Voluntary Alignment definition
Examples of Voluntary Alignment in a sentence
The ACO shall require its Participant Providers and Preferred Providers to instruct Beneficiaries to call the ACO for questions about how to make changes to a Voluntary Alignment Form or how to designate a primary clinician on XxXxxxxxxx.xxx, Xxxxxxxx.xxx, or any successor site.
The ACO may instruct its Participant Providers and Preferred Providers to answer questions from Beneficiaries regarding Voluntary Alignment, but must prohibit Participant Providers and Preferred Providers from completing a Voluntary Alignment Form or designating a clinician on XxXxxxxxxx.xxx, Xxxxxxxx.xxx, or any successor site on behalf of the Beneficiary.
CMS shall, according to the methodology set forth in Appendix A and the precedence rules described in Section 5.01.C, use both Voluntary Alignment and Claims-Based Alignment to align Beneficiaries to the ACO for each Performance Year.
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.
The in-kind item or service is not furnished in whole or in part to reward the Beneficiary for designating, or agreeing to designate, a Participant Provider as his or her primary clinician, main doctor, main provider, or the main place where the Beneficiary receives care through Voluntary 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 voluntarily aligned to the ACO if the designation is the most recent Valid Designation made by the Beneficiary.
The ACO shall conduct, and shall require its Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities or Marketing Activities, to conduct Marketing Activities, including Voluntary Alignment Activities, only in accordance with this Article V and, if the ACO has selected to participate in SVA, Appendix C of the Agreement.
The ACO shall ensure that any Participant Provider or Preferred Provider that has been terminated pursuant to Sections 4.01.F or 17.01, or has been removed from the Participant Provider List or Preferred Provider List pursuant to Section 4.03.B, as applicable, does not engage in any ACO Activities, Marketing Activities, Voluntary Alignment Activities, Benefit Enhancements, or Beneficiary Engagement Incentives after the effective date of such termination.