Required Public Disclosure for Use of an Arrangement Entered Into Under the ACO Participation Waiver
CHESS Innovation, LLC (the “ACO”), participates in the Medicare Shared Savings Program Accountable Care Organization ACO Model under a contract (the “Participation Agreement”) with the Centers for Medicare & Medicaid Services’ (“CMS”’). The Department of Health and Human Services has provided certain waivers of federal fraud and abuse laws pursuant to “Medicare Program; Final Waivers in Connection with the Shared Savings Program.” 80 Fed. Reg. 66,726 (Oct. 29, 2015), as amended from time to time (“Participation Waiver”).
The ACO has discovered that certain Medicare Shared Savings Program Beneficiaries are unable to procure transportation to and from clinical visits, potentially resulting in a deterioration in their health conditions, emergency room visits, other hospitalization, and/or disease progression. The ACO desires to improve the health of these Beneficiaries by providing access to transportation to travel to clinical visits at no cost to the Beneficiary, which will aid in improving the quality and reducing the overall cost of care.
On December 14, 2021, the Governing Body of the ACO, via unanimous consent, authorized an arrangement whereby the ACO reimburses certain transportation providers to provide transportation assistance to Eligible Beneficiaries who experience a qualifying hardship in obtaining a ride to any eligible locations or facilities within an eligible mile radius, as determined by the Governing Body.
As part of its December 14, 2021 authorization, the Governing Body of the ACO made a bona fide and duly authorized determination, consistent with its duty under 42 C.F.R § 425.106, that the Arrangement is reasonably related to ACO Activities. Specifically, the Arrangement will promote accountability for the quality, cost, and overall care for a Medicare population by enabling certain Medicare Shared Savings Program Beneficiaries to have access to transportation services that could reduce preventable emergency room visits, other hospitalizations, and disease progression, thereby increasing quality and improving care while potentially reducing overall costs.
After determining that the Arrangement meets all conditions to enable the ACO to avail itself of the Participation Waiver, the ACO entered into an Arrangement with Circulation, Inc. on December 15, 2021 to provide access to transportation services, and posted this notice on January 5th, 2022.