CMS Requirements Sample Clauses

CMS Requirements. The principle that a clinician's caseload capacity, including the clinician's secondary caseload capacity, and case management is determined by a range of factors including:

CMS Requirements. 15.1 The Producer agrees to, and shall cause its employee producers and Retail Producers to agree to perform its services hereunder in a manner that is consistent and in compliance with Highmark’s contractual obligations under the Medicare Advantage and Medicare Part D programs. 15.2 The Producer agrees to, and shall cause its employee producers and Retail Producers to agree to, comply with and perform its marketing activities in accordance with all applicable Federal laws, including but not limited to Medicare Advantage and Medicare Part D laws and other federal health care laws (including civil monetary penalty laws), State laws and regulations and instructions of the Centers for Medicare and Medicaid Services (CMS), including but not limited to CMS marketing guidelines, and Highmark Medicare Marketing standards of conduct, as provided in Schedule F to this Agreement. 15.3 Highmark is responsible for ensuring that the Producer complies with the provisions set forth herein. 15.4 The Producer agrees to, and shall cause its employee producers and Retail Producers to agree to comply with State and Federal privacy and security requirements, including the confidentiality and security provisions stated in the regulations for the Medicare Part D program at 42 CFR §423.136 and the Medicare Advantage Program at 42 CFR §422.118. 15.5 The Producer agrees to, and shall cause its employee producers and Retail Producers to agree to make the following disclosures in writing, either prior to enrollment or at the time of enrollment, to a potential enrollee: A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you, with the exception of emergencies. If your doctor or hospital does not agree to accept Highmark’s payment terms and conditions, they may not provide healthcare services to you, except in emergencies. Providers can find the plan’s terms and conditions on Highmark’s website at: xxx.xxxxxxxx.xxx. 15.6 The Producer agrees to grant the U.S. Department of Health and Human Services, the Comptroller General, or their designees, the right to inspect, evaluate and audit any pertinent contracts, books, documents, papers and records of the Producer involving transactions related to Highmark’s contract with CMS for a period of 10 years from the final date of the contract period or the date of audit completion, ...

CMS Requirements. If you choose to be reimbursed by Medicare, please make sure to understand and abide by the DMEPOS Supplier Standards, which are listed entirely in 42.C.F.R pt. 424.57(c), and can also be found at xxx.xxxxxxxxxxxx.xxx/Xxxxxxxx-Xxxxxx.xxxx.

CMS Requirements. (1) If CMS finds that the OPO has changed to such an extent that it no longer satisfies the requirements for OPO designation, CMS may de-certify the OPO and xx- xxxxx the OPO’s service area to be an open area. An OPO may appeal such a de-certification as set forth in § 486.314. The OPO’s service area is not opened for competition until the conclusion of the administrative appeals process. (2) If CMS finds that the changed OPO continues to satisfy the require- ments for OPO designation, the period of designation of the changed OPO is the remaining portion of the 4-year term of the OPO that was reorganized. If more than one designated OPO is in- volved in the reorganization, the re- maining designation term is the long- est of the remaining periods unless CMS determines that a shorter period is in the best interest of the Medicare and Medicaid programs. The changed OPO must continue to meet the re- quirements for certification at § 486.303 throughout the remaining period. Re-Certification and De- Certification