Common use of ACO Selections Clause in Contracts

ACO Selections. ‌ A. The parties acknowledge that the ACO was required to submit its selections for the following in advance of the Effective Date by a date and in a form and manner specified by CMS: 1. The ACO’s Risk Sharing Option (Professional or Global) for the ACO’s first Performance Year subject to the requirements of Section 8.01.D; 2. The ACO’s selected Capitation Payment Mechanism for the ACO’s first Performance Year; 3. The ACO’s selection whether to participate in the APO for the ACO’s first Performance Year, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year; 4. The maximum Enhanced PCC Percentage for the ACO’s first Performance Year within the range specified in Appendix E, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year; 5. The Benefit Enhancements or Beneficiary Engagement Incentives, if any, that the ACO selected to offer with its Participant Providers and Preferred Providers during the ACO’s first Performance Year; 6. The ACO’s selected Alignment Methodology (Prospective Alignment or Prospective Plus Alignment) for the ACO’s first Performance Year; 7. The ACO’s decision with respect to participation in SVA for the ACO’s first Performance Year. The ACO’s decision with respect to participation in SVA for the ACO’s first Performance Year refers to the ACO’s decision to participate in Voluntary Alignment Activities specific to SVA in accordance with Appendix C during the ACO’s first Performance Year for purposes of: (1) aligning Beneficiaries to the ACO for the ACO’s second Performance Year; and (2) aligning Beneficiaries to the ACO for the second, third, and fourth calendar quarters of the ACO’s first Performance Year, provided that the ACO has selected Prospective Plus Alignment for the ACO’s first Performance Year and submits an SVA List (as described in Appendix C) to CMS in advance of the relevant calendar quarter; and 8. The ACO’s decision whether to participate in Provisional Financial Settlement for the ACO’s first Performance Year. B. In a form and manner and by the date(s) specified by CMS, the ACO shall submit to CMS: 1. Its selection whether to participate in a Stop-Loss Arrangement for the ACO’s first Performance Year; and 2. An update to the maximum Enhanced PCC Percentage for the ACO’s first Performance Year within the range specified in Appendix E, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year and wants to adjust the maximum Enhanced PCC Percentage the ACO previously selected for its first Performance Year as described in Section 8.01.A.4. 3. Its selection, if any, to participate in the 3-Day SNF Rule Waiver Benefit Enhancement and the Nurse Practitioner and Physician Assistant Services Benefit Enhancement. C. In a form and manner and by one or more dates specified by CMS, the ACO shall submit to CMS its selections for the following for the ACO’s second Performance Year and each subsequent Performance Year: 1. The ACO’s decision whether to participate in Provisional Financial Settlement for the Performance Year; 2. The ACO’s selected Capitation Payment Mechanism for the Performance Year; 3. The ACO’s selection whether to participate in the APO for the Performance Year, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the Performance Year; 4. The maximum Enhanced PCC Percentage for the Performance Year within the range specified in Appendix E, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the Performance Year; 5. The ACO’s decision whether to participate in the Stop-Loss Arrangement for the Performance Year; 6. The Benefit Enhancements or Beneficiary Engagement Incentives, if any, that the ACO selects to offer with its Participant Providers and Preferred Providers during the Performance Year; 7. The ACO’s selected Alignment Methodology (Prospective Alignment or Prospective Plus Alignment) for the Performance Year; and 8. The ACO’s decision with respect to participation in SVA for the Performance Year. The ACO’s decision to participate in SVA for a Performance Year refers to the ACO’s decision to participate in Voluntary Alignment Activities specific to SVA in accordance with Appendix C during the Performance Year for purposes of: (1) aligning Beneficiaries to the ACO for the following Performance Year, and (2) aligning Beneficiaries to the ACO for the second, third, and fourth calendar quarters of the Performance Year, provided that the ACO has selected Prospective Plus Alignment for the Performance Year and submits an SVA List (as described in Appendix C) to CMS in advance of the relevant calendar quarter. D. If the ACO selected Professional as its Risk Sharing Option for the ACO’s first Performance Year as described in Section 8.01.A, the ACO may select to change its Risk Sharing Option to Global for the ACO’s second Performance Year or any subsequent Performance Year pursuant to this Section 8.01.D. Such selection must be submitted to CMS in a form and manner and by a date specified by CMS. If the ACO selected Professional as its Risk Sharing Option for the ACO’s first Performance Year as described in Section 8.01.A and has not since selected to change its Risk Sharing Option to Global pursuant to this Section 8.01.D, the ACO’s selection of Professional as its Risk Sharing Option will remain in effect. If the ACO selected Global as its Risk Sharing Option for the ACO’s first Performance Year as described in Section 8.01.A, the ACO’s selection of Global as its Risk Sharing Option will remain in effect for the duration of the Agreement Performance Period. E. Regardless of whether the ACO selects to provide the Telehealth Benefit Enhancement for a Performance Year as described in this Section 8.01, payment to Participant Providers for telehealth services furnished pursuant to section 1899(l) of the Act is governed by the terms and conditions of Appendix K of the Agreement. F. 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. Such selection must be submitted to CMS in a form and manner and by a date specified by CMS. A selection made pursuant to this Section 8.01.F that is not rejected by CMS pursuant to Section 8.02 will take effect at the start of the subsequent Performance Year and will remain in effect for the remainder of the Agreement Performance Period. G. 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. Such selection must be submitted to CMS in a form and manner and by a date specified by CMS. A selection made pursuant to this Section 8.01.G that is not rejected by CMS pursuant to Section 8.02 will take effect at the start of the ACO’s second Performance Year and will remain in effect for the remainder of the Agreement Performance Period, unless and until the ACO accepts an offer pursuant to Section 5.03.B to participate in the Model as a Standard ACO.

