§512.545. Determination of reconciliation target prices. — Inbound Citations

(3) The sale, lease, exchange, or other transfer (in one transaction or a series of transactions) of all or substantially all of the assets of the TEAM participant.

(b) The episode is canceled and is not included in the reconciliation calculation as specified in § 512.545 if any of the following occur:

(1) The beneficiary ceases to meet any criterion listed in § 512.535.

(2) The beneficiary dies during the anchor hospitalization or the outpatient stay for the anchor procedure.

(3) An extreme and uncontrollable circumstance occurs if both of the following criteria are met:

(A) Is located in an emergency area, as those terms are defined in section 1135(g) of the Act, for which the Secretary has issued a waiver under section 1135 of the Act; and

(B) Is located in a county, parish, or tribal government designated in a major disaster declaration or emergency disaster declaration under the Stafford Act.

(ii) The date of admission to the anchor hospitalization or the date of the anchor procedure is during an emergency period (as defined in section 1135(g) of the Act) or in the 30 days before the date that the emergency period (as defined in section 1135(g) of the Act) begins.

(c) CMS compares the reconciliation target prices described in § 512.545 and the TEAM participant's performance year spending to establish a reconciliation amount for the TEAM participant for each performance year as follows:

(1) CMS determines the performance year spending for each episode included in the performance year (other than episodes that have been canceled in accordance with § 512.537(b)) for each MS-DRG/HCPCS episode type using claims data that is available 6 months after the end of the performance year.

(2) CMS calculates and applies the high-cost outlier cap for performance year episode spending by applying the calculation described in § 512.540(b)(4) to performance year episode spending for each MS-DRG/HCPCS episode type.

(3) CMS applies the adjustments specified in § 512.545 to the preliminary target prices computed in accordance with § 512.540 to calculate the reconciliation target prices for each MS-DRG/HCPCS episode type.

(4) CMS aggregates the reconciliation target prices computed in accordance with paragraph (c)(3) of this section for all episodes included in the performance year (other than episodes that have been canceled in accordance with § 512.537(b)) for each MS-DRG/HCPCS episode type.

(5) CMS subtracts the performance year spending amount determined under paragraphs (c)(1) and (2) of this section from the reconciliation target price amount determined under paragraph (c)(4) of this section for each MS-DRG/HCPCS episode type.

(6) CMS sums the values calculated under paragraph (c)(5) of this section across all MS-DRG/HCPCS episode types to determine the reconciliation amount.

(7) CMS caps the performance year spending amount for each MS-DRG/HCPCS episode type determined under paragraphs (c)(1) and (2) of this section to equal the reconciliation target price computed in accordance with paragraph (c)(3) of this section for episode categories where the TEAM participant did not meet the low volume threshold of at least 31 episodes during the 3-year baseline period. Low volume hospital episodes, including episode categories where CMS caps performance year spending, are included in the CQS, as calculated in § 512.547(b), and stop-loss/stop-gain thresholds, as applied at paragraph (e) of this section.

For the purposes of this part, the following definitions are applicable unless otherwise stated:

(i) CMS applies risk adjustment multipliers, as specified in § 512.545(a)(1) through (3), to the most recent baseline year episodes to calculate the estimated risk-adjusted target price for all performance year episodes.

(c) The annual linear regression analysis produces exponentiated coefficients to determine the anticipated marginal effect of each risk adjustment factor on episode costs. CMS transforms, or exponentiates, these coefficients, and the resulting coefficients are the beneficiary and hospital-level risk adjustment factors, specified in paragraphs (a)(1) through (6) of this section, that would be used during reconciliation for the subsequent performance year.

(i) CMS applies risk adjustment multipliers, as specified in § 512.545(a)(1) through (3), to the most recent baseline year episodes to calculate the estimated risk-adjusted target price for all performance year episodes.

(c) The annual linear regression analysis produces exponentiated coefficients to determine the anticipated marginal effect of each risk adjustment factor on episode costs. CMS transforms, or exponentiates, these coefficients, and the resulting coefficients are the beneficiary and hospital-level risk adjustment factors, specified in paragraphs (a)(1) through (6) of this section, that would be used during reconciliation for the subsequent performance year.

(i) CMS applies risk adjustment multipliers, as specified in § 512.545(a)(1) through (3), to the most recent baseline year episodes to calculate the estimated risk-adjusted target price for all performance year episodes.

