Day SNF Rule Waiver Benefit Enhancement. A. Appendix I shall apply to the Agreement for any Performance Year for which the ACO has selected the 3-Day SNF Rule Waiver 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 3-Day SNF Rule Waiver 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 3-Day SNF Rule Waiver Benefit Enhancement, an individual or entity must be: 1. A Participant Provider or Preferred Provider; and 2. A skilled-nursing facility (“SNF”) or a hospital or critical access hospital that has swing-bed approval for Medicare post-hospital extended care services (“Swing-Bed Hospital”); and 3. Designated on the Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the 3-Day SNF Rule Waiver Benefit Enhancement; and 4. Approved by CMS according to the criteria described in this Section
Appears in 3 contracts
Samples: Participation Agreement, Participation Agreement, Participation Agreement
Day SNF Rule Waiver Benefit Enhancement.
A. Appendix I shall apply to the Agreement for any Performance Year for which the ACO has selected the 3-Day SNF Rule Waiver 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 3-Day SNF Rule Waiver 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 3-Day SNF Rule Waiver Benefit Enhancement, an individual or entity must be:
1. A Participant Provider or Preferred Provider; and
2. A skilled-nursing facility (“SNF”) or a hospital or critical access hospital that has swing-bed approval for Medicare post-hospital extended care services (“Swing-Bed Hospital”); and
3. Designated on the Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the 3-Day SNF Rule Waiver Benefit Enhancement; and
4. Approved by CMS according to the criteria described in this Section
Appears in 3 contracts
Samples: Participation Agreement, Participation Agreement, Model Performance Period Participation Agreement
Day SNF Rule Waiver Benefit Enhancement.
A. Appendix I shall apply to the Agreement for any Performance Year for which the ACO DCE has selected the 3-Day SNF Rule Waiver Benefit Enhancement as described in Section 8.01 and for which the ACO DCE has submitted an Implementation Plan under Section 10.01.B for the 3-Day SNF Rule Waiver Benefit Enhancement and CMS has not rejected the ACO’s 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 REACH DC Beneficiaries pursuant to the 3-Day SNF Rule Waiver Benefit Enhancement, an individual or entity must be:
1. A DC Participant Provider or Preferred Provider; and
2. A skilled-nursing facility (“SNF”) or a hospital or critical access hospital that has swing-bed approval for Medicare post-hospital extended care services (“Swing-Bed Hospital”); and
3. Designated on the DC Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the 3-Day SNF Rule Waiver Benefit Enhancement; and
4. Approved by CMS according to the criteria described in this Section
Appears in 1 contract
Samples: Global and Professional Direct Contracting Model Participation Agreement
Day SNF Rule Waiver Benefit Enhancement.
A. Appendix I shall apply to the Agreement for any Performance Year for which the ACO DCE has selected the 3-Day SNF Rule Waiver Benefit Enhancement as described in Section 8.01 and for which the ACO DCE has submitted an Implementation Plan under Section 10.01.B for the 3-Day SNF Rule Waiver Benefit Enhancement and CMS has not rejected the ACODCE’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 DC Beneficiaries pursuant to the 3-Day SNF Rule Waiver Benefit Enhancement, an individual or entity must be:
1. A DC Participant Provider or Preferred Provider; and
2. A skilled-nursing facility (“SNF”) or a hospital or critical access hospital that has swing-bed approval for Medicare post-hospital extended care services (“Swing-Bed Hospital”); and
3. Designated on the DC Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the 3-Day SNF Rule Waiver Benefit Enhancement; and
4. Approved by CMS according to the criteria described in this Section
Appears in 1 contract
Samples: Global and Professional Direct Contracting Model Performance Period Participation Agreement
