Exception for Certain In-Kind Remuneration Clause Samples
The 'Exception for Certain In-Kind Remuneration' clause defines circumstances under which non-cash compensation, such as goods or services provided instead of money, is permitted or exempted from general restrictions in an agreement. For example, this clause might allow a party to receive products, equipment, or other tangible benefits as part of their compensation, even if the contract otherwise limits or prohibits in-kind payments. Its core function is to provide flexibility in compensation arrangements by clarifying when and how in-kind remuneration is acceptable, thereby preventing misunderstandings or disputes over non-monetary payments.
Exception for Certain In-Kind Remuneration. 1. Consistent with the provisions of Sections 5.08.A and 5.08.B, and subject to compliance with all other applicable laws and regulations, beginning on the Start Date, the ACO may provide and may permit its Participant Providers, Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities to provide certain in-kind items or services to Beneficiaries in conjunction with any ACO Activities if the following conditions are satisfied:
a. The in-kind items or services are preventive care items and services or will advance one or more of the following clinical goals for the Beneficiary: adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition.
b. The in-kind item or service has a reasonable connection to the Beneficiary’s health care.
c. The in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a Benefit Enhancement is considered a Medicare-covered item or service, regardless of whether the ACO has selected to participate in such Benefit Enhancement for the Performance Year as described in Section 8.01.
d. 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.
e. The in-kind item or service is furnished to a Beneficiary directly by the ACO, a Participant Provider, or a Preferred Provider.
2. For each in-kind item or service provided under this Section 5.08.C, the ACO shall maintain and make available to the government upon request, and shall require its Participant Providers and Preferred Providers to maintain and make available to the government upon request, all materials and records sufficient to establish whether such in-kind item or service was furnished in a manner that meets the conditions of this Section 5.08.C. Such materials and records must be maintained in accordance with