(c) The annual linear regression analysis produces exponentiated coefficients to determine the anticipated marginal effect of each risk adjustment factor on episode costs. CMS transforms, or exponentiates, these coefficients, and the resulting coefficients are the beneficiary and hospital-level risk adjustment factors, specified in paragraphs (a)(1) through (6) of this section, that would be used during reconciliation for the subsequent performance year.

(c) The annual linear regression analysis produces exponentiated coefficients to determine the anticipated marginal effect of each risk adjustment factor on episode costs. CMS transforms, or exponentiates, these coefficients, and the resulting coefficients are the beneficiary and hospital-level risk adjustment factors, specified in paragraphs (a)(1) through (6) of this section, that would be used during reconciliation for the subsequent performance year.

(c) The annual linear regression analysis produces exponentiated coefficients to determine the anticipated marginal effect of each risk adjustment factor on episode costs. CMS transforms, or exponentiates, these coefficients, and the resulting coefficients are the beneficiary and hospital-level risk adjustment factors, specified in paragraphs (a)(1) through (6) of this section, that would be used during reconciliation for the subsequent performance year.

(c) The annual linear regression analysis produces exponentiated coefficients to determine the anticipated marginal effect of each risk adjustment factor on episode costs. CMS transforms, or exponentiates, these coefficients, and the resulting coefficients are the beneficiary and hospital-level risk adjustment factors, specified in paragraphs (a)(1) through (6) of this section, that would be used during reconciliation for the subsequent performance year.

(a) CMS risk adjusts the preliminary episode target prices computed under § 512.540 at the beneficiary level using a TEAM Hierarchical Condition Category (HCC) count risk adjustment factor, an age bracket risk adjustment factor, a beneficiary economic risk adjustment factor, and at the hospital level using a hospital bed size risk adjustment factor and a safety net hospital risk adjustment factor, and at the episode category-specific beneficiary level using factors specified in paragraphs (a)(6)(i) through (v) of this section.

(1) The TEAM HCC count risk adjustment factor uses five variables, representing beneficiaries with zero, one, two, three, or four or more CMS-HCC conditions based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure.

(2) The age bracket risk adjustment factor uses four variables, representing beneficiaries in the following age groups as of the first day of the episode:

(ii) 65 to less than 75 years.

(iii) 75 years to less than 85 years.

(iv) 85 years or more.

(3) The beneficiary economic risk adjustment factor uses two variables, representing beneficiaries that, as of the first day of the episode—

(A) [Reserved]

(4) The hospital bed size risk adjustment factor uses four variables based on the TEAM participant's characteristics:

(i) 250 beds or fewer.

(ii) 251-500 beds.

(iii) 501-850 beds.

(iv) 850 beds or more.

(5) The safety net hospital risk adjustment factor is based on the TEAM participant meeting the definition of safety net hospital, as defined in § 512.505.

(6) Episode category-specific beneficiary level risk adjustment factors represent the presence or absence in beneficiaries, based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure, of each of the following conditions:

(B) Diabetes with Chronic Complications.

(C) Morbid Obesity.

(D) Dementia, Severe.

(E) Dementia, Moderate.

(F) Dementia, Mild or Unspecified.

(G) Major Depression, Moderate or Severe, without Psychosis.

(H) Parkinson and Other Degenerative Disease of Basal Ganglia.

(I) Cardio-Respiratory Failure and Shock.

(J) Acute on Chronic Heart Failure.

(K) Heart Failure, Except End-Stage and Acute.

(L) Acute Myocardial Infarction.

(M) Unstable Angina and Other Acute Ischemic Heart Disease.

(N) Specified Heart Arrhythmias.

(O) Ischemic or Unspecified Stroke.

(P) Hemiplegia/Hemiparesis.

(Q) Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene.

(R) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(S) Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage.

(T) Chronic Kidney Disease, Stage 5.

(U) Chronic Kidney Disease, Severe (Stage 4).

(V) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(W) [Reserved]

(X) Amputation Status, Lower Limb/Amputation Complications.

(A) Ankle procedure or reattachment, partial hip procedure, partial knee arthroplasty, total hip arthroplasty or hip resurfacing procedure, and total knee arthroplasty.

(D) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(E) Diabetes with Severe Acute Complications.

