Common use of Exception for Certain In-Kind Remuneration Clause in Contracts

Exception for Certain In-Kind Remuneration. 1. Consistent with the provisions of Sections 5.08.A and 5.08.B, and subject to compliance with all other applicable laws and regulations, beginning on the Start Date, the ACO may provide and may permit its Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities to provide certain in-kind items or services to Beneficiaries in conjunction with any ACO Activities if the following conditions are satisfied: a. The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the Beneficiary: adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition. b. The in-kind item or service has a reasonable connection to the Beneficiary’s health care. c. The in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01. d. The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary Alignment. e. The in-kind item or service is furnished to a Beneficiary directly by the ACO, a Participant Provider, or a Preferred Provider. 2. For each in-kind item or service provided under this Section 5.08.C, the ACO shall maintain and make available to the government upon request, and shall require its Participant Providers and Preferred Providers to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. Such materials and records must be maintained in accordance with Section 16.02 and include, without limitation, documentation of the following: a. The nature of the in-kind item or service; b. The identity of each Beneficiary that received the in-kind item or service; c. The identity of the individual or entity that furnished the in-kind item or service; and d. The date the in-kind item or service was furnished.

Exception for Certain In-Kind Remuneration. 1. (i) Consistent with the provisions of Sections 5.08.A 4.6(a) and 5.08.B4.6(b), and subject to compliance with all other applicable laws and regulations, beginning on the Start DateJanuary 1, 2024, the ACO MDPCP Practice may provide provide, and may permit its Participant Providers, Preferred Providers, and MDPCP Practitioners or other individuals or entities performing functions or providing services related to ACO MDPCP Practice Site Activities to provide provide, certain in-kind items or services to MDPCP Beneficiaries in conjunction with any ACO Activities if the following conditions are satisfied: a. (A) The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the MDPCP Beneficiary: adherence to a treatment regimeregimen, adherence to a drug regimeregimen, adherence to a follow-up care plan, or management of a chronic disease or conditioncare plan. b. (B) The in-kind item or service has a reasonable connection to the MDPCP Beneficiary’s health care. c. (C) The in-kind item or service is not a Medicare-covered item or service for the MDPCP Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01. d. The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary Alignment. e. (D) The in-kind item or service is furnished to a an MDPCP Beneficiary directly by the ACOMDPCP Practice, a Participant ProviderMDPCP Practitioner, or a Preferred Providerby an agent of the MDPCP Practice operating under the MDPCP Practice’s direction and control. 2. (ii) For each in-kind item or service provided under this Section 5.08.C4.6(c), the ACO MDPCP Practice shall maintain and make available to the government upon request, request and shall require its Participant Providers and Preferred Providers MDPCP Practitioners to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. 4.6(c). Such materials and records must be maintained in accordance with Section 16.02 Article XII and include, without limitation, documentation of the following: a. (A) The nature of the in-kind item or service; b. (B) The identity of each MDPCP Beneficiary that received the in-kind item or service; c. (C) The identity of the individual or entity that furnished the in-kind item or service; and d. (D) The date the in-kind item or service was furnished.

Exception for Certain In-Kind Remuneration. 1. Consistent with the provisions of Sections 5.08.A and 5.08.B, and subject to compliance with all other applicable laws and regulations, beginning on the Start Date, the ACO may provide and may permit its Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities to provide certain in-kind items or services to Beneficiaries in conjunction with any ACO Activities if the following conditions are satisfied: a. The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the Beneficiary: adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition. b. The in-kind item or service has a reasonable connection to the Beneficiary’s health care. c. The in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01. d. The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary Alignment. e. The in-kind item or service is furnished to a Beneficiary directly by the ACO, a Participant Provider, or a Preferred Provider. 2. For each in-kind item or service provided under this Section 5.08.C, the ACO shall maintain and make available to the government upon request, and shall require its Participant Providers and Preferred Providers to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. Such materials and records must be maintained in accordance with Section 16.02 and include, without limitation, documentation of the following: a. The nature of the in-kind item or service; b. The identity of each Beneficiary that received the in-kind item or service; c. The identity of the individual or entity that furnished the in-kind item or service; and d. The date the in-kind item or service was furnished.with

Exception for Certain In-Kind Remuneration. 1. Consistent with the provisions of Sections 5.08.A and 5.08.B, 5.08.B and subject to compliance with all other applicable laws and regulations, beginning on the Start Date, the ACO may provide and may permit its Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities to provide certain in-kind items or services to Beneficiaries in conjunction with any ACO Activities if the following conditions are satisfied: a. The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the Beneficiary: adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition. b. The in-kind item or service has a reasonable connection to the Beneficiary’s health care. c. The in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01. d. The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary Alignment. e. The in-kind item or service is furnished to a Beneficiary directly by the ACO, a Participant Provider, or a Preferred Provider. 2. For each in-kind item or service provided under this Section 5.08.C, the ACO shall maintain and make available to the government upon request, and shall require its Participant Providers and Preferred Providers to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. Such materials and records must be maintained in accordance with Section 16.02 and include, without limitation, documentation of the following: a. The nature of the in-kind item or service; b. The identity of each Beneficiary that received the in-kind item or service; c. The identity of the individual or entity that furnished the in-kind item or service; and d. The date the in-kind item or service was furnished.with

