Common use of GMCB Duties Clause in Contracts

GMCB Duties. i. In order for a Vermont ACO to be eligible to participate in the Vermont Medicare ACO Initiative or be eligible to become a Vermont Modified Next Generation ACO, the GMCB must submit to CMS a letter jointly signed by the GMCB and the Vermont ACO attesting that the two entities will work together to achieve the ACO Scale Targets, Statewide Financial Targets, and Statewide Health Outcomes and Quality of Care Targets of the Vermont All-payer ACO Model. The GMCB and the Vermont ACO shall submit the letter in a manner and by a deadline determined by CMS. ii. Except as described in sections 7.c and 9.d, the GMCB shall prospectively develop the Vermont Medicare ACO Initiative Benchmarks for both Vermont Modified Next Generation ACOs and VMA ACOs for Performance Year 1 and subsequent Performance Years in accordance with the terms of this Agreement and subject to CMS approval. 1. The methodology for developing the Vermont Medicare ACO Initiative Benchmarks must be consistent with each of the following principles and criteria: a. The Vermont Medicare ACO Initiative Benchmarks should incentivize high-quality care, promote efficient care, and support improvement in the health of aligned beneficiaries. b. For Performance Year 1: i. If the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be less than 2.7 percent, as discussed in section 9.b.iv, the growth rates for the Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be no greater than 1.0 percentage point above the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1; or ii. If the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be less than 3.7 percent but greater than or equal to 2.7 percent, as discussed in section 9.b.iv, the growth rates for Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be no more than 3.5 percent; or iii. If the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be greater than or equal to 3.7 percent, the growth rates for Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be at least 0.1 percentage points below the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1.

GMCB Duties. i. In order for a Vermont ACO to be eligible to participate in the Vermont Medicare ACO Initiative or be eligible to become a Vermont Modified Next Generation ACO, the GMCB must submit to CMS a letter jointly signed by the GMCB and the Vermont ACO attesting that the two entities will work together to achieve the ACO Scale Targets, Statewide Financial Targets, and Statewide Health Outcomes and Quality of Care Targets of the Vermont All-payer ACO Model. The GMCB and the Vermont ACO shall submit the letter in a manner and by a deadline determined by CMS. ii. Except as described in sections 7.c and 9.d, the GMCB shall prospectively develop the Vermont Medicare ACO Initiative Benchmarks for both Vermont Modified Next Generation ACOs and VMA ACOs for Performance Year 1 and subsequent Performance Years in accordance with the terms of this Agreement and subject to CMS approval. 1. The methodology for developing the Vermont Medicare ACO Initiative Benchmarks must be consistent with each of the following principles and criteria: a. The Vermont Medicare ACO Initiative Benchmarks should incentivize high-quality care, promote efficient care, and support improvement in the health of aligned beneficiaries. b. For Performance Year 1: i. If the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be less than 2.7 percent, as discussed in section 9.b.iv, the growth rates for the Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be no greater than 1.0 percentage point above the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1; orTotal ii. If the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be less than 3.7 percent but greater than or equal to 2.7 percent, as discussed in section 9.b.iv, the growth rates for Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be no more than 3.5 percent; or iii. If the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be greater than or equal to 3.7 percent, the growth rates for Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be at least 0.1 percentage points below the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1.

