ACO Program Rules, Clinical Model and ACO Policies. Participant and Preferred Provider agree to support, comply with, and implement the Clinical Model, the ACO Compliance Program and ACO Policies. The Parties acknowledge that the Clinical Model is an iterative, data driven model developed with the participation of the ACO’s network of Providers that will include ACO-wide initiatives as well as HSA specific initiatives and that may vary over the course of this Agreement. Participant and Preferred Provider shall cooperate with ACO’s care coordination protocols, which may include: permitting ACO to conduct telephonic and on-site utilization management and quality assurance activities; and/or requiring Participant or Preferred Provider to coordinate with ACO or other Participant or Preferred Provider hospital’s or facility’s care coordinators regarding the care of ACO Program Beneficiaries. Participant and Preferred Provider acknowledge that sharing of provider identifiable quality and cost data is a core component of ACO’s Programs and consent to the sharing of such information. Participant and Preferred Provider shall implement such cost and quality control protocols or other interventions as may be adopted by ACO regarding the care of ACO Program Beneficiaries. ACO shall make new or revised policies available to Participants on the ACO Provider Portal at least thirty (30) days prior to their implementation unless those policies are changed to achieve regulatory or legal compliance for which immediate effectiveness is required. For changes that are not legal or regulatory in nature and that present material administrative burden or material expense to Participants or Preferred Providers, ACO will work collaboratively on the methods and timing for implementation. Changes to ACO Policies supporting the Program of Payment may only be made in accordance with Section 3 of this Agreement. Participant and Preferred Provider also agree to participate in the ACO’s Compliance Program including, but not limited to, participating in audits, attending compliance training, ensuring Participant’s and Preferred Provider’s policies are consistent or do not conflict with the ACO Program Rules, Clinical Model or ACO Policies, educating Participant's and Preferred Provider’s staff and reporting instances of non-compliance.
ACO Program Rules, Clinical Model and ACO Policies. Participant and Affiliate agree to support, comply with, and implement the Clinical Model, the ACO Compliance Program and applicable ACO Program policies. Participant and Affiliate shall cooperate with ACO’s case management protocols, which may include: placing in-office case managers at Participant’s or Affiliate’s practice; permitting ACO to conduct telephonic and on-site utilization management and quality assurance activities; and/or requiring Participant or Affiliate to coordinate with ACO or other Participant or Affiliate hospital’s or facility’s case managers regarding the care of ACO Program Beneficiaries. Participant and Affiliate acknowledge that sharing of provider identifiable quality and cost data is a core component of ACO’s Programs and consent to the sharing of such information. Participant and Affiliate shall implement such cost and quality control protocols or other interventions as may be adopted by ACO regarding the care of ACO Program Beneficiaries. ACO shall, to the extent practicable, make new policies available to Participants on the ACO Provider Portal prior to their implementation, unless those policies are changed to achieve regulatory or legal compliance for which immediate effectiveness is required. Participant and Affiliate also agree to participate in the ACO’s Compliance Program including, but not limited to, participating in audits, attending compliance training, ensuring Participant’s and Affiliate’s policies are consistent or do not conflict with the ACO Program Rules, Clinical Model or ACO Policies, educating Participant's and Affiliate’s staff and reporting instances of non-compliance.
