Part D Rewards and Incentives Programs Structure and Content Sample Clauses

Part D Rewards and Incentives Programs Structure and Content. A. If the Part D Sponsor is implementing a Part D RI Program under the Model, the parties acknowledge that Part D Sponsor has submitted as part of its application for participation in the Part D Senior Savings Model, a proposal to offer one or more Part D RI Programs. B. Part D Sponsor shall identify Targeted Enrollees for each Part D RI Program without discrimination and using objective criteria that comply with the terms of the Addendum, including this Appendix 2, and are specified in the Approved Proposal or are otherwise approved in writing by CMS. Such objective criteria must identify the subset of enrollees who would receive the greatest health care value from receiving the benefits or participating in the activities associated with the particular reward or incentive in the Part D RI Program and must include that the enrollee have Diabetes or Pre-diabetes. C. The Part D Sponsor acknowledges that for each Part D RI Program the Approved Proposal contains the following: i. The goals of the Part D RI Program; ii. The list of Model PBPs in which the Part D RI Program will be implemented; iii. The nature and scope of the Part D RI Program, including the criteria for identifying Targeted Enrollees and the beneficiary engagement methodology; iv. The eligibility criteria that must be met for an individual targeted enrollee to qualify to receive the reward or incentive, including the associated healthcare activity that must be completed for the reward or incentive to be available, and, if eligibility includes an adherence metric, the specific criteria for measuring adherence and the evidence base to support the clinical appropriateness of the adherence criteria; v. The type and per unit value of each reward or incentive and the method for providing the reward or incentive to eligible Targeted Enrollees; vi. The maximum number and frequency of the rewards and incentives that may be obtained by an eligible Targeted Enrollee per year; and vii. The evidence base and theory of change used to develop the reward or incentive and the expected outcomes of the Part D RI Program. D. The Part D Sponsor shall: i. Provide the rewards and incentives only to eligible Targeted Enrollees and only in accordance with the Approved Proposal and this Addendum; ii. Not provide any individual reward or incentive the value of which exceeds the value of the expected impact on enrollee behavior or benefit of the healthcare activity on which receipt of the reward or incentive is based, bu...