(F) Diabetes with Chronic Complications.

(G) Morbid Obesity.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Schizophrenia.

(L) Major Depression, Moderate or Severe, without Psychosis.

(M) Parkinson and Other Degenerative Disease of Basal Ganglia.

(N) Acute on Chronic Heart Failure.

(O) Acute Heart Failure (Excludes Acute on Chronic).

(P) Heart Failure, Except End-Stage and Acute.

(Q) Specified Heart Arrhythmias.

(R) Hemiplegia/Hemiparesis.

(S) Deep Vein Thrombosis and Pulmonary Embolism.

(T) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(U) [Reserved]

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Bladder, Colorectal, and Other Cancers.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Intestinal Obstruction/Perforation.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Schizophrenia.

(K) Major Depression, Moderate or Severe, without Psychosis.

(L) Parkinson and Other Degenerative Disease of Basal Ganglia.

(M) Seizure Disorders and Convulsions.

(N) Respirator Dependence/Tracheostomy Status/Complications.

(O) Cardio-Respiratory Failure and Shock.

(P) Acute on Chronic Heart Failure.

(Q) Heart Failure, Except End-Stage and Acute.

(R) Specified Heart Arrhythmias.

(S) Hemiplegia/Hemiparesis.

(T) Deep Vein Thrombosis and Pulmonary Embolism.

(U) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Artificial Openings for Feeding or Elimination.

(A) Diabetes with Severe Acute Complications.

(B) Diabetes with Chronic Complications.

(C) Diabetes with Glycemic, Unspecified, or No Complications.

(D) Morbid Obesity.

(E) Chronic Liver Failure/End-Stage Liver Disorders.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Acquired Hemolytic, Aplastic, and Sideroblastic Anemias.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Quadriplegia.

(L) Paraplegia.

(M) Quadriplegic Cerebral Palsy.

(N) Multiple Sclerosis.

(O) Parkinson and Other Degenerative Disease of Basal Ganglia.

(P) Respirator Dependence/Tracheostomy Status/Complications.

(Q) Cardio-Respiratory Failure and Shock.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(W) Chronic Kidney Disease, Stage 5.

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Major Depression, Moderate or Severe, without Psychosis.

(K) Quadriplegia.

(L) Paraplegia.

(M) Spinal Cord Disorders/Injuries.

(N) Cerebral Palsy, Except Quadriplegic.

(O) Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy.

(P) Parkinson and Other Degenerative Disease of Basal Ganglia.

(Q) Acute on Chronic Heart Failure.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Monoplegia, Other Paralytic Syndromes.

(W) Deep Vein Thrombosis and Pulmonary Embolism.

(X) Chronic Kidney Disease, Stage 5.

(Y) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Z) Vertebral Fractures without Spinal Cord Injury.

(a) CMS risk adjusts the preliminary episode target prices computed under § 512.540 at the beneficiary level using a TEAM Hierarchical Condition Category (HCC) count risk adjustment factor, an age bracket risk adjustment factor, a beneficiary economic risk adjustment factor, and at the hospital level using a hospital bed size risk adjustment factor and a safety net hospital risk adjustment factor, and at the episode category-specific beneficiary level using factors specified in paragraphs (a)(6)(i) through (v) of this section.

(1) The TEAM HCC count risk adjustment factor uses five variables, representing beneficiaries with zero, one, two, three, or four or more CMS-HCC conditions based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure.

(2) The age bracket risk adjustment factor uses four variables, representing beneficiaries in the following age groups as of the first day of the episode:

(ii) 65 to less than 75 years.

(iii) 75 years to less than 85 years.

(iv) 85 years or more.

(3) The beneficiary economic risk adjustment factor uses two variables, representing beneficiaries that, as of the first day of the episode—

(A) [Reserved]

(4) The hospital bed size risk adjustment factor uses four variables based on the TEAM participant's characteristics:

(i) 250 beds or fewer.

(ii) 251-500 beds.

(iii) 501-850 beds.

(iv) 850 beds or more.

(5) The safety net hospital risk adjustment factor is based on the TEAM participant meeting the definition of safety net hospital, as defined in § 512.505.

(6) Episode category-specific beneficiary level risk adjustment factors represent the presence or absence in beneficiaries, based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure, of each of the following conditions:

(B) Diabetes with Chronic Complications.