GMCB Duties. i. In order for a Vermont ACO to be eligible to participate in the Vermont Medicare ACO Initiative or be eligible to become a Vermont Modified Next Generation ACO, the GMCB must submit to CMS a letter jointly signed by the GMCB and the Vermont ACO attesting that the two entities will work together to achieve the ACO Scale Targets, Statewide Financial Targets, and Statewide Health Outcomes and Quality of Care Targets of the Vermont All-payer ACO Model. The GMCB and the Vermont ACO shall submit the letter in a manner and by a deadline determined by CMS. ii. Except as described in sections 7.c 5.c and 9.d6.d of this Agreement, the GMCB shall prospectively develop the Vermont Medicare ACO Initiative Benchmarks for both Vermont Modified Next Generation ACOs and each VMA ACOs for Performance Year 1 and subsequent Performance Years ACO in accordance with the terms of this Agreement and subject to CMS approvalagreement. 1. The benchmarking methodology for developing the Vermont Medicare ACO Initiative Benchmarks must shall be consistent with each of the following principles and criteriaprinciples: a. The Vermont Medicare ACO Initiative Benchmarks should incentivize high-Incentivize high quality care, promote and efficient care, care and support improvement in the health of for aligned beneficiaries.; b. For If for Performance Year 1: i. If 1 the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be less than 2.7 percent, as discussed in section 9.b.iv, the growth rates for the Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be no greater than 1.0 percentage point above the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1; or ii. If the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be less than 3.7 percent but greater than or equal to 2.7 percent, (as discussed in section 9.b.iv6.b.iii), have the growth rates for Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be no more than come in at most 3.5 percent; or iii. If for Performance Year 1 the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be greater than or equal to 3.7 percent, have the growth rates for Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be come in at least 0.1 percentage points below the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1. c. For Performance Years 2-5 have the Vermont Medicare ACO Initiative Benchmarks either i. Be such that the growth rates for Vermont Medicare ACO Initiative Benchmarks come in at least 0.2 percentage points (or 0.1 percentage points if, as discussed in section 6.b.iii, the Projected National Medicare Total Cost of Care per Beneficiary Growth for PY1 is calculated to be is less than 3.7 percent) below the Projected National Medicare Total Cost of Care per Beneficiary Growth for the Performance Year during which the Vermont Medicare ACO Initiative Benchmark would be applicable, or ii. Be such that the compounded annualized growth rates for Vermont Medicare ACO Initiative Benchmarks over PY1 through the Performance Year in question come in at less than 0.1 percentage points above the compounded annualized growth rate for the Projected National Medicare Total Cost of Care per Beneficiary Growth over the same period of time; d. Apply the growth rates in (b) and (c) to the best estimate available on Medicare FFS expenditures incurred during the year prior to the Performance Year in question for the Medicare FFS beneficiaries who are aligned to the Vermont Modified Next Generation ACO for PY1 and VMA ACO for PY2-PY5, respectively. e. Enable achievement of the Financial Targets described above in section 6; f. Incorporate ACO quality performance into the benchmark; g. Place a percentage of benchmarks at risk due to ACO quality performance that at minimum meets the percentage tied to ACO quality scores for ACOs participating in the Next Generation ACO Model; h. Mitigate adverse patient selection, or any behavior to increase the alignment of healthier beneficiaries while avoiding more medically complex beneficiaries; i. Provide benchmarks to the ACO prospectively; and j. Set separate benchmarks for Medicare FFS Aged and Disabled beneficiaries and ESRD beneficiaries. 2. The GMCB shall submit to CMS for approval the Vermont Medicare ACO Initiative Benchmarks for each VMA ACO at least 30 days prior to the beginning of each Performance Year for which the benchmarks would be applicable. CMS will assess the benchmarks to ensure consistency with standards articulated in section 7.b.ii.1 and will make a decision within 10 days of GMCB’s submission on whether to approve the Vermont Medicare ACO Initiative Benchmarks. iii. For Performance Year 1 of the Model, before the Initiative begins, Vermont shall develop the Vermont Medicare ACO Initiative Benchmarks for each Vermont Modified Next Generation ACO in the same manner as the requirements, exceptions, and standards articulated in Sections 5.c, 6.d, and 7.b.ii of this Agreement. iv. To the extent it has the authority, the GMCB may direct a VMA ACO and a Vermont Modified Next Generation ACO, to make specific infrastructure and care delivery investments. v. GMCB shall obtain waivers of all state fraud and abuse laws necessary to implement the Model and the Initiative. vi. The GMCB shall work with CMS throughout the year prior to each Performance Year to analyze and understand data to inform how Vermont Medicare ACO Initiative Benchmarks are set for Vermont Modified Next Generation ACOs and VMA ACOs.

