---
kind: "section"
citation: "42 C.F.R. § 412.168"
title: "42"
number: "412.168"
heading: "Special rules for FY 2022 and FY 2023."
url: "https://uscodex.org/cfr/42/412.168"
---

# §412.168. Special rules for FY 2022 and FY 2023.

- (a) This section sets forth the scoring and payment methodology for each of fiscal years 2022 and 2023Hospital VBP Program.
- (b) CMS calculates a measure rate for all measures selected under [§ 412.164(a)](/cfr/42/412.164.md?p=a) for fiscal year 2022 but only applies [§ 412.165(a)](/cfr/42/412.165.md?p=a) to the measures included in the Clinical Outcomes Domain for that fiscal year, which are the following:
  - (1) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Acute Myocardial Infarction (AMI) Hospitalization (MORT-30-AMI).
  - (2) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Heart Failure (HF) Hospitalization (MORT-30-HF).
  - (3) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Pneumonia Hospitalization (MORT-30-PN (updated cohort)).
  - (4) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Chronic Obstructive Pulmonary Disease (COPD) Hospitalization (MORT-30-COPD).
  - (5) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Coronary Artery Bypass Graft (CABG) Surgery (MORT-30-CABG).
  - (6) Hospital-Level Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) (COMP-HIP-KNEE).
- (c) CMS calculates a domain score for the measures described in [paragraph (b)(1)](#b-1) of this section for hospitals that report the minimum number of measures in the Clinical Outcomes Domain.
- (d) **CMS does not award a Total Performance Score to any hospital.**
- (e) The total amount available for value-based incentive payments for fiscal year 2022 is equal to the total amount of base-operating DRG payment reductions for that fiscal year, as estimated by the Secretary.
- (f) CMS awards value-based incentive payment percentages (as defined in [§ 412.160](/cfr/42/412.160.md)) for all hospitals to ensure that each hospital receives an incentive payment amount equal to the amount of the reduction made to its base-operating DRG payment amounts.
- (g) CMS calculates a measure rate for all measures selected under [§ 412.164(a)](/cfr/42/412.164.md?p=a) for fiscal year 2023 but only applies [§ 412.165(a)](/cfr/42/412.165.md?p=a) to the measures included in the Clinical Outcomes Domain and the Efficiency and Cost Reduction Domain for that fiscal year, which are the following:
  - (1) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Acute Myocardial Infarction (AMI) Hospitalization (MORT-30-AMI).
  - (2) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Heart Failure (HF) Hospitalization (MORT-30-HF).
  - (3) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Pneumonia Hospitalization (MORT-30-PN (updated cohort)).
  - (4) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Chronic Obstructive Pulmonary Disease (COPD) Hospitalization (MORT-30-COPD).
  - (5) Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Coronary Artery Bypass Graft (CABG) Surgery (MORT-30-CABG).
  - (6) Hospital-Level Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) (COMP-HIP-KNEE).
  - (7) **Medicare Spending Per Beneficiary (MSPB)—** Hospital.
- (h) **CMS calculates—**
  - (1) A Clinical Outcomes Domain score for fiscal year 2023 for hospitals that report the minimum number of cases and measures with respect to the measures described in [paragraphs (g)(1) through (6)](#g-1..g-6) of this section; and
  - (2) An Efficiency and Cost Reduction Domain score for fiscal year 2023 for hospitals that report the minimum number of cases with respect to the measure described in [paragraph (g)(7)](#g-7) of this section.
- (i) **CMS does not award a Total Performance Score to any hospital for fiscal year 2023.**
- (j) The total amount available for value-based incentive payments for fiscal year 2023 is equal to the total amount of base-operating DRG payment reductions for that fiscal year, as estimated by the Secretary.
- (k) CMS awards a value-based incentive payment percentage (as defined in [§ 412.160](/cfr/42/412.160.md)) for fiscal year 2023 to all hospitals to ensure that each hospital receives a value-based incentive payment amount equal to the amount of the reduction made to its base-operating DRG payment amounts.

## Notes

### Amendments

[86 FR 45520, Aug. 13, 2021, as amended at 87 FR 49404, Aug. 10, 2022]

### Source

Source: 77 FR 53674, Aug. 31, 2012, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 50 FR 12741, Mar. 29, 1985, unless otherwise noted.

### Amendments

[86 FR 45520, Aug. 13, 2021, as amended at 87 FR 49404, Aug. 10, 2022]