Medicare Shared Savings Program

FRAUD AND ABUSE WAIVERS

• ACO Participation Waiver

The following information describes each arrangement for which our ACO seeks protection under the ACO Participation Waiver, including any material amendment or modification to a disclosed arrangement. 

HIE

• Parties to the arrangement: All Network Participants
• Date of arrangement: 08/14/2014
• Items, services, goods, or facility provided: To further the purposes of the MSSP and the clinical integration efforts of MHP and its participants, the MHP Board of Directors authorizes the provision of the required connectivity to the Mission Health System HIE for all network participants and their employed providers at no cost in order to facilitate the exchange of data necessary to evaluate and measure the quality outcomes of all network participants according to the requirements of the MSSP. 

Quality Incentive Program

• Parties to the arrangement: All Network Participants
• Date of arrangement: 04/11/2016
• Items, services, goods, or facility provided: A Quality Incentive Program that is designed to incentivize quality improvement behaviors among network providers, set a culture of communication and collaboration, build infrastructure and establish goodwill by providing financial incentives to providers who meet or exceed pre-established connectivity, reporting and quality metrics. The Quality Incentive Program will contribute to the promotion of high quality and efficient care to network patients by encouraging providers to adhere to quality metrics and facilitate management and coordination of care. 

Clinical Documentation Integrity “CDI” Services   

• Parties to the arrangement: All Network Participants
• Date of arrangement: 08/11/2016    
• Items, services, goods, or facility provided: Clinical Documentation Integrity “CDI” services which will include documentation specificity queries, code reviews, data analysis and education on findings related to documentation requirements and tools to support processes. These services will ensure that accurate documentation and code capture is at the most appropriate delivery of quality care.         

Psychiatric Consulting Services

• Parties to the arrangement: Mission Health Partners, LLC and Mountain Area Health Education Center (“MAHEC”); all Network Participants
• Date of arrangement: 01/01/2024
• Items, services, goods, or facility provided: To further the purposes for the MSSP, including improving the ability of MHP providers to manage and coordinate the care of patients, the MHP Board of Directors authorized MHP to enter into an arrangement with MAHEC, pursuant to which MAHEC psychiatrists will provide psychiatric telehealth consultation services to MHP primary care practices in support of developing their capacity to implement the Collaborative Care Model for more effective behavior health care management. MHP will make these services available to its MHP providers to facilitate the coordination and management of care of patients.