Availability of Services. A. The ACO shall require its Participant Providers and Preferred Providers to make Medically Necessary Covered Services available to Beneficiaries in accordance with applicable laws, regulations and guidance. Beneficiaries and their assignees retain their right to appeal claims determinations in accordance with 42 CFR Part 405, Subpart I. B. The ACO shall not, and shall require its Participant Providers and Preferred Providers to not, take any action to avoid treating At-Risk Beneficiaries or to target certain Beneficiaries for services for the purpose of trying to affect the population of Beneficiaries aligned to the ACO for a subsequent Performance Year.
Appears in 9 contracts
Sources: Participation Agreement, Participation Agreement, Participation Agreement