GMCB Duties. i. In order for a Vermont ACO to be eligible to participate in the Vermont Medicare ACO Initiative or be eligible to become a Vermont Modified Next Generation ACO, the GMCB must submit to CMS a letter jointly signed by the GMCB and the Vermont ACO attesting that the two entities will work together to achieve the ACO Scale Targets, Statewide Financial Targets, and Statewide Health Outcomes and Quality of Care Targets of the Vermont All-payer ACO Model. The GMCB and the Vermont ACO shall submit the letter in a manner and by a deadline determined by CMS. ii. Except as described in sections 7.c 5.c and 9.d6.d of this Agreement, the GMCB shall prospectively develop the Vermont Medicare ACO Initiative Benchmarks for both Vermont Modified Next Generation ACOs and each VMA ACOs for Performance Year 1 and subsequent Performance Years ACO in accordance with the terms of this Agreement and subject to CMS approvalagreement. 1. The benchmarking methodology for developing the Vermont Medicare ACO Initiative Benchmarks must shall be consistent with each of the following principles and criteriaprinciples: a. The Vermont Medicare ACO Initiative Benchmarks should incentivize high-Incentivize high quality care, promote and efficient care, care and support improvement in the health of for aligned beneficiaries.; b. For If for Performance Year 1: i. If 1 the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be less than 2.7 percent, as discussed in section 9.b.iv, the growth rates for the Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be no greater than 1.0 percentage point above the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1; or ii. If the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be less than 3.7 percent but greater than or equal to 2.7 percent, (as discussed in section 9.b.iv6.b.iii), have the growth rates for Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be no more than come in at most 3.5 percent; or iii. If for Performance Year 1 the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1 is calculated to be greater than or equal to 3.7 percent, have the growth rates for Vermont Medicare ACO Initiative Benchmarks for Performance Year 1 must be come in at least 0.1 percentage points below the Annual Projected National Medicare Total Cost of Care per Beneficiary Growth for Performance Year 1. c. For Performance Years 2-5 have the Vermont Medicare ACO Initiative Benchmarks either i. Be such that the growth rates for Vermont Medicare ACO Initiative Benchmarks come in at least 0.2 percentage points (or 0.1 percentage points if, as discussed in section 6.b.iii, the Projected National Medicare Total Cost of Care per Beneficiary Growth for PY1 is calculated to be is less than 3.7 percent) below the Projected National Medicare Total Cost of Care per Beneficiary Growth for the Performance Year during which the Vermont Medicare ACO Initiative Benchmark would be applicable, or ii. Be such that the compounded annualized growth rates for Vermont Medicare ACO Initiative Benchmarks over PY1 through the Performance Year in question come in at less than 0.1 percentage points above the compounded annualized growth rate for the Projected National Medicare Total Cost of Care per Beneficiary Growth over the same period of time; d. Apply the growth rates in (b) and (c) to the best estimate available on Medicare FFS expenditures incurred during the year prior to the Performance Year in question for the Medicare FFS beneficiaries who are aligned to the Vermont Modified Next Generation ACO for PY1 and VMA ACO for PY2-PY5, respectively. e. Enable achievement of the Financial Targets described above in section 6; f. Incorporate ACO quality performance into the benchmark; g. Place a percentage of benchmarks at risk due to ACO quality performance that at minimum meets the percentage tied to ACO quality scores for ACOs participating in the Next Generation ACO Model; h. Mitigate adverse patient selection, or any behavior to increase the alignment of healthier beneficiaries while avoiding more medically complex beneficiaries; i. Provide benchmarks to the ACO prospectively; and j. Set separate benchmarks for Medicare FFS Aged and Disabled beneficiaries and ESRD beneficiaries. 2. The GMCB shall submit to CMS for approval the Vermont Medicare ACO Initiative Benchmarks for each VMA ACO at least 30 days prior to the beginning of each Performance Year for which the benchmarks would be applicable. CMS will assess the benchmarks to ensure consistency with standards articulated in section 7.b.ii.1 and will make a decision within 10 days of GMCB’s submission on whether to approve the Vermont Medicare ACO Initiative Benchmarks. iii. For Performance Year 1 of the Model, before the Initiative begins, Vermont shall develop the Vermont Medicare ACO Initiative Benchmarks for each Vermont Modified Next Generation ACO in the same manner as the requirements, exceptions, and standards articulated in Sections 5.c, 6.d, and 7.b.ii of this Agreement. iv. To the extent it has the authority, the GMCB may direct a VMA ACO and a Vermont Modified Next Generation ACO, to make specific infrastructure and care delivery investments. v. GMCB shall obtain waivers of all state fraud and abuse laws necessary to implement the Model and the Initiative. vi. The GMCB shall work with CMS throughout the year prior to each Performance Year to analyze and understand data to inform how Vermont Medicare ACO Initiative Benchmarks are set for Vermont Modified Next Generation ACOs and VMA ACOs.