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Next Generation ACO Participation Waiver Disclosures

The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that otherwise limit innovation by ACOs participating in the Next Generation ACO Model (see HHS, Notice of Amended Waivers of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model, published December 29, 2016).  Pursuant to that notice, UNC Senior Alliance seeks protection under the Next Generation ACO Participation Waiver for the following arrangements set forth below:

  • UNCSA will provide financial support to the UNC School of Medicine Department of Family Medicine in order to support and sustain the REACH Program from January 1, 2017 through June 30, 2017.  The Program provides enhanced home-based primary care and other necessary services to medically complex patients living in Assisted Living Facilities or at home, including a significant number of Medicare beneficiaries who are attributed to UNCSA.  This arrangement supports UNCSA’s objectives related to improving care coordination and ensuring care is provided to Next Gen Beneficiaries in the most efficient, cost-effective and medically appropriate setting.
  • Effective February 27, 2017, UNCSA provides all ACO Participants and Preferred Providers with access to HealthLink PM, an after-hours call coverage and nurse-based triage service for assisting Next Generation Beneficiaries with their care needs.  The phone service is an important tool in our efforts to improve the quality and lower the total cost of care provided to our Next Generation Beneficiaries.