Common use of Home Health Homebound Waiver Benefit Enhancement Clause in Contracts

Home Health Homebound Waiver Benefit Enhancement. ‌ A. Appendix N shall apply to the Agreement for any Performance Year for which the ACO has selected the Home Health Homebound 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 Home Health Homebound Waiver Benefit Enhancement and CMS has not rejected the ACO’s selection pursuant to Section 8.02 or Section 10.01.E. B. The ACO shall require that, in order to be eligible to submit claims for services furnished to REACH Beneficiaries pursuant to the Home Health Homebound Waiver Benefit Enhancement, the individual or entity must be: 1. A home health agency that is a Participant Provider or Preferred Provider; and 2. Designated on the Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the Home Health Homebound Waiver Benefit Enhancement; and 3. Approved by CMS according to the criteria described in this Section 10.06.B and Appendix N of the Agreement. C. If CMS notifies the ACO that a home health agency that is a Participant Provider or Preferred Provider has not been approved for participation in the Home Health Homebound Waiver Benefit Enhancement under this Section 10.06, but the home health agency is otherwise eligible to be a Participant Provider or Preferred Provider, the ACO may either remove the home health agency from the Participant Provider or Preferred Provider List, or amend the relevant list to reflect that the home health agency will not participate in the Home Health Homebound Waiver Benefit Enhancement. The ACO shall amend the relevant list no later than 30 Days after the date of the notice from CMS. D. The ACO shall ensure the Participant Providers and Preferred Providers do not substitute home health services for inpatient services when inpatient services are more clinically appropriate. E. The ACO shall ensure that Participant Providers and Preferred Providers only furnish Medically Necessary home health services and do not use home health services to prevent or deter a Beneficiary from seeking or receiving inpatient care when such care is Medically Necessary.

Home Health Homebound Waiver Benefit Enhancement. ‌ A. Appendix N shall apply to the Agreement for any Performance Year for which the ACO has selected the Home Health Homebound 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 Home Health Homebound Waiver Benefit Enhancement and CMS has not rejected the ACO’s selection pursuant to Section 8.02 or Section 10.01.E. B. The ACO shall require that, in order to be eligible to submit claims for services furnished to REACH Beneficiaries pursuant to the Home Health Homebound Waiver Benefit Enhancement, the individual or entity must be: 1. A home health agency that is a Participant Provider or Preferred Provider; and 2. Designated on the Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the Home Health Homebound Waiver Benefit Enhancement; and 3. Approved by CMS according to the criteria described in this Section 10.06.B and Appendix N of the Agreement. C. If CMS notifies the ACO that a home health agency that is a Participant Provider or Preferred Provider has not been approved for participation in the Home Health Homebound Waiver Benefit Enhancement under this Section 10.06, but the home health agency is otherwise eligible to be a Participant Provider or Preferred Provider, the ACO may either remove the home health agency from the Participant Provider or Preferred Provider List, or amend the relevant list to reflect that the home health agency will not participate in the Home Health Homebound Waiver Benefit Enhancement. The ACO shall amend the relevant list no later than 30 Days after the date of the notice from CMS. D. The ACO shall ensure the Participant Providers and Preferred Providers do not substitute home health services for inpatient services when inpatient services are more clinically appropriate. E. The ACO shall ensure that Participant Providers and Preferred Providers only furnish Medically Necessary home health services and do not use home health services to prevent or deter a Beneficiary from seeking or receiving inpatient care when such care is Medically Necessary.

Home Health Homebound Waiver Benefit Enhancement. ‌ A. Appendix N shall apply to the Agreement for any Performance Year for which the ACO DCE has selected the Home Health Homebound 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 Home Health Homebound Waiver Benefit Enhancement and CMS has not rejected the ACODCE’s selection pursuant to Section 8.02 or Section 10.01.E. B. The ACO DCE shall require that, in order to be eligible to submit claims for services furnished to REACH DC Beneficiaries pursuant to the Home Health Homebound Waiver Benefit Enhancement, the individual or entity must be: 1. A home health agency that is a DC Participant Provider or Preferred Provider; and 2. Designated on the DC Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the Home Health Homebound Waiver Benefit Enhancement; and 3. Approved by CMS according to the criteria described in this Section 10.06.B and Appendix N of the Agreement. C. If CMS notifies the ACO DCE that a home health agency that is a DC Participant Provider or Preferred Provider has not been approved for participation in the Home Health Homebound Waiver Benefit Enhancement under this Section 10.06, but the home health agency is otherwise eligible to be a DC Participant Provider or Preferred Provider, the ACO DCE may either remove the home health agency from the DC Participant Provider or Preferred Provider List, or amend the relevant list to reflect that the home health agency will not participate in the Home Health Homebound Waiver Benefit Enhancement. The ACO DCE shall amend the relevant list no later than 30 Days after the date of the notice from CMS. D. The ACO DCE shall ensure the DC Participant Providers and Preferred Providers do not substitute home health services for inpatient services when inpatient services are more clinically appropriate. E. The ACO DCE shall ensure that DC Participant Providers and Preferred Providers only furnish Medically Necessary home health services and do not use home health services to prevent or deter a Beneficiary from seeking or receiving inpatient care when such care is Medically Necessary.