Fraud and Abuse Waivers

Payment Rule Waiver:

  • Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
    • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.

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.

  • Medical Director Arrangement
    • Parties to the arrangement: Augusta Health and the Medical Director of Augusta Care Partners
    • Date of arrangement: 01/01/2014
    • Items, services, goods, or facility provided: Compensation for Medical Director services for Augusta Care Partners
    • Date and nature of any amendments to the arrangement, if applicable: N/A
  • Board / Committee Service Arrangement
    • Parties to the arrangement: Augusta Health and members of the Board/Committees of Augusta Care Partners
    • Date of arrangement: 01/01/2014
    • Items, services, goods, or facility provided: Compensation for Board/Committee time
    • Date and nature of any amendments to the arrangement, if applicable: N/A
  • General Operating Expenses Arrangement
    • Parties to the arrangement: Augusta Health and Augusta Care Partners
    • Date of arrangement: 01/01/2014
    • Items, services, goods, or facility provided: Payments or contributions of general operating expenses of the ACO including: supplies; meeting meals; dues and subscriptions; marketing materials; support staff; data analytics staff and software; care coordination staff and software (Lightbeam).
    • Date and nature of any amendments to the arrangement, if applicable: N/A
  • CAHPS for MIPS Arrangement
    • Parties to the arrangement: Augusta Health and Augusta Care Partners
    • Date of arrangement: 08/01/2020
    • Items, services, goods, or facility provided: Payments to third parties for patient satisfaction survey and analysis (Professional Research Consultants)
    • Date and nature of any amendments to the arrangement, if applicable: N/A
  • Professional Development Arrangement
    • Parties to the arrangement: Augusta Health and Augusta Care Partners
    • Date of arrangement: 01/01/2014
    • Items, services, goods, or facility provided: Payments for ACO related professional development and conference expenses for Augusta Care Partners staff and leadership.
    • Date and nature of any amendments to the arrangement, if applicable: N/A

Shared Savings Distribution Waiver