Compliance and Enforcement. A. CMS may revoke its approval of a Next Generation Participant or Preferred Provider to participate as an Eligible SNF under the 3-Day SNF Rule Waiver Benefit Enhancement at any time if the Next Generation Participant or Preferred Provider’s continued participation in this 3-Day SNF Rule Waiver Benefit Enhancement might compromise the integrity of the Next Generation ACO Model. B. The ACO must have appropriate procedures in place to ensure that Next Generation Participants and Preferred Providers have access to the most up-to-date information regarding Next Generation Beneficiary alignment to the ACO. C. The ACO shall submit quarterly reports to CMS, in a manner to be determined by CMS, regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancement. The ACO shall provide CMS with supplemental information upon request regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancement. D. CMS will monitor the ACO’s use of the 3-Day SNF Rule Waiver Benefit Enhancement to ensure that services furnished under the Benefit Enhancement are medically appropriate and consistent with the terms of this Benefit Enhancement. E. In accordance with Section XIX of the Agreement, CMS may terminate or suspend the 3- Day SNF Rule Waiver under Section II of this Appendix or take other remedial action, as appropriate, if the ACO or any of its Next Generation Participants or Preferred Providers fails to comply with the terms and conditions of the 3-Day SNF Rule Waiver Benefit Enhancement. I. Election of the Telehealth Expansion Benefit Enhancement A. Submitted to CMS an Implementation Plan in accordance with Section XI of this Agreement; and B. Submitted in accordance with Section IV of this Agreement a true, accurate, and complete list of Next Generation Participants that have agreed to participate in the Telehealth Expansion Benefit Enhancement and a true, accurate, and complete list of Preferred Providers that have agreed to participate in the Telehealth Expansion Benefit Enhancement.
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Samples: Next Generation Aco Model Participation Agreement, Next Generation Aco Model Participation Agreement
Compliance and Enforcement. A. CMS may revoke its approval reject the ACO’s designation of a Preferred Provider as an Eligible Telehealth Provider or of a Next Generation Participant or Preferred Provider to participate as an Eligible SNF under the 3-Day SNF Rule Waiver Benefit Enhancement Asynchronous Telehealth Provider at any time if the Next Generation Participant or Preferred Provider’s continued participation in this 3-Day SNF Rule Waiver Telehealth Expansion Benefit Enhancement might compromise the integrity of the Next Generation ACO Model.
B. The ACO must have appropriate procedures in place to ensure that Next Generation Participants and Preferred Providers have access to the most up-to-date information regarding Next Generation Beneficiary alignment to the ACO.
C. The ACO shall submit quarterly reports to CMS, in a manner to be determined by CMS, regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancement. The ACO shall provide CMS with supplemental information upon request regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancement.[RESERVED]
D. CMS will monitor the ACO’s use of the 3-Day SNF Rule Waiver Telehealth Expansion Benefit Enhancement to ensure that services furnished under the Benefit Enhancement are medically appropriate and consistent with the terms of this the Benefit Enhancement.
E. In accordance with Section XIX of the this Agreement, CMS may terminate or suspend one or more of the 3- Day SNF Rule Waiver waivers under Section II of this Appendix or take other remedial action, as appropriate, action if the ACO or any of its Next Generation Participants or Preferred Providers fails to comply with the terms and conditions of the 3-Day SNF Rule Waiver Benefit Enhancement.
I. Election of the Telehealth Expansion Benefit Enhancement
A. Submitted . Section 50324 of the Bipartisan Budget Act of 2018 (Pub. L. No. 115-123) (codified at Section 1899(l) of the Act) provides for Medicare payment for certain telehealth services furnished by a physician or other practitioner participating in an applicable ACO to CMS an Implementation Plan in accordance with Beneficiaries who are prospectively aligned to that ACO without regard for the geographic requirements under Section XI 1834(m)(4)(C)(i) of this Agreement; and
B. Submitted in accordance with Section IV of this Agreement a truethe Act, accurateeffective January 1, 2020. This Appendix sets forth the terms and complete list of conditions under which Next Generation Participants that have agreed may receive payment for telehealth services furnished to participate in Next Generation Beneficiaries pursuant to Section 1899(l) of the Telehealth Expansion Benefit Enhancement and Act, provides for a true, accuratewaiver of the originating site requirements to allow for Medicare payment for otherwise covered telehealth services furnished to Beneficiaries by Next Generation Participants during a grace period, and complete list of Preferred Providers that have agreed incorporates Beneficiary safeguards to participate in the Telehealth Expansion Benefit Enhancementensure Beneficiaries are not charged for certain non-covered telehealth services furnished by a Next Generation Participant.
