule — the statute is self-executing and controls; the reg conformance is only proposed in CMS-1848-P. `QPP[2025]` (pay 2027: 75/50) and `QPP[2027]` (pay 2029: 75/50) are correct. Also fix: the P36-era header comment in [`src/qpp/__init__.py`](https://git.fhirworx.io/homelab/stack/src/branch/main/src/qpp/__init__.py) (~L323-327), `QPP[2026].proposed.changes` prose, the shared threshold helpers (values now differ by year), `TestApmIncentivePct` docstring ('sunsets after 2026' — revived at 3.1% for pay 2028), and add one docstring note re CMS's internal drafting error at 414.1430(b)(2)(i)(D) (91 FR 44220/…:42589). **Blocks #616** (notebooks render this table).
kert added this to the P37: CY2027 PFS Proposed Rule — capture, ingest, APM analysis milestone 2026-08-14 02:07:28 +00:00
kert added the qppquality labels 2026-08-14 02:07:28 +00:00
kert commented 2026-08-14 03:53:33 +00:00
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Fixed in 5063a77 (branch p37-cy2027-rule), re-review verified every correction against the amendatory text line-by-line: QPP[2023]/[2024] → QP 50/35, Partial 40/25 (42 CFR 414.1430(a), lines 42548/42556/42566/42573 of the captured NPRM; CAA 2024 §304 at 91 FR 44219); QPP[2026] → 50/35, 40/25, apm_incentive_pct 3.1 (91 FR 44286 line 42632) with the CAA-2026-supersedes-90-FR-49980 story in the docstring; QPP[2025]/[2027] confirmed unchanged at 75/50 (payment years 2027/2029). Helpers split per-year; payment-year keying documented in the header; CMS's own drafting error at 414.1430(b)(2)(i)(D) noted. tests/qpp 74/74; both notebooks read the registry live and self-correct. Merges with P37.

Fixed in 5063a77 (branch p37-cy2027-rule), re-review verified every correction against the amendatory text line-by-line: QPP[2023]/[2024] → QP 50/35, Partial 40/25 (42 CFR 414.1430(a), lines 42548/42556/42566/42573 of the captured NPRM; CAA 2024 §304 at 91 FR 44219); QPP[2026] → 50/35, 40/25, apm_incentive_pct 3.1 (91 FR 44286 line 42632) with the CAA-2026-supersedes-90-FR-49980 story in the docstring; QPP[2025]/[2027] confirmed unchanged at 75/50 (payment years 2027/2029). Helpers split per-year; payment-year keying documented in the header; CMS's own drafting error at 414.1430(b)(2)(i)(D) noted. tests/qpp 74/74; both notebooks read the registry live and self-correct. Merges with P37.
kert closed this issue 2026-08-14 03:53:33 +00:00
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Reference: homelab/stack#620
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