Day SNF Rule Waiver Benefit Enhancement Sample Clauses
Day SNF Rule Waiver Benefit Enhancement.
A. Appendix I shall apply to the Agreement for any Performance Year for which the ACO has selected the 3-Day SNF Rule 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 3-Day SNF Rule Waiver Benefit Enhancement and CMS has not rejected the ACO’s selection pursuant to Section 8.02 or Section 10.01.E.
B. In order to be eligible to submit claims for services furnished to REACH Beneficiaries pursuant to the 3-Day SNF Rule Waiver Benefit Enhancement, an individual or entity must be:
1. A Participant Provider or Preferred Provider; and
2. A skilled-nursing facility (“SNF”) or a hospital or critical access hospital that has swing-bed approval for Medicare post-hospital extended care services (“Swing-Bed Hospital”); and
3. Designated on the Participant Provider List or Preferred Provider List submitted in accordance with Article IV as participating in the 3-Day SNF Rule Waiver Benefit Enhancement; and
4. Approved by CMS according to the criteria described in this Section
Day SNF Rule Waiver Benefit Enhancement.
1. Appendix I shall apply to this Agreement for any Performance Year for which the ACO has selected the 3-Day SNF Rule Waiver Benefit Enhancement under Section X.A.4, and for which the ACO has submitted an Implementation Plan under Section XI.A.1 for the 3-Day SNF Rule Waiver Benefit Enhancement.
2. The ACO shall require that, in order to be eligible to submit claims for services furnished to Next Generation Beneficiaries pursuant to the 3-Day SNF Rule Waiver Benefit Enhancement, an entity must be:
(a) A Next Generation Participant or Preferred Provider; and
(b) A skilled-nursing facility (“SNF”) or a hospital or critical access hospital that has swing-bed approval for Medicare post-hospital extended care services (“Swing-Bed Hospital”); and
(c) Designated on the Participant List or Preferred Provider List as participating in the 3-Day SNF Rule Waiver Benefit Enhancement; and
(d) Approved by CMS according to the criteria described in Appendix I.
3. If CMS notifies the ACO that a SNF or Swing-Bed Hospital has not been approved for participation in the 3-Day SNF Rule Waiver Benefit Enhancement under this Section XI.B, but the provider is otherwise eligible to be a Next Generation Participant or Preferred Provider, the ACO may either remove the provider from the Participant List or Preferred Provider List, or amend the relevant list to reflect that the provider will not participate in the 3-Day SNF Rule Waiver Benefit Enhancement. The ACO shall amend the relevant list no later than 30 days after the date of the notice from CMS.
Day SNF Rule Waiver Benefit Enhancement. The ACO shall provide CMS with supplemental information upon request regarding its use of the 3-Day SNF Rule Waiver Benefit Enhancement.
Day SNF Rule Waiver Benefit Enhancement. If the ACO wishes to offer the 3-Day SNF Rule Waiver Benefit Enhancement during a Performance Year, the ACO must– EXEMPLAR