(C) Morbid Obesity.

(D) Dementia, Severe.

(E) Dementia, Moderate.

(F) Dementia, Mild or Unspecified.

(G) Major Depression, Moderate or Severe, without Psychosis.

(H) Parkinson and Other Degenerative Disease of Basal Ganglia.

(I) Cardio-Respiratory Failure and Shock.

(J) Acute on Chronic Heart Failure.

(K) Heart Failure, Except End-Stage and Acute.

(L) Acute Myocardial Infarction.

(M) Unstable Angina and Other Acute Ischemic Heart Disease.

(N) Specified Heart Arrhythmias.

(O) Ischemic or Unspecified Stroke.

(P) Hemiplegia/Hemiparesis.

(Q) Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene.

(R) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(S) Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage.

(T) Chronic Kidney Disease, Stage 5.

(U) Chronic Kidney Disease, Severe (Stage 4).

(V) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(W) [Reserved]

(X) Amputation Status, Lower Limb/Amputation Complications.

(A) Ankle procedure or reattachment, partial hip procedure, partial knee arthroplasty, total hip arthroplasty or hip resurfacing procedure, and total knee arthroplasty.

(D) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(E) Diabetes with Severe Acute Complications.

(F) Diabetes with Chronic Complications.

(G) Morbid Obesity.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Schizophrenia.

(L) Major Depression, Moderate or Severe, without Psychosis.

(M) Parkinson and Other Degenerative Disease of Basal Ganglia.

(N) Acute on Chronic Heart Failure.

(O) Acute Heart Failure (Excludes Acute on Chronic).

(P) Heart Failure, Except End-Stage and Acute.

(Q) Specified Heart Arrhythmias.

(R) Hemiplegia/Hemiparesis.

(S) Deep Vein Thrombosis and Pulmonary Embolism.

(T) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(U) [Reserved]

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Bladder, Colorectal, and Other Cancers.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Intestinal Obstruction/Perforation.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Schizophrenia.

(K) Major Depression, Moderate or Severe, without Psychosis.

(L) Parkinson and Other Degenerative Disease of Basal Ganglia.

(M) Seizure Disorders and Convulsions.

(N) Respirator Dependence/Tracheostomy Status/Complications.

(O) Cardio-Respiratory Failure and Shock.

(P) Acute on Chronic Heart Failure.

(Q) Heart Failure, Except End-Stage and Acute.

(R) Specified Heart Arrhythmias.

(S) Hemiplegia/Hemiparesis.

(T) Deep Vein Thrombosis and Pulmonary Embolism.

(U) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Artificial Openings for Feeding or Elimination.

(A) Diabetes with Severe Acute Complications.

(B) Diabetes with Chronic Complications.

(C) Diabetes with Glycemic, Unspecified, or No Complications.

(D) Morbid Obesity.

(E) Chronic Liver Failure/End-Stage Liver Disorders.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Acquired Hemolytic, Aplastic, and Sideroblastic Anemias.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Quadriplegia.

(L) Paraplegia.

(M) Quadriplegic Cerebral Palsy.

(N) Multiple Sclerosis.

(O) Parkinson and Other Degenerative Disease of Basal Ganglia.

(P) Respirator Dependence/Tracheostomy Status/Complications.

(Q) Cardio-Respiratory Failure and Shock.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(W) Chronic Kidney Disease, Stage 5.

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Major Depression, Moderate or Severe, without Psychosis.

(K) Quadriplegia.

(L) Paraplegia.

(M) Spinal Cord Disorders/Injuries.

(N) Cerebral Palsy, Except Quadriplegic.

(O) Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy.

(P) Parkinson and Other Degenerative Disease of Basal Ganglia.

(Q) Acute on Chronic Heart Failure.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Monoplegia, Other Paralytic Syndromes.

(W) Deep Vein Thrombosis and Pulmonary Embolism.

(X) Chronic Kidney Disease, Stage 5.

(Y) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Z) Vertebral Fractures without Spinal Cord Injury.

(a) CMS risk adjusts the preliminary episode target prices computed under § 512.540 at the beneficiary level using a TEAM Hierarchical Condition Category (HCC) count risk adjustment factor, an age bracket risk adjustment factor, a beneficiary economic risk adjustment factor, and at the hospital level using a hospital bed size risk adjustment factor and a safety net hospital risk adjustment factor, and at the episode category-specific beneficiary level using factors specified in paragraphs (a)(6)(i) through (v) of this section.

