Benefit Enhancement definition
Examples of Benefit Enhancement in a sentence
The individual performing services under this Benefit Enhancement must be “auxiliary personnel” as defined at 42 CFR § 410.26(a)(1).
If CMS rejects the ACO’s selection of a Benefit Enhancement or Beneficiary Engagement Incentive, the ACO shall not implement the Benefit Enhancement or Beneficiary Engagement Incentive for the following Performance Year.
Appendix M shall apply to the Agreement for any Performance Year for which the ACO has selected the Care Management Home Visits 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 Care Management Home Visits Benefit Enhancement and CMS has not rejected the ACO’s selection pursuant to Section 8.02 or Section 10.01.E.
Appendices I, J, L through Q, and T shall apply to the Agreement for a given Performance Year only if the ACO selected to provide the relevant Benefit Enhancement or Beneficiary Engagement Incentive for that Performance Year as described in Section 8.01 and that selection was not rejected by CMS pursuant to Sections 8.02 or 10.01.E.
If the ACO selects to provide a Benefit Enhancement for a Performance Year, the ACO’s Participant Providers and Preferred Providers, as indicated on the relevant Participant Provider List and Preferred Provider List under Article IV, may submit claims for services furnished pursuant to such Benefit Enhancement as described in this Article X during the Performance Year for which the ACO selected to provide the Benefit Enhancement.
Appendix O shall apply to the Agreement for any Performance Year for which the ACO has selected the Concurrent Care for Beneficiaries that Elect Medicare Hospice 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 Concurrent Care for Beneficiaries that Elect Medicare Hospice Benefit Enhancement and CMS has not rejected the ACO’s selection under Section 8.02 or Section 10.01.E.
If CMS determines that the ACO’s proposed implementation of a Benefit Enhancement or Beneficiary Engagement Incentive is inconsistent with the terms of the Agreement or likely to result in program integrity concerns, CMS may reject the ACO’s selection to provide the Benefit Enhancement or Beneficiary Engagement Incentive or may require the ACO to submit a new Implementation Plan.
In the case of a Benefit Enhancement, such notification shall state that following a date that is 90 Days after the effective date of termination, services furnished under the Benefit Enhancement will no longer be covered by Medicare and the Beneficiary may be responsible for the payment of such services.
Appendix N shall apply to the Agreement for any Performance Year for which the ACO has selected the Home Health Homebound Waiver 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 Home Health Homebound Waiver Benefit Enhancement and CMS has not rejected the ACO’s selection pursuant to Section 8.02 or Section 10.01.E.
For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01.