Common use of Review, Certification, and Finalization of the Participant Provider List and Preferred Provider List Clause in Contracts

Review, Certification, and Finalization of the Participant Provider List and Preferred Provider List. 1. CMS shall conduct a Program Integrity Screening for each individual and entity on the Proposed Revised Participant Provider List and the Proposed Revised Preferred Provider List. 2. CMS may reject any individual or entity on a Proposed Revised Participant Provider List or a Proposed Revised Preferred Provider List on the basis of the results of the Program Integrity Screening, history of program integrity issues, or: a. For any individual or entity on a Proposed Revised Participant Provider List, if CMS determines that the individual or entity does not satisfy the criteria in paragraphs (1) through (4) of Section 4.01.A; or b. For any individual or entity on a Proposed Revised Preferred Provider List, if CMS determines that the individual or entity does not satisfy the criteria in paragraphs (1) through (4) of Section 4.01.B. 3. CMS will provide the ACO with a list of individuals and entities tentatively approved to be Participant Providers and Preferred Providers at the start of the subsequent Performance Year. 4. In a form and manner and by a date specified by CMS, the ACO shall after a review of the lists of tentatively approved Participant Providers and Preferred Providers, confirm the accuracy of the revised Proposed Revised Participant Provider List and the revised Proposed Revised Preferred Provider List with any necessary corrections, including the removal of any individuals and entities that: a. Have not agreed to participate in the Model during the subsequent Performance Year pursuant to a written arrangement meeting the requirements of Section 3.04.G; b. Fail to meet the requirements of paragraphs (1) through (4) of Section 4.01.A or Section 4.01.B, as applicable c. Are otherwise ineligible to participate in the Model as a Participant Provider or Preferred Provider, as applicable; or d. Are identified as a Participant Provider and have not agreed to participate in the ACO’s selected Capitation Payment Mechanism with the ACO in accordance with Section 12.02.E. No additions to the Proposed Revised Participant Provider List or the Proposed Revised Preferred Provider List are permitted at this time. 5. In a form and manner and by one or more dates specified by CMS, the ACO shall certify: a. That the revised Proposed Revised Participant Provider List and the revised Proposed Revised Preferred Provider List are each a true, accurate, and complete list of individuals and entities that have agreed to be Participant Providers or Preferred Providers, as applicable, subject to CMS approval, during the subsequent Performance Year; b. That each individual and entity on the revised Proposed Revised Participant Provider List and the revised Proposed Revised Preferred Provider List meets the requirements of paragraphs (1) through (4) of Section 4.01.A or Section 4.01.B, as applicable; c. That, for every individual and entity included on the revised Proposed Revised Participant Provider List and the revised Proposed Revised Preferred Provider List, the ACO has either: i. Entered into a fully executed written arrangement with the individual or entity meeting the requirements of Sections