(1) The TEAM HCC count risk adjustment factor uses five variables, representing beneficiaries with zero, one, two, three, or four or more CMS-HCC conditions based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure.

(2) The age bracket risk adjustment factor uses four variables, representing beneficiaries in the following age groups as of the first day of the episode:

(ii) 65 to less than 75 years.

(iii) 75 years to less than 85 years.

(iv) 85 years or more.

(3) The beneficiary economic risk adjustment factor uses two variables, representing beneficiaries that, as of the first day of the episode—

(A) [Reserved]

(4) The hospital bed size risk adjustment factor uses four variables based on the TEAM participant's characteristics:

(i) 250 beds or fewer.

(ii) 251-500 beds.

(iii) 501-850 beds.

(iv) 850 beds or more.

(5) The safety net hospital risk adjustment factor is based on the TEAM participant meeting the definition of safety net hospital, as defined in § 512.505.

(6) Episode category-specific beneficiary level risk adjustment factors represent the presence or absence in beneficiaries, based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure, of each of the following conditions:

(B) Diabetes with Chronic Complications.

(C) Morbid Obesity.

(D) Dementia, Severe.

(E) Dementia, Moderate.

(F) Dementia, Mild or Unspecified.

(G) Major Depression, Moderate or Severe, without Psychosis.

(H) Parkinson and Other Degenerative Disease of Basal Ganglia.

(I) Cardio-Respiratory Failure and Shock.

(J) Acute on Chronic Heart Failure.

(K) Heart Failure, Except End-Stage and Acute.

(L) Acute Myocardial Infarction.

(M) Unstable Angina and Other Acute Ischemic Heart Disease.

(N) Specified Heart Arrhythmias.

(O) Ischemic or Unspecified Stroke.

(P) Hemiplegia/Hemiparesis.

(Q) Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene.

(R) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(S) Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage.

(T) Chronic Kidney Disease, Stage 5.

(U) Chronic Kidney Disease, Severe (Stage 4).

(V) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(W) [Reserved]

(X) Amputation Status, Lower Limb/Amputation Complications.

(A) Ankle procedure or reattachment, partial hip procedure, partial knee arthroplasty, total hip arthroplasty or hip resurfacing procedure, and total knee arthroplasty.

(D) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(E) Diabetes with Severe Acute Complications.

(F) Diabetes with Chronic Complications.

(G) Morbid Obesity.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Schizophrenia.

(L) Major Depression, Moderate or Severe, without Psychosis.

(M) Parkinson and Other Degenerative Disease of Basal Ganglia.

(N) Acute on Chronic Heart Failure.

(O) Acute Heart Failure (Excludes Acute on Chronic).

(P) Heart Failure, Except End-Stage and Acute.

(Q) Specified Heart Arrhythmias.

(R) Hemiplegia/Hemiparesis.

(S) Deep Vein Thrombosis and Pulmonary Embolism.

(T) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(U) [Reserved]

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Bladder, Colorectal, and Other Cancers.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Intestinal Obstruction/Perforation.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Schizophrenia.

(K) Major Depression, Moderate or Severe, without Psychosis.

(L) Parkinson and Other Degenerative Disease of Basal Ganglia.

(M) Seizure Disorders and Convulsions.

(N) Respirator Dependence/Tracheostomy Status/Complications.

(O) Cardio-Respiratory Failure and Shock.

(P) Acute on Chronic Heart Failure.

(Q) Heart Failure, Except End-Stage and Acute.

(R) Specified Heart Arrhythmias.

(S) Hemiplegia/Hemiparesis.

(T) Deep Vein Thrombosis and Pulmonary Embolism.

(U) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Artificial Openings for Feeding or Elimination.

(A) Diabetes with Severe Acute Complications.

(B) Diabetes with Chronic Complications.

(C) Diabetes with Glycemic, Unspecified, or No Complications.

(D) Morbid Obesity.

(E) Chronic Liver Failure/End-Stage Liver Disorders.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Acquired Hemolytic, Aplastic, and Sideroblastic Anemias.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Quadriplegia.

(L) Paraplegia.

(M) Quadriplegic Cerebral Palsy.

(N) Multiple Sclerosis.