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Compliance and Enforcement. A. The ACO shall ensure, through its agreement with each Next Generation Professional and Preferred Provider that will be participating in the Post-Discharge Home Visits Benefit Enhancement, that the Next Generation Professional or Preferred Provider shall require all auxiliary personnel to comply with the terms of this Agreement and Appendix.
B. CMS may revoke its approval of remove a Next Generation Participant Professional or Preferred Provider to from the list of Next Generation Professionals or Preferred Providers that may participate as an Eligible SNF under the 3-Day SNF Rule Waiver in this Post- Discharge Home Visits Benefit Enhancement at any time if the Next Generation Participant Professional or Preferred Provider’s continued participation in this 3Post-Day SNF Rule Waiver Benefit Discharge Home Visits Benefits Enhancement might compromise the integrity of the Next Generation ACO Model.
B. C. The ACO must have appropriate procedures in place to ensure that Next Generation Participants and Preferred Providers have access to the most up-to-date information regarding Next Generation Beneficiary alignment to the ACO.
C. The D. As a condition of this waiver, the ACO shall is required to submit quarterly reports to CMS, in a manner to be determined by CMS, regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancement. The ACO shall this waiver and to provide CMS with supplemental information upon request regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancementwaiver.
D. E. CMS will monitor the ACO’s use of the 3-Day SNF Rule Waiver Benefit Enhancement waiver under Section II of this Appendix to ensure that services furnished under the Benefit Enhancement waiver are medically appropriate and consistent with the terms of this Benefit Enhancementwaiver.
E. F. In accordance with Section XIX of the this Agreement, CMS may terminate or suspend the 3- Day SNF Rule Waiver under Section II of this Appendix waiver or take other remedial action, as appropriate, action if the ACO or any of its Next Generation Participants or Preferred Providers fails to comply with the terms and conditions of the 3-Day SNF Rule Waiver Benefit Enhancement.waiver under Section II of this Appendix..
I. Election G. Notwithstanding Section XXI.D of the Telehealth Expansion Benefit Enhancement
A. Submitted Agreement, CMS may amend this Appendix K without the ACO’s consent. To the extent practicable, CMS shall provide the ACO with 30 calendar days advance written notice of any such unilateral amendment, which notice shall specify the amendment’s effective date. This Appendix provides requirements regarding the ACO’s financial guarantee for repayment of amounts owed to CMS an Implementation Plan in accordance with as Shared Losses and/or Other Monies Owed, as required under Section XI XIV.D of this Agreement; and
B. Submitted in accordance with Section IV of this Agreement a true, accurate, and complete list of Next Generation Participants that have agreed to participate in the Telehealth Expansion Benefit Enhancement and a true, accurate, and complete list of Preferred Providers that have agreed to participate in the Telehealth Expansion Benefit Enhancement.
Appears in 1 contract
Samples: Participation Agreement (Apollo Medical Holdings, Inc.)
Compliance and Enforcement. A. CMS may revoke its approval reject the ACO’s designation of a Next Generation Participant or Preferred Provider to participate as an Eligible SNF under Telehealth Provider at any time if the 3-Day SNF Rule Waiver Next Generation Participant or Preferred participate in this Telehealth Expansion Benefit Enhancement at any time if the Next Generation Participant or Preferred Provider’s continued participation in this 3-Day SNF Rule Waiver Telehealth Expansion Benefit Enhancement might compromise the integrity of the Next Generation ACO Model.
