Qualification to Participate. Participant and Preferred Provider shall participate in each ACO Program that qualifies for All Payer Model Scale Targets, that is designated by the Board as a Core Program and for which a Program Addendum is provided within the time frames set forth in paragraph 3.1 (“Core ACO Programs”) and that is offered by a Payer for which Participant or Preferred Provider is an enrolled provider and in good standing, by signing an ACO Program Addendum for each such ACO Program.
Qualification to Participate. Participant and Preferred Provider shall participate in each ACO Program that qualifies for All Payer Model Scale Targets, for which a Program Addendum is provided within the time frames set forth in paragraph 3.1 (“Core ACO Programs”) and that is offered by a Payer for which Participant or Preferred Provider is an enrolled provider and in good standing, by signing an ACO Program Addendum for each such ACO Program. A Participant or Preferred Provider may, with ACO’s approval, choose not to participate in a Core ACO Program if: (1) it shows good cause as determined by the ACO Core Program Exceptions Policy; (2) it demonstrates to the Board’s reasonable satisfaction that the financial risk would jeopardize financial solvency thresholds established by Payer, ACO Program or the ACO; or (3) it demonstrates to the Board’s reasonable satisfaction that the operational demands would materially negatively impact its operations or there is no resource capacity to fully participate in the clinical and quality programs of ACO. Additionally, ACO may offer non-Core ACO Programs which Participant and Preferred Provider may choose not to participate in for any reason. Participants, Providers and Preferred Providers will maintain good standing to provide services with each ACO Program Payer for which it is enrolled and will remain duly licensed in good standing to practice their professions in each state in which they practice. Any Participant who is eligible to align or attribute lives may only participate in one ACO Program per Payer, for example if an eligible aligning Participant is in Medicare NextGen or Vermont Medicare ACO Initiative, it may not be in MSSP. Nothing in this Agreement supersedes any of the terms and conditions of Participant’s or Preferred Provider’s enrollment in a Payer’s insurance program unless the Payer’s requirements have been waived or modified in the Program Agreement between ACO and Payer. ACO, may, in its discretion, require additional reasonable verification of professional qualifications. Providers who are denied status as Participants or Preferred Providers, those who are not renewed for any reason and those who are terminated from OneCare will receive a written notice explaining the reason for denied status with instruction on how to appeal the decision to ACO, consistent with the ACO’s Appeals Policy.
Qualification to Participate. In no case shall the Leave of Absence be for a period of less than six months and each Participant shall return to employment for a period of time at least equal to the period of the Leave of Absence.
Qualification to Participate. Participant and Affiliate agree to participate in each ACO Program offered by a Payer for which Participant or Affiliate is an enrolled provider and in good standing. Participant, Providers and Affiliate Providers will maintain good standing to provide services under this Agreement with each Payer and will remain duly licensed in good standing to practice their professions in each state in which they practice. Any Participant who is eligible to align or attribute lives may only participate in one ACO Program per Payer, for example if an eligible aligning Participant is in Medicare NextGen, it may not be in MSSP. Nothing in this Agreement supersedes any of the terms and conditions of Participant’s or Affiliate Provider’s enrollment in a Payer’s program. ACO, may, in its discretion, require additional reasonable verification of professional qualifications. Providers applying to be a Participant or Affiliate who do not meet the Clinical Model criteria, any ACO Program criteria, and Participants or Affiliates who are not renewed for any other reason will receive a written notice explaining the reason for denied participation status including instruction on how to appeal such denial to ACO.
Qualification to Participate. The Participant represents and warrants to OCA that the Participant has, along with his or her respective OrthAlliance Affiliated PC (as defined in the Programs), executed and delivered to OrthAlliance their respective (i) Amendments (as defined in the Programs) and/or (ii) OCA Business Services Agreement (as defined in the Programs), as applicable, on the date(s) specified on Schedule 1 hereto. The Participant further represents and warrants to OCA that he or she is an OrthAlliance Affiliated Practitioner (as defined in the Programs). The Participant also represents and warrants to OCA that the execution, delivery and performance of this Agreement by the Participant has been duly authorized by all necessary laws, resolutions and corporate action, and that this Agreement constitutes the valid and enforceable obligations of the Participant in accordance with its terms.
Qualification to Participate. The leave of absence shall occur according to, and be governed by, the deferred salary leave plan policy then established by the Board for its employees.
