Limitations on Review. There is no administrative or judicial review under Sections 1869 or 1878 of the Act or otherwise for the following:
i. The selection of states, organizations, sites, or participants in the Model and Initiative, including the decision by CMS to terminate this Agreement or to require the termination of any individual’s or entity’s status in the Model or Initiative;
ii. The elements, parameters, scope, and duration of the Model and the Initiative, including the benchmarks developed under this Model;
iii. The termination or modification of the design and implementation of the Model and Initiative under Section 1115A(b)(3)(B) of the Act;
iv. The selection of models for testing or expansion under Section 1115A of the Act;
v. Determinations regarding budget neutrality under Section 1115A(b)(3) of the Act; and
vi. Determinations about expansion of the duration and scope of the Model under Section 1115A(c) of the Act, including the determination that the Model is not expected to meet criteria described in paragraph (1) or (2) of such subsection.
Limitations on Review. Every effort will be made to deal with requests submitted pursuant to this article in an expeditious manner. Teachers may not request more than one review every 12 months unless their workload and/or extracurricular assignments have been altered.
Limitations on Review. Notwithstanding any other provision of this Agreement, there is no administrative or judicial review under sections 1869 or 1878 of the Act or otherwise for the following:
(a) The selection of models for testing or expansion under section 1115A of the Act;
(b) The selection of organizations, sites, or participants to test the selected models, including the decision by CMS to terminate this Agreement, or to require the Hospital to terminate any Care Partner Arrangement or Downstream Care Partner Arrangement;
(c) The elements, parameters, scope, and duration of such models for testing or dissemination, including the addition or removal of a CRP Track and the methodologies used to calculate PAU Savings, and the Incentive Payment Pool;
(d) Determinations regarding budget neutrality under subsection 1115A(b)(3) of the Act;
(e) The termination or modification of the design and implementation of a model under subsection 1115A(b)(3)(B) of the Act; or
(f) Decisions about expansion of the duration and scope of a model under subsection 1115A(c) of the Act, including the determination that a model is not expected to meet criteria described in paragraph (1) or (2) of such subsection.
Limitations on Review. There is no administrative or judicial review under sections 1869 or 1878 of the Act or otherwise for the following:
1. The selection of Part D sponsors to participate in the Model, including the decision by CMS to terminate this Addendum or to direct the termination of any Model PBPs;
2. The selection of manufacturers to participate in the Model, including the decision by CMS to terminate a manufacturer’s participation in the Model;
3. The elements, parameters, scope, and duration of the Model;
4. Determinations regarding budget neutrality under section 1115A(b)(3);
5. The termination or modification of the design and implementation of a Model under section 1115A(b)(3)(B);
6. Decisions about expansion of the duration and scope of a model under subsection 1115A(c), including the determination that a model is not expected to meet criteria described in paragraph (1) or (2) of such subsection; or
7. The determination of a Model PBP’s eligibility for the optional first risk corridor.
Limitations on Review. There is no administrative or judicial review under sections 1869 or 1878 of the Act or otherwise for the following:
Limitations on Review. There is no administrative or judicial review under Sections 1869 or 1878 of the Act or otherwise for the following:
i. The selection of states, organizations, sites, or participants in the Model and Initiative, including the decision by CMS to terminate this agreement or to require the termination of any individual’s or entity’s status in the Model or Initiative;
ii. The elements, parameters, scope, and duration of the Model and the Initiative;
iii. The termination or modification of the design and implementation of the Model and/or Initiative under subsection 1115A(b)(3)(B); and
iv. Determinations about expansion of the duration and scope of the Model under subsection 1115A(c), including the determination that the Model is not expected to meet criteria described in paragraph (1) or (2) of such subsection.
Limitations on Review. X. Xxxxxxxx to Section 1115A(d)(2) of the Act, there is no administrative or judicial review under Sections 1869 or 1878 of the Act or otherwise of the following:
1. The selection of organizations, sites, or participants to test the Track 1+ Model, including the decision by CMS to terminate this Agreement pursuant to Section X.
2. The elements, parameters, scope, and duration of the Track 1+ Model.
3. Determinations regarding budget neutrality of the Track 1+ Model under Section 1115A(b)(3) of the Act.
4. The termination or modification of the design and implementation of the Track 1+ Model under Section 1115A(b)(3)(B).
5. Determinations about expansion of the duration and scope of the Track 1+ Model under Section 1115A(c), including the determination that the Track 1+ Model is not expected to meet the criteria described in Section 1115A(c)(1) or (2).
B. The preclusion of administrative and judicial review under Section 1899(g) of the Act and 42 CFR part 425, subpart I, continues to apply with respect to the Track 1+ ACO’s participation in Track 1 of the Shared Savings Program.
C. There is no reconsideration, appeal, or other administrative or judicial review of the following determinations under the Track 1+ Model:
1. The assignment of Medicare fee-for-service beneficiaries;
2. The initial or revised initial determination of whether the Track 1+ ACO is liable for shared losses and the amount of such shared losses, including the initial determination or revised initial determination of the estimated average per capita expenditures under the Track 1+ ACO for Medicare fee-for-service beneficiaries assigned to the Track 1+ ACO and the average benchmark for the Track 1+ ACO; and
3. The percent of shared losses and the limit on the total amount of shared losses.
D. For those matters that are not precluded from administrative and judicial review, the reconsideration review process will be consistent with the processes specified in 42 CFR part 425, subpart I and related guidance.
Limitations on Review. Every effort shall be made to deal with requests submitted pursuant to this article in an expeditious manner. Employees may not request more than one review every 12 months unless their workload and/or extracurricular assignments have been altered.
Limitations on Review. X. Xxxxxxxx to Section 1115A(d)(2) of the Act, there is no administrative or judicial review under Sections 1869 or 1878 of the Act or otherwise of the following:
1. The selection of organizations, sites, or participants to test the Track 1+ Model, including the decision by CMS to terminate this Agreement pursuant to Section X.
2. The elements, parameters, scope, and duration of the Track 1+ Model.
3. Determinations regarding budget neutrality of the Track 1+ Model under Section 1115A(b)(3) of the Act.
4. The termination or modification of the design and implementation of the Track 1+ Model under Section 1115A(b)(3)(B).
5. Determinations about expansion of the duration and scope of the Track 1+ Model under Section 1115A(c), including the determination that the Track 1+ Model is not expected to meet the criteria described in Section 1115A(c)(1) or (2).
Limitations on Review. Notwithstanding any other provision of this Agreement, there is no administrative or judicial review under sections 1869 or 1878 of the Act or otherwise for the following: The selection of models for testing or expansion under section 1115A of the Act; The selection of organizations, sites, or participants to test the selected models, including the decision by CMS to terminate this Agreement, or to require the Hospital to terminate any Care Partner Arrangement or Downstream Care Partner Arrangement; The elements, parameters, scope, and duration of such models for testing or dissemination, including the addition or removal of a CRP Track and the methodologies used to calculate PAU Savings, and the Incentive Payment Pool; Determinations regarding budget neutrality under subsection 1115A(b)(3) of the Act; The termination or modification of the design and implementation of a model under subsection 1115A(b)(3)(B) of the Act; or Decisions about expansion of the duration and scope of a model under subsection 1115A(c) of the Act, including the determination that a model is not expected to meet criteria described in paragraph (1) or (2) of such subsection.
