CMS Evaluation. CMS shall evaluate the Model in accordance with Section 1115A(b)(4) of the Act. CMS and the State agree that the State and its agents shall cooperate with CMS and its contractor(s) and provide all data needed by CMS to monitor and evaluate the Model in accordance with applicable law, including, but not limited to, individually-identifiable health information. The State shall ensure the production of such data through statutory or regulatory mandates on entities holding the required data, or through alternative legal arrangements. The State must ensure that all written agreements or legal relationships have been secured with any relevant entities (e.g., Vermont Commercial Plans and Vermont Self-insured Plans) and with institutional review boards that are necessary to ensure that CMS or its designee(s) can access individual-level, identifiable data to carry out monitoring and evaluation activities to the extent allowable by law. CMS shall have the authority to share all Model data, documents, and other information with its designees for evaluation, monitoring, oversight, and other purposes, in accordance with applicable law. CMS shall have the authority to use any data obtained pursuant to the Model to publicly disseminate quantitative and qualitative results, in accordance with applicable law.
CMS Evaluation. CMS shall evaluate the Model in accordance with Section 1115A(b)(4) of the Act. CMS and the State agree that the State or its agents shall cooperate with CMS and/or its contractor(s) and provide all data needed to monitor and evaluate the Model in accordance with applicable law. Such data may include, but would not be limited to, individually identifiable health information that is needed to carry out CMS’ evaluation and monitoring of this Model. The State shall ensure the production of such data through statutory or regulatory mandates on those holding the required data, or through alternative legal arrangements. The State must ensure that all written agreements and/or legal relationships have been secured with any relevant entities (e.g. Vermont Commercial Plans and Vermont Self-insured Plans) as well as with institutional review boards that are necessary to ensure CMS or its designee(s) can access individual-level, identifiable data and to carry out monitoring and evaluation activities.. CMS shall have the authority to share all Model data, documents, and other information with its designees for evaluation, monitoring, oversight, and other purposes, in accordance with applicable law. CMS shall have the authority to use any data obtained pursuant to the Model to publically disseminate quantitative and qualitative results, in accordance with applicable law.
CMS Evaluation i. CMS will evaluate the Model in accordance with Section 1115A(b)(4) of the Act.
ii. The State must cooperate with CMS and/or CMS’ designee(s) and provide all data that the State is required to provide under the provisions of Section 15 of this Agreement or that CMS may request from the State to evaluate and monitor the Model in accordance with applicable law and this Agreement. Such data may include, but would not be limited to, beneficiary identifiable information that is needed to carry out CMS’ evaluation and monitoring of this Model and the terms of any arrangements related to rate- or budget-setting or payment entered into between the State, Participant Hospitals, and Participant Primary Care Practices prior to or during the Model.
iii. The State must ensure that all necessary written agreements and/or legal relationships have been secured with any relevant entities, agents, or partners and include terms expressly identifying the means by which CMS and CMS’ designee(s) are entitled to access individually identifiable data to carry out evaluation and monitoring activities. See 42 C.F.R. § 403.1110(b).
iv. CMS will share Model data, documents, and other information with its designees for evaluation, monitoring, oversight, and other purposes, in accordance with applicable law. CMS will use any data obtained pursuant to the Model to publicly disseminate de-identified quantitative and qualitative results, in accordance with applicable law.