B. The ACO must have appropriate procedures in place to ensure that Next Generation Participants and Preferred Providers have access to the most up-to-date information regarding Next Generation Beneficiary alignment to the ACO.
C. The As a condition of this waiver, the ACO shall is required to submit quarterly reports to CMS, in a manner to be determined by CMS, regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancement. The ACO shall this waiver and to provide CMS with supplemental information upon request regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancementwaiver.
D. CMS will monitor the ACO’s use of the 3-Day SNF Rule Waiver Benefit Enhancement waiver under Section II of this Appendix to ensure that services furnished under the Benefit Enhancement waiver are medically appropriate and consistent with the terms of this Benefit Enhancementthe waiver.
E. In accordance with Section XIX of the this Agreement, CMS may terminate or suspend the 3- Day SNF Rule Waiver under Section II of this Appendix waiver or take other remedial action, as appropriate, action if the ACO or any of its Next Generation Participants or Preferred Providers fails to comply with the terms and conditions of the 3-Day SNF Rule Waiver Benefit Enhancementwaiver under Section II of this Appendix.
I. Election F. Notwithstanding Section XXI.D of the Telehealth Expansion Benefit Enhancement
A. Submitted to Agreement, CMS an Implementation Plan in accordance may amend this Appendix J without the ACO’s consent. To the extent practicable, CMS shall provide the ACO with Section XI 30 calendar days advance written notice of this Agreement; and
B. Submitted in accordance with Section IV of this Agreement a trueany such unilateral amendment, accurate, and complete list of Next Generation Participants that have agreed to participate in which notice shall specify the Telehealth Expansion Benefit Enhancement and a true, accurate, and complete list of Preferred Providers that have agreed to participate in the Telehealth Expansion Benefit Enhancementamendment’s effective date.
Appears in 1 contract
Samples: Participation Agreement (Apollo Medical Holdings, Inc.)
Compliance and Enforcement. A. CMS may revoke its approval of a Next Generation Participant or Preferred Provider to participate as an Eligible SNF under the 3-Day SNF Rule Waiver Benefit Enhancement at any time if the Next Generation Participant or Preferred Provider’s continued participation in this 3-Day SNF Rule Waiver Benefit Enhancement might compromise the integrity of the Next Generation ACO Model.
B. The ACO must have appropriate procedures in place to ensure that Next Generation Participants and Preferred Providers have access to the most up-to-date information regarding Next Generation Beneficiary alignment to the ACO.
C. The ACO shall submit quarterly reports to CMS, in a manner to be determined by CMS, regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancementunder Section II of this Appendix. The ACO shall provide CMS with supplemental information upon request regarding its use of the 3-Day SNF Rule Waiver Benefit EnhancementWaiver.
D. CMS will monitor the ACO’s use of the 3-Day SNF Rule Waiver Benefit Enhancement under Section II of this Appendix to ensure that services furnished under the Benefit Enhancement waiver are medically appropriate and consistent with the terms of this Benefit Enhancementwaiver.
E. In accordance with Section XIX of the Agreement, CMS may terminate or suspend the 3- Day SNF Rule Waiver under Section II of this Appendix or take other remedial action, as appropriate, if the ACO or any of its Next Generation Participants or Preferred Providers fails to comply with the terms and conditions of the 3-Day SNF Rule Waiver Benefit EnhancementWaiver.
I. Election F. Notwithstanding Section XXI.D of the Telehealth Expansion Benefit Enhancement
A. Submitted to Agreement, CMS an Implementation Plan in accordance may amend this Appendix I without the ACO’s consent. To the extent practicable, CMS shall provide the ACO with Section XI 30 calendar days advance written notice of this Agreement; and
B. Submitted in accordance with Section IV of this Agreement a trueany such unilateral amendment, accurate, and complete list of Next Generation Participants that have agreed to participate in which notice shall specify the Telehealth Expansion Benefit Enhancement and a true, accurate, and complete list of Preferred Providers that have agreed to participate in the Telehealth Expansion Benefit Enhancementamendment’s effective date.
Appears in 1 contract
Samples: Participation Agreement (Apollo Medical Holdings, Inc.)