(O) Parkinson and Other Degenerative Disease of Basal Ganglia.

(P) Respirator Dependence/Tracheostomy Status/Complications.

(Q) Cardio-Respiratory Failure and Shock.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(W) Chronic Kidney Disease, Stage 5.

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Major Depression, Moderate or Severe, without Psychosis.

(K) Quadriplegia.

(L) Paraplegia.

(M) Spinal Cord Disorders/Injuries.

(N) Cerebral Palsy, Except Quadriplegic.

(O) Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy.

(P) Parkinson and Other Degenerative Disease of Basal Ganglia.

(Q) Acute on Chronic Heart Failure.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Monoplegia, Other Paralytic Syndromes.

(W) Deep Vein Thrombosis and Pulmonary Embolism.

(X) Chronic Kidney Disease, Stage 5.

(Y) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Z) Vertebral Fractures without Spinal Cord Injury.

(a) CMS risk adjusts the preliminary episode target prices computed under § 512.540 at the beneficiary level using a TEAM Hierarchical Condition Category (HCC) count risk adjustment factor, an age bracket risk adjustment factor, a beneficiary economic risk adjustment factor, and at the hospital level using a hospital bed size risk adjustment factor and a safety net hospital risk adjustment factor, and at the episode category-specific beneficiary level using factors specified in paragraphs (a)(6)(i) through (v) of this section.

(1) The TEAM HCC count risk adjustment factor uses five variables, representing beneficiaries with zero, one, two, three, or four or more CMS-HCC conditions based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure.

(2) The age bracket risk adjustment factor uses four variables, representing beneficiaries in the following age groups as of the first day of the episode:

(ii) 65 to less than 75 years.

(iii) 75 years to less than 85 years.

(iv) 85 years or more.

(3) The beneficiary economic risk adjustment factor uses two variables, representing beneficiaries that, as of the first day of the episode—

(A) [Reserved]

(4) The hospital bed size risk adjustment factor uses four variables based on the TEAM participant's characteristics:

(i) 250 beds or fewer.

(ii) 251-500 beds.

(iii) 501-850 beds.

(iv) 850 beds or more.

(5) The safety net hospital risk adjustment factor is based on the TEAM participant meeting the definition of safety net hospital, as defined in § 512.505.

(6) Episode category-specific beneficiary level risk adjustment factors represent the presence or absence in beneficiaries, based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure, of each of the following conditions:

(B) Diabetes with Chronic Complications.

(C) Morbid Obesity.

(D) Dementia, Severe.

(E) Dementia, Moderate.

(F) Dementia, Mild or Unspecified.

(G) Major Depression, Moderate or Severe, without Psychosis.

(H) Parkinson and Other Degenerative Disease of Basal Ganglia.

(I) Cardio-Respiratory Failure and Shock.

(J) Acute on Chronic Heart Failure.

(K) Heart Failure, Except End-Stage and Acute.

(L) Acute Myocardial Infarction.

(M) Unstable Angina and Other Acute Ischemic Heart Disease.

(N) Specified Heart Arrhythmias.

(O) Ischemic or Unspecified Stroke.

(P) Hemiplegia/Hemiparesis.

(Q) Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene.

(R) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(S) Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage.

(T) Chronic Kidney Disease, Stage 5.

(U) Chronic Kidney Disease, Severe (Stage 4).

(V) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(W) [Reserved]

(X) Amputation Status, Lower Limb/Amputation Complications.

(A) Ankle procedure or reattachment, partial hip procedure, partial knee arthroplasty, total hip arthroplasty or hip resurfacing procedure, and total knee arthroplasty.

(D) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(E) Diabetes with Severe Acute Complications.

(F) Diabetes with Chronic Complications.

(G) Morbid Obesity.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Schizophrenia.

(L) Major Depression, Moderate or Severe, without Psychosis.

(M) Parkinson and Other Degenerative Disease of Basal Ganglia.

(N) Acute on Chronic Heart Failure.

(O) Acute Heart Failure (Excludes Acute on Chronic).

(P) Heart Failure, Except End-Stage and Acute.

(Q) Specified Heart Arrhythmias.

(R) Hemiplegia/Hemiparesis.

(S) Deep Vein Thrombosis and Pulmonary Embolism.

(T) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(U) [Reserved]

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Bladder, Colorectal, and Other Cancers.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Intestinal Obstruction/Perforation.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Schizophrenia.