ACO Selections. ‌ A. The parties acknowledge that the ACO was required to submit its selections for the following in advance of the Effective Date by a date and in a form and manner specified by CMS: 1. The ACO’s Risk Sharing Option (Professional or Global) for the ACO’s first Performance Year subject to the requirements of Section 8.01.D; 2. The ACO’s selected Capitation Payment Mechanism for the ACO’s first Performance Year; 3. The ACO’s selection whether to participate in the APO for the ACO’s first Performance Year, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year; 4. The maximum Enhanced PCC Percentage for the ACO’s first Performance Year within the range specified in Appendix E, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year; 5. The Benefit Enhancements or Beneficiary Engagement Incentives, if any, that the ACO selected to offer with its Participant Providers and Preferred Providers during the ACO’s first Performance Year; 6. The ACO’s selected Alignment Methodology (Prospective Alignment or Prospective Plus Alignment) for the ACO’s first Performance Year; 7. The ACO’s decision with respect to participation in SVA for the ACO’s first Performance Year. The ACO’s decision with respect to participation in SVA for the ACO’s first Performance Year refers to the ACO’s decision to participate in Voluntary Alignment Activities specific to SVA in accordance with Appendix C during the ACO’s first Performance Year for purposes of: (1) aligning Beneficiaries to the ACO for the ACO’s second Performance Year; and (2) aligning Beneficiaries to the ACO for the second, third, and fourth calendar quarters of the ACO’s first Performance Year, provided that the ACO has selected Prospective Plus Alignment for the ACO’s first Performance Year and submits an SVA List (as described in Appendix C) to CMS in advance of the relevant calendar quarter; and 8. The ACO’s decision whether to participate in Provisional Financial Settlement for the ACO’s first Performance Year. B. In a form and manner and by the date(s) a date specified by CMS, the ACO shall submit to CMS: 1. Its selection whether to participate in a Stop-Loss Arrangement for the ACO’s first Performance Year; and 2. An update to the maximum Enhanced PCC Percentage for the ACO’s first Performance Year within the range specified in Appendix E, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year and wants to adjust the maximum Enhanced PCC Percentage the ACO previously selected for its first Performance Year as described in Section 8.01.A.4. 3. Its selection, if any, to participate in the 3-Day SNF Rule Waiver Benefit Enhancement and the Nurse Practitioner and Physician Assistant Services Benefit Enhancement. C. In a form and manner and by one or more dates specified by CMS, the ACO shall submit to CMS its selections for the following for the ACO’s second Performance Year and each subsequent Performance Year: 1. The ACO’s decision whether to participate in Provisional Financial Settlement for the Performance Year; 2. The ACO’s selected Capitation Payment Mechanism for the Performance Year; 3. The ACO’s selection whether to participate in the APO for the Performance Year, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the Performance Year; 4. The maximum Enhanced PCC Percentage for the Performance Year within the range specified in Appendix E, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the Performance Year; 5. The ACO’s decision whether to participate in the Stop-Loss Arrangement for the Performance Year; 6. The Benefit Enhancements or Beneficiary Engagement Incentives, if any, that the ACO selects to offer with its Participant Providers and Preferred Providers during the Performance Year; 7. The ACO’s selected Alignment Methodology (Prospective Alignment or Prospective Plus Alignment) for the Performance Year; and 8. The ACO’s decision with respect to participation in SVA for the Performance Year. The ACO’s decision to participate in SVA for a Performance Year refers to the ACO’s decision to participate in Voluntary Alignment Activities specific to SVA in accordance with Appendix C during the Performance Year for purposes of: (1) aligning Beneficiaries to the ACO for the following Performance Year, and (2) aligning Beneficiaries to the ACO for the second, third, and fourth calendar quarters of the Performance Year, provided that the ACO has selected Prospective Plus Alignment for the Performance Year and submits an SVA List (as described in Appendix C) to CMS in advance of the relevant calendar quarter. D. If the ACO selected Professional as its Risk Sharing Option for the ACO’s first Performance Year as described in Section 8.01.A, the ACO may select to change its Risk Sharing Option to Global for the ACO’s second Performance Year or any subsequent Performance Year pursuant to this Section 8.01.D. Such selection must be submitted to CMS in a form and manner and by a date specified by CMS. If the ACO selected Professional as its Risk Sharing Option for the ACO’s first Performance Year as described in Section 8.01.A and has not since selected to change its Risk Sharing Option to Global pursuant to this Section 8.01.D, the ACO’s selection of Professional as its Risk Sharing Option will remain in effect. If the ACO selected Global as its Risk Sharing Option for the ACO’s first Performance Year as described in Section 8.01.A, the ACO’s selection of Global as its Risk Sharing Option will remain in effect for the duration of the Agreement Performance Period. E. Regardless of whether the ACO selects to provide the Telehealth Benefit Enhancement for a Performance Year as described in this Section 8.01, payment to Participant Providers for telehealth services furnished pursuant to section 1899(l) of the Act is governed by the terms and conditions of Appendix K of the Agreement. F. 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. Such selection must be submitted to CMS in a form and manner and by a date specified by CMS. A selection made pursuant to this Section 8.01.F that is not rejected by CMS pursuant to Section 8.02 will take effect at the start of the subsequent Performance Year and will remain in effect for the remainder of the Agreement Performance Period. G. 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. Such selection must be submitted to CMS in a form and manner and by a date specified by CMS. A selection made pursuant to this Section 8.01.G that is not rejected by CMS pursuant to Section 8.02 will take effect at the start of the ACO’s second Performance Year and will remain in effect for the remainder of the Agreement Performance Period, unless and until the ACO accepts an offer pursuant to Section 5.03.B to participate in the Model as a Standard ACO.