Common use of Generation Participant and Preferred Provider Overlap Clause in Contracts

Generation Participant and Preferred Provider Overlap. X. Xxxxxxxx to section 1899(b)(4)(A) of the Act, a Next Generation Participant may not also be an ACO participant, ACO provider/supplier and/or ACO professional in an accountable care organization in the MSSP. B. A Next Generation Professional who is a primary care specialist as defined in Appendix B of this Agreement may not: (a) be identified as a Next Generation Participant by a different accountable care organization in this Model; (b) be an ACO participant, ACO provider/supplier or ACO professional in the MSSP; or (c) participate in another Medicare shared savings initiative, except as expressly permitted by CMS. C. A Next Generation Participant who is a non-primary care specialist as defined in Appendix B of this Agreement may be a Next Generation Participant in another accountable care organization in this Model, or serve in an equivalent role in any other shared savings initiative in which such non-primary care specialists are not required to be exclusive to one participating entity. D. A Preferred Provider may serve in the following roles provided all other applicable requirements are met: 1. Preferred Provider for one or more other accountable care organizations participating in this Model; 2. Subject to Section III.B of this Appendix, Next Generation Participant in one or more other accountable care organizations participating in this Model; 3. Pursuant to the waiver in Section I of this Appendix, an ACO participant, ACO provider/supplier, and/or ACO professional in an accountable care organization in the MSSP; and/or 4. Role similar in function to a Next Generation Participant in another shared savings initiative. 1.1. Overview of Performance Year Benchmark Methodology 3

Generation Participant and Preferred Provider Overlap. X. Xxxxxxxx to section 1899(b)(4)(A) of the Act, a Next Generation Participant may not also be an ACO participant, ACO provider/supplier and/or ACO professional in an accountable care organization in the MSSP. B. A Next Generation Professional who is a primary care specialist as defined in Appendix B of this Agreement may not: (a) be identified as a Next Generation Participant by a different accountable care organization in this Model; (b) be an ACO participant, ACO provider/supplier or ACO professional in the MSSP; or (c) participate in another Medicare shared savings initiative, except as expressly permitted by CMS. C. A Next Generation Participant who is a non-primary care specialist as defined in Appendix B of this Agreement may be a Next Generation Participant in another accountable care organization in this Model, or serve in an equivalent role in any other shared savings initiative in which such non-primary care specialists are not required to be exclusive to one participating entity. D. A Preferred Provider may serve in the following roles provided all other applicable requirements are met: 1. Preferred Provider for one or more other accountable care organizations participating in this Model; 2. Subject to Section III.B of this Appendix, Next Generation Participant in one or more other accountable care organizations participating in this Model; 3. Pursuant to the waiver in Section I of this Appendix, an ACO participant, ACO provider/supplier, and/or ACO professional in an accountable care organization in the MSSP; and/or 4. Role similar in function to a Next Generation Participant in another shared savings initiative. 1.1. Overview of The document, “Next Generation ACO Model Benchmarking Methods Performance Years 1 through 3,” prepared by RTI International following this Appendix B cover sheet represents Appendix B “Next Generation ACO Alignment and Financial Reconciliation” for Performance Year Benchmark Methodology 32018 and subsequent Performance Years. Next Generation ACO Model Benchmarking Methods Performance Years 1 through 3 December 8, 2017