Common use of Precedence Rules Clause in Contracts

Precedence Rules. 1. CMS shall establish precedence rules to govern the order in which Beneficiary alignment is conducted across Claims-Based Alignment, SVA, and MVA under the Model. CMS will not align a Beneficiary to the ACO for the Performance Year if the Beneficiary is aligned, assigned, or attributed to an entity participating in another shared savings initiative, or an entity in another model currently tested under the authority of section 1115A of the Act for which beneficiary overlap with the Model is prohibited for the Performance Year, except as otherwise specified by CMS. 2. Under the precedence rules described in this Section 5.01.C, the most recent Valid Designation (as described in Section 5.02.A) of a Participant Provider as a Beneficiary’s primary clinician, main doctor, main provider, and/or the main place they receive care (whether through MVA or SVA) will take precedence over any prior designations and over any invalid designations, and Voluntary Alignment will take precedence over Claims- Based Alignment. In addition, a Beneficiary who has designated a provider or supplier that is not a Participant Provider as her or his primary clinician through Voluntary Alignment will not be aligned to the ACO if the designation is the most recent Valid Designation made by the Beneficiary. 3. The parties acknowledge that CMS notified the ACO of the precedence rules that apply to Beneficiary alignment in advance of the ACO’s first Performance Year. CMS will notify the ACO of any changes to the precedence rules that will apply to Beneficiary alignment for each subsequent Performance Year prior to the start of that Performance Year.

Precedence Rules. 1. CMS shall establish precedence rules to govern the order in which Beneficiary alignment is conducted across Claims-Based Alignment, SVAPaper-Based Voluntary Alignment, and MVA Electronic Voluntary Alignment under the Model. CMS will not align a Beneficiary Beneficiaries to the ACO DCE for the Performance Year if the Beneficiary is aligned, assigned, or attributed to an entity participating in another shared savings initiative, or an entity in another model currently tested under the authority of section 1115A of the Act for which beneficiary overlap with the Model is prohibited for the Performance Year, except as otherwise specified by CMS. 2. Under the precedence rules described in this Section 5.01.C, the most recent Valid Designation (as described in Section 5.02.A) of a DC Participant Provider as a Beneficiary’s 's primary clinician, main doctor, main provider, and/or the main place they receive care (whether through MVA Electronic Voluntary Alignment or SVAPaper-Based Voluntary Alignment) will take precedence over any prior designations and over any invalid designations, and Voluntary Alignment will take precedence over Claims- Based Alignment. In addition, a Beneficiary who has designated a provider or supplier that is not a DC Participant Provider as her or his primary clinician through Voluntary Alignment will not be aligned to the ACO DCE if the designation is the most recent Valid Designation made by the Beneficiary. 3. The parties acknowledge that CMS notified the ACO DCE of the precedence rules that apply to Beneficiary alignment in advance of the ACO’s DCE's first Performance Year. CMS will notify the ACO DCE of any changes to the precedence rules that will apply to Beneficiary alignment for each subsequent Performance Year prior to the start of that Performance Year.