Common use of Nurse Practitioner and Physician Assistant Services Benefit Enhancement‌ Clause in Contracts

Nurse Practitioner and Physician Assistant Services Benefit Enhancement‌. A. Appendix T shall apply to the Agreement for any Performance Year for which the ACO has selected the Nurse Practitioner and Physician Assistant Services 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 Nurse Practitioner and Physician Assistant Services Benefit Enhancement and CMS has not rejected the ACO’s selection under Section 8.02 or Section 10.01.E. B. The ACO shall require that, in order for an individual to certify, establish a plan of care for, or provide a referral for any of the services identified in Section II of Appendix T of the Agreement for REACH Beneficiaries pursuant to the Nurse Practitioner and Physician Assistant Services Benefit Enhancement, the individual must be: 1. A nurse practitioner (as described in 42 CFR § 410.75(b)) and either a Participant Provider or Preferred Provider identified on the Participant Provider List or Preferred Provider List as participating in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and approved by CMS according to the criteria described in this Section 10.12 and Appendix T of the Agreement (“Eligible Nurse Practitioner”); or 2. Beginning on the date(s) specified by CMS, a physician assistant (as described in 42 CFR § 410.74(a)) and either a Participant Provider or Preferred Provider identified on the Participant Provider List or Preferred Provider List as participating in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and approved by CMS according to the criteria described in this Section 10.12 and Appendix T of the Agreement (“Eligible Physician Assistant”). C. Beginning on the date(s) specified by CMS, if CMS notifies the ACO that a nurse practitioner or physician assistant that is a Participant Provider or Preferred Provider has not been approved for participation in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement under this Section 10.12, but the nurse practitioner or physician assistant is otherwise eligible to be a Participant Provider or Preferred Provider, the ACO may either remove the nurse practitioner or physician assistant from the Participant Provider or Preferred Provider List, or amend the relevant list to reflect that the nurse practitioner or physician assistant will not participate in the Nurse Practitioner and Physician Assistant Services 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 that Participant Providers and Preferred Providers only certify, establish a plan of care for, or provide a referral for Medically Necessary services under the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and that certification of, establishment of a plan of care for, or referral for services pursuant to the Nurse Practitioner and Physician Assistant Services Benefit Enhancement is not used to prevent or deter a Beneficiary from seeking or receiving other Medically Necessary care.

Nurse Practitioner and Physician Assistant Services Benefit Enhancement‌. A. Beginning Performance Year 2023, Appendix T shall apply to the Agreement for any Performance Year for which the ACO has selected the Nurse Practitioner and Physician Assistant Services 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 Nurse Practitioner and Physician Assistant Services Benefit Enhancement and CMS has not rejected the ACO’s selection under Section 8.02 or Section 10.01.E. B. The ACO shall require that, in order for an individual to certify, establish a plan of care for, or provide a referral for any of the services identified in Section II of Appendix T of the Agreement for REACH Beneficiaries pursuant to the Nurse Practitioner and Physician Assistant Services Benefit Enhancement, the individual must be: 1. A Beginning Performance Year 2023, a nurse practitioner (as described in 42 CFR § 410.75(b)) and either a Participant Provider or Preferred Provider identified on the Participant Provider List or Preferred Provider List as participating in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and approved by CMS according to the criteria described in this Section 10.12 and Appendix T of the Agreement (“Eligible Nurse Practitioner”); or 2. Beginning on the a date(s) specified by CMS, a physician assistant (as described in 42 CFR § 410.74(a)) and either a Participant Provider or Preferred Provider identified on the Participant Provider List or Preferred Provider List as participating in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and approved by CMS according to the criteria described in this Section 10.12 and Appendix T of the Agreement (“Eligible Physician Assistant”). C. Beginning on the a date(s) specified by CMS, if CMS notifies the ACO that a nurse practitioner or physician assistant that is a Participant Provider or Preferred Provider has not been approved for participation in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement under this Section 10.12, but the nurse practitioner or physician assistant is otherwise eligible to be a Participant Provider or Preferred Provider, the ACO may either remove the nurse practitioner or physician assistant from the Participant Provider or Preferred Provider List, or amend the relevant list to reflect that the nurse practitioner or physician assistant will not participate in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement. The ACO shall amend the relevant list no later than 30 Days after the date of the notice from CMS. D. The Beginning Performance Year 2023, the ACO shall ensure that Participant Providers and Preferred Providers only certify, establish a plan of care for, or provide a referral for Medically Necessary services under the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and that certification of, establishment of a plan of care for, or referral for services pursuant to the Nurse Practitioner and Physician Assistant Services Benefit Enhancement is not used to prevent or deter a Beneficiary from seeking or receiving other Medically Necessary care.

Nurse Practitioner and Physician Assistant Services Benefit Enhancement‌. A. Beginning Performance Year 2023, Appendix T shall apply to the Agreement for any Performance Year for which the ACO has selected the Nurse Practitioner and Physician Assistant Services Benefit Enhancement as described in Section 8.01 and for which the ACO has submitted an Implementation Plan under Section 10.01.B Section 10.01. B for the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and CMS has not rejected the ACO’s selection under Section 8.02 or Section 10.01.E. B. The ACO shall require that, in order for an individual to certify, establish a plan of care for, or provide a referral for any of the services identified in Section II of Appendix T of the Agreement for REACH Beneficiaries pursuant to the Nurse Practitioner and Physician Assistant Services Benefit Enhancement, the individual must be: 1. A Beginning Performance Year 2023, a nurse practitioner (as described in 42 CFR § 410.75(b)) and either a Participant Provider or Preferred Provider identified on the Participant Provider List or Preferred Provider List as participating in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and approved by CMS according to the criteria described in this Section 10.12 and Appendix T of the Agreement (“Eligible Nurse Practitioner”); or 2. Beginning on the a date(s) specified by CMS, a physician assistant (as described in 42 CFR § 410.74(a)) and either a Participant Provider or Preferred Provider identified on the Participant Provider List or Preferred Provider List as participating in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and approved by CMS according to the criteria described in this Section 10.12 and Appendix T of the Agreement (“Eligible Physician Assistant”). C. Beginning on the a date(s) specified by CMS, if CMS notifies the ACO that a nurse practitioner or physician assistant that is a Participant Provider or Preferred Provider has not been approved for participation in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement under this Section 10.12, but the nurse practitioner or physician assistant is otherwise eligible to be a Participant Provider or Preferred Provider, the ACO may either remove the nurse practitioner or physician assistant from the Participant Provider or Preferred Provider List, or amend the relevant list to reflect that the nurse practitioner or physician assistant will not participate in the Nurse Practitioner and Physician Assistant Services Benefit Enhancement. The ACO shall amend the relevant list no later than 30 Days after the date of the notice from CMS. D. The Beginning Performance Year 2023, the ACO shall ensure that Participant Providers and Preferred Providers only certify, establish a plan of care for, or provide a referral for Medically Necessary services under the Nurse Practitioner and Physician Assistant Services Benefit Enhancement and that certification of, establishment of a plan of care for, or referral for services pursuant to the Nurse Practitioner and Physician Assistant Services Benefit Enhancement is not used to prevent or deter a Beneficiary from seeking or receiving other Medically Necessary care.