High Needs Population ACO definition

High Needs Population ACO means a REACH ACO that focuses on Beneficiaries with complex, high needs, including dually eligible individuals, and is approved by CMS to participate in the Model as a High Needs Population ACO prior to the Effective Date, and has not subsequently been approved by CMS to participate in the Model as a New Entrant ACO or a Standard ACO pursuant to Article VIII. A High Needs Population ACO qualifies for the alternative Beneficiary alignment minimums specified in Section 5.03.C and qualifies for the methodology for calculating the Performance Year Benchmark described in Section III of Appendix B of the Agreement.
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Examples of High Needs Population ACO in a sentence

  • If the ACO is a High Needs Population ACO, the ACO may select to participate in the Model as a Standard ACO in advance of the ACO’s second Performance Year or any subsequent Performance Year.

  • If the ACO is a High Needs Population ACO, the ACO may select to participate in the Model as a New Entrant ACO in advance of the ACO’s second Performance Year.

  • If the ACO is a Standard ACO or a New Entrant ACO, the ACO may not be owned by an individual or entity that also owns another REACH ACO that is High Needs Population ACO that is participating in the Model and that operates in the same ACO Service Area, as defined in Section 5.04.

  • If Beneficiary and/or Consumer Advocate representation on the ACO governing body is prohibited by state law or, beginning in Performance Year 2025, if a High Needs Population ACO experiences an extreme hardship in finding a beneficiary representative to serve on the board, the ACO shall notify CMS and request CMS approval of an alternative mechanism to ensure that its policies and procedures reflect consumer and patient perspectives.

  • If Beneficiary and/or Consumer Advocate representation on the ACO governing body is prohibited by state law or if a High Needs Population ACO experiences an extreme hardship in finding a beneficiary representative to serve on the board, the ACO shall notify CMS and request CMS approval of an alternative mechanism to ensure that its policies and procedures reflect consumer and patient perspectives.