Common use of ACO Service Area Clause in Contracts

ACO Service Area. 1. Except as described in Section 5.04.H.4, the ACO Service Area consists of the Core Service Area described in Section 5.04.H.2 and the Extended Service Area described in Section 5.04.H. 2. The Core Service Area includes the counties in which the ACO’s Participant Providers have physical office locations. In advance of each Performance Year, by a time and in a form and manner specified by CMS, the ACO shall submit to CMS a list of the counties in which the ACO’s Participant Providers have physical office locations. CMS will use this information for purposes of defining the ACO’s Core Service Area for the Performance Year. 3. The Extended Service Area includes all counties adjacent to the Core Service Area. CMS will identify the counties adjacent to the counties in the ACO’s Core Service Area for purposes of defining the ACO’s Extended Service Area. 4. If CMS determines that the ACO’s clinical care model does not rely on physical practice locations, such as if the ACO is located in a Rural Area or is a High-Needs Population ACO, and the ACO proposed an alternative service area definition which CMS approved, the ACO’s ACO Service Area shall be the alternative service area so approved by CMS. 5. CMS may offer the ACO one or more opportunities to add counties to the ACO’s Core Service Area during a given Performance Year to account for the addition of new physical office locations for either newly added Participant Providers or existing Participant Providers during the Performance Year. Any such additions must be submitted in a form and manner and by a deadline specified by CMS. If the ACO adds any counties to the ACO’s Core Service Area, the change to the Core Service Area and any changes to the Extended Service Area and the ACO’s Service Area that result from such change shall be effective on the date specified in writing by CMS.