(K) Major Depression, Moderate or Severe, without Psychosis.

(L) Parkinson and Other Degenerative Disease of Basal Ganglia.

(M) Seizure Disorders and Convulsions.

(N) Respirator Dependence/Tracheostomy Status/Complications.

(O) Cardio-Respiratory Failure and Shock.

(P) Acute on Chronic Heart Failure.

(Q) Heart Failure, Except End-Stage and Acute.

(R) Specified Heart Arrhythmias.

(S) Hemiplegia/Hemiparesis.

(T) Deep Vein Thrombosis and Pulmonary Embolism.

(U) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Artificial Openings for Feeding or Elimination.

(A) Diabetes with Severe Acute Complications.

(B) Diabetes with Chronic Complications.

(C) Diabetes with Glycemic, Unspecified, or No Complications.

(D) Morbid Obesity.

(E) Chronic Liver Failure/End-Stage Liver Disorders.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Acquired Hemolytic, Aplastic, and Sideroblastic Anemias.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Quadriplegia.

(L) Paraplegia.

(M) Quadriplegic Cerebral Palsy.

(N) Multiple Sclerosis.

(O) Parkinson and Other Degenerative Disease of Basal Ganglia.

(P) Respirator Dependence/Tracheostomy Status/Complications.

(Q) Cardio-Respiratory Failure and Shock.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(W) Chronic Kidney Disease, Stage 5.

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Major Depression, Moderate or Severe, without Psychosis.

(K) Quadriplegia.

(L) Paraplegia.

(M) Spinal Cord Disorders/Injuries.

(N) Cerebral Palsy, Except Quadriplegic.

(O) Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy.

(P) Parkinson and Other Degenerative Disease of Basal Ganglia.

(Q) Acute on Chronic Heart Failure.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Monoplegia, Other Paralytic Syndromes.

(W) Deep Vein Thrombosis and Pulmonary Embolism.

(X) Chronic Kidney Disease, Stage 5.

(Y) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Z) Vertebral Fractures without Spinal Cord Injury.

(a) CMS risk adjusts the preliminary episode target prices computed under § 512.540 at the beneficiary level using a TEAM Hierarchical Condition Category (HCC) count risk adjustment factor, an age bracket risk adjustment factor, a beneficiary economic risk adjustment factor, and at the hospital level using a hospital bed size risk adjustment factor and a safety net hospital risk adjustment factor, and at the episode category-specific beneficiary level using factors specified in paragraphs (a)(6)(i) through (v) of this section.

(1) The TEAM HCC count risk adjustment factor uses five variables, representing beneficiaries with zero, one, two, three, or four or more CMS-HCC conditions based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure.

(2) The age bracket risk adjustment factor uses four variables, representing beneficiaries in the following age groups as of the first day of the episode:

(ii) 65 to less than 75 years.

(iii) 75 years to less than 85 years.

(iv) 85 years or more.

(3) The beneficiary economic risk adjustment factor uses two variables, representing beneficiaries that, as of the first day of the episode—

(A) [Reserved]

(4) The hospital bed size risk adjustment factor uses four variables based on the TEAM participant's characteristics:

(i) 250 beds or fewer.

(ii) 251-500 beds.

(iii) 501-850 beds.

(iv) 850 beds or more.

(5) The safety net hospital risk adjustment factor is based on the TEAM participant meeting the definition of safety net hospital, as defined in § 512.505.

(6) Episode category-specific beneficiary level risk adjustment factors represent the presence or absence in beneficiaries, based on a 180-day lookback period that ends on the day prior to the anchor hospitalization or anchor procedure, of each of the following conditions:

(B) Diabetes with Chronic Complications.

(C) Morbid Obesity.

(D) Dementia, Severe.

(E) Dementia, Moderate.

(F) Dementia, Mild or Unspecified.

(G) Major Depression, Moderate or Severe, without Psychosis.

(H) Parkinson and Other Degenerative Disease of Basal Ganglia.

(I) Cardio-Respiratory Failure and Shock.

(J) Acute on Chronic Heart Failure.

(K) Heart Failure, Except End-Stage and Acute.

(L) Acute Myocardial Infarction.

(M) Unstable Angina and Other Acute Ischemic Heart Disease.

