Care Management Home Visits Benefit Enhancement.
A. Appendix M shall apply to the Agreement for any Performance Year for which the ACO has selected the Care Management Home Visits Benefit Enhancement as described in Section 8.01 and for which the ACO has submitted an Implementation Plan under Section 10.01.B for the Care Management Home Visits Benefit Enhancement and CMS has not rejected the ACO’s selection pursuant to Section 8.02 or Section 10.01.E.
B. In order to be eligible to submit claims for services furnished to REACH Beneficiaries pursuant to the Care Management Home Visits Benefit Enhancement, the supervising physician or other practitioner must be:
1. A physician or a non-physician practitioner who is authorized by the Act to receive payment for services “incident to” his or her own services, as described in 42 CFR § 410.26(a)(7), who is a Participant Provider or Preferred Provider; and
2. Eligible under Medicare rules to submit for “incident to” services as defined in Chapter 15, Section 60 of the Medicare Benefit Policy Manual; and
3. Designated on the Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the Care Management Home Visits Benefit Enhancement; and
4. Approved by CMS according to the criteria described in this Section 10.05.B and Appendix M of the Agreement.
C. If CMS notifies the ACO that a physician or non-physician practitioner has not been approved for participation in the Care Management Home Visits Benefit Enhancement under this Section 10.05, but the physician or non-physician practitioner is otherwise eligible to be a Participant Provider or Preferred Provider, the ACO may either remove the physician or non-physician practitioner from the Participant Provider or Preferred Provider List, or amend the relevant list to reflect that the physician or non-physician practitioner will not participate in the Care Management Home Visits Benefit Enhancement. The ACO shall amend the relevant list no later than 30 Days after the date of the notice from CMS.
D. The individual performing services under this Benefit Enhancement must be “auxiliary personnel” as defined at 42 CFR § 410.26(a)(1).
E. The ACO shall ensure that care management home visits are not used to prevent or deter a Beneficiary from seeking or receiving other Medically Necessary care.
Care Management Home Visits Benefit Enhancement. A. Appendix M shall apply to the Agreement for any Performance Year for which the DCE has selected the Care Management Home Visits Benefit Enhancement as described in Section 8.01 and for which the DCE has submitted an Implementation Plan under Section 10.01.B for the Care Management Home Visits Benefit Enhancement and CMS has not rejected the DCE's selection pursuant to Section 8.02 or Section 10.01.E.
B. In order to be eligible to submit claims for services furnished to DC Beneficiaries pursuant to the Care Management Home Visits Benefit Enhancement, the supervising physician or other practitioner must be:
1. A physician or non-physician practitioner listed at 42 CFR § 410.78(b)(2) who is a DC Participant Provider or Preferred Provider; and
2. Eligible under Medicare rules to submit for “incident to” services as defined in Chapter 15, Section 60 of the Medicare Benefit Policy Manual; and
3. Designated on the DC Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the Care Management Home Visits Benefit Enhancement; and
4. Approved by CMS according to the criteria described in this Section