Exception for Certain In-Kind Remuneration. 1. Consistent with the provisions of Sections 5.08.A and 5.08.B, and subject to compliance with all other applicable laws and regulations, beginning on the Start Date, the ACO DCE may provide and may permit its DC Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO DCE Activities to provide certain in-kind items or services to Beneficiaries in conjunction with any ACO DCE Activities if the following conditions are satisfied: a. The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the Beneficiary: adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition.; b. The in-kind item or service has a reasonable connection to the Beneficiary’s health care.; c. The in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO DCE has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01. d. The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a DC Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary Alignment. e. The in-kind item or service is furnished to a Beneficiary directly by the ACODCE, a DC Participant Provider, or a Preferred Provider. 2. For each in-kind item or service provided under this Section 5.08.C, the ACO DCE shall maintain and make available to the government upon request, and shall require its DC Participant Providers and Preferred Providers to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. Such materials and records must be maintained in accordance with Section 16.02 and include, without limitation, documentation of the following: a. The nature of the in-kind item or service; b. The identity of each Beneficiary that received the in-kind item or service; c. The identity of the individual or entity that furnished the in-kind item or service; and d. The date the in-kind item or service was furnished.

Exception for Certain In-Kind Remuneration. 1. Consistent with the provisions of Sections 5.08.A and 5.08.B, and subject to compliance with all other applicable laws and regulations, beginning on the Start Date, the ACO DCE may provide and may permit its DC Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO DCE Activities to provide certain in-kind items or services to Beneficiaries in conjunction with any ACO DCE Activities if the following conditions are satisfied: a. The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the Beneficiary: adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition.; b. The in-kind item or service has a reasonable connection to the Beneficiary’s 's health care.; c. The in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO DCE has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01. d. The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a DC Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary Alignment. e. The in-kind item or service is furnished to a Beneficiary directly by the ACODCE, a DC Participant Provider, or a Preferred Provider. 2. For each in-kind item or service provided under this Section 5.08.C, the ACO DCE shall maintain and make available to the government upon request, and shall require its DC Participant Providers and Preferred Providers to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. Such materials and records must be maintained in accordance with Section 16.02 and include, without limitation, documentation of the following: a. The nature of the in-kind item or service; b. The identity of each Beneficiary that received the in-kind item or service; c. The identity of the individual or entity that furnished the in-kind item or service; and d. The date the in-kind item or service was furnished.

Exception for Certain In-Kind Remuneration. 1. Consistent with the provisions of Sections 5.08.A and 5.08.B, 5.08.B and subject to compliance with all other applicable laws and regulations, beginning on the Start Date, the ACO may provide and may permit its Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities to provide certain in-kind items or services to Beneficiaries in conjunction with any ACO Activities if the following conditions are satisfied: a. The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the Beneficiary: adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition.; b. The in-kind item or service has a reasonable connection to the Beneficiary’s health care.; c. The in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01. d. The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary Alignment. e. The in-kind item or service is furnished to a Beneficiary directly by the ACO, a Participant Provider, or a Preferred Provider. 2. For each in-kind item or service provided under this Section 5.08.C, the ACO shall maintain and make available to the government upon request, and shall require its Participant Providers and Preferred Providers to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. Such materials and records must be maintained in accordance with Section 16.02 and include, without limitation, documentation of the following: a. The nature of the in-kind item or service; b. The identity of each Beneficiary that received the in-kind item or service; c. The identity of the individual or entity that furnished the in-kind item or service; and d. The date the in-kind item or service was furnished.

Exception for Certain In-Kind Remuneration. 1. Consistent with the provisions of Sections 5.08.A and 5.08.B, 5.08.B and subject to compliance with all other applicable laws and regulations, beginning on the Start Date, the ACO may provide and may permit its Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities to provide certain in-kind items or services to Beneficiaries in conjunction with any ACO Activities if the following conditions are satisfied: a. The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the Beneficiary: adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition.; b. The in-kind item or service has a reasonable connection to the Beneficiary’s health care.; c. The in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01. d. The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary Alignment. e. The in-kind item or service is furnished to a Beneficiary directly by the ACO, a Participant Provider, or a Preferred Provider. 2. For each in-kind item or service provided under this Section 5.08.C, the ACO shall maintain and make available to the government upon request, and shall require its Participant Providers and Preferred Providers to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. Such materials and records must be maintained in accordance with Section 16.02 and include, without limitation, documentation of the following: a. The nature of the in-kind item or service; b. The identity of each Beneficiary that received the in-kind item or service; c. The identity of the individual or entity that furnished the in-kind item or service; and d. The date the in-kind item or service was furnished.with