(N) Specified Heart Arrhythmias.

(O) Ischemic or Unspecified Stroke.

(P) Hemiplegia/Hemiparesis.

(Q) Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene.

(R) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(S) Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage.

(T) Chronic Kidney Disease, Stage 5.

(U) Chronic Kidney Disease, Severe (Stage 4).

(V) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(W) [Reserved]

(X) Amputation Status, Lower Limb/Amputation Complications.

(A) Ankle procedure or reattachment, partial hip procedure, partial knee arthroplasty, total hip arthroplasty or hip resurfacing procedure, and total knee arthroplasty.

(D) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(E) Diabetes with Severe Acute Complications.

(F) Diabetes with Chronic Complications.

(G) Morbid Obesity.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Schizophrenia.

(L) Major Depression, Moderate or Severe, without Psychosis.

(M) Parkinson and Other Degenerative Disease of Basal Ganglia.

(N) Acute on Chronic Heart Failure.

(O) Acute Heart Failure (Excludes Acute on Chronic).

(P) Heart Failure, Except End-Stage and Acute.

(Q) Specified Heart Arrhythmias.

(R) Hemiplegia/Hemiparesis.

(S) Deep Vein Thrombosis and Pulmonary Embolism.

(T) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(U) [Reserved]

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Bladder, Colorectal, and Other Cancers.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Intestinal Obstruction/Perforation.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Schizophrenia.

(K) Major Depression, Moderate or Severe, without Psychosis.

(L) Parkinson and Other Degenerative Disease of Basal Ganglia.

(M) Seizure Disorders and Convulsions.

(N) Respirator Dependence/Tracheostomy Status/Complications.

(O) Cardio-Respiratory Failure and Shock.

(P) Acute on Chronic Heart Failure.

(Q) Heart Failure, Except End-Stage and Acute.

(R) Specified Heart Arrhythmias.

(S) Hemiplegia/Hemiparesis.

(T) Deep Vein Thrombosis and Pulmonary Embolism.

(U) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(V) Chronic Kidney Disease, Stage 5.

(W) Chronic Kidney Disease, Severe (Stage 4).

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Artificial Openings for Feeding or Elimination.

(A) Diabetes with Severe Acute Complications.

(B) Diabetes with Chronic Complications.

(C) Diabetes with Glycemic, Unspecified, or No Complications.

(D) Morbid Obesity.

(E) Chronic Liver Failure/End-Stage Liver Disorders.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Acquired Hemolytic, Aplastic, and Sideroblastic Anemias.

(H) Dementia, Severe.

(I) Dementia, Moderate.

(J) Dementia, Mild or Unspecified.

(K) Quadriplegia.

(L) Paraplegia.

(M) Quadriplegic Cerebral Palsy.

(N) Multiple Sclerosis.

(O) Parkinson and Other Degenerative Disease of Basal Ganglia.

(P) Respirator Dependence/Tracheostomy Status/Complications.

(Q) Cardio-Respiratory Failure and Shock.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders.

(W) Chronic Kidney Disease, Stage 5.

(X) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Y) Hip Fracture/Dislocation.

(B) Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic.

(C) Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid.

(D) Diabetes with Chronic Complications.

(E) Morbid Obesity.

(F) Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders.

(G) Dementia, Severe.

(H) Dementia, Moderate.

(I) Dementia, Mild or Unspecified.

(J) Major Depression, Moderate or Severe, without Psychosis.

(K) Quadriplegia.

(L) Paraplegia.

(M) Spinal Cord Disorders/Injuries.

(N) Cerebral Palsy, Except Quadriplegic.

(O) Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy.

(P) Parkinson and Other Degenerative Disease of Basal Ganglia.

(Q) Acute on Chronic Heart Failure.

(R) Heart Failure, Except End-Stage and Acute.

(S) Specified Heart Arrhythmias.

(T) Ischemic or Unspecified Stroke.

(U) Hemiplegia/Hemiparesis.

(V) Monoplegia, Other Paralytic Syndromes.

(W) Deep Vein Thrombosis and Pulmonary Embolism.

(X) Chronic Kidney Disease, Stage 5.

(Y) Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle.

(Z) Vertebral Fractures without Spinal Cord Injury.

(3) The sale, lease, exchange, or other transfer (in one transaction or a series of transactions) of all or substantially all of the assets of the TEAM participant.