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CHRONIC CARE MANAGEMENT (CCM) ADDENDUM

Effective as of October 1, 2024 (Version Number: 45566)


Chronic Care Management (CCM) - If the executed COF includes Chronic Care Management (“CCM”) in any form, the following additional terms and conditions apply:

  1. Primary Service. DAS will generate all enrollment documentation and shall perform some or all of the CCM services as follows:
    1. Provide a comprehensive assessment of and care planning for patients requiring chronic care management services per CMS’s guidelines under CPT Code G0506, reportable once per CCM billing practitioner, in conjunction with CCM initiation; 
    2. Provide at least 20+ minutes of non- face-to-face time monthly, per CMS’s guidelines under CPT Code 99490, for each patient who enrolls in the program; 
    3. in some cases requiring moderate or high complexity medical decision making, provide up to 30+ or 60+ minutes of additional non-face-to-face time monthly, per CMS’s guidelines under CPT Codes 99489 or 99487 respectively.
  2. Care Plan. DAS shall also create and maintain an electronic care plan (care coordination document), for each patient, addressing the patient’s physical, mental, cognitive, psychosocial, functional and environmental needs, and also maintain an inventory of supportive patient resources.
  3. Documentation Management. DAS shall maintain sufficient documentation of provided services, including time spent communicating with each patient, and with other treating health professionals, for care coordination.
  4. Intentionally Omitted.
  5. Account Services. DAS shall assign an experienced account representative to serve as Client’s direct service contact. Client will receive a complete list monthly of enrolled patients who may be eligible to be billed pursuant to one of the CCM Services listed above, which will assist Client’s billing staff or service in billing CMS.
  6. Client’s Responsibilities. 
    1. Client shall give DAS full and complete access to its EHR system within seven (7) days of the Effective Date, and continuously thereafter on a real-time (or near real-time) basis, including the ability to update the Care Plan for each patient in the CCM Services;
    2. Client shall identify all of Client’s Medicare patients who qualify for CCM services under CPT Code 99490 (i.e., having two (2) or more chronic conditions expected to last at least 12 months, or the remainder of the patient's life, that place the patient at significant risk of acute exacerbation/decompensation or functional decline), as well as which patients qualify as “complex patients” and can be serviced for CPT codes 99489 and/or 99487; Client’s Physician practitioner is solely responsible for determining which patients are eligible for service and billing. 
    3. With DAS’s assistance (including its customized patient-directed enrollment letter explaining the benefits of Chronic Care Management), Client shall inform all qualifying and interested patients of the nature of the CCM services to be provided by DAS, the patient’s responsibility for any associated co-pays and/or deductibles, the possible need for sharing their health information with other practitioners, and the patient’s right to disenroll from the program at any time. 
    4. Client shall enroll its first patient under this Addendum within 45 days of the Effective Date, and shall use reasonable commercial efforts to enroll at least 10% of all eligible patients within the first six (6) months from the Effective Date;
    5. Although no longer required by CMS, Client will obtain written consent from all patients for which CCM services are to be rendered by DAS.
    6. Client is solely responsible and liable for ensuring a face-to-face visit is conducted with any patient receiving CCM Services, provided such face-to-face visit is required by CMS.
    7. Client is solely responsible and liable for determining and ensuring whether or not the necessary monthly time element or component of the CCM Services has been met.
    8. Client is solely responsible for the appropriate billing and collections from CMS, and if applicable, from its enrolled patients, any and all amounts owed relating to the CCM Services provided, whether provided by the Client or DAS. 
    9. Client is solely responsible and liable for full compliance with all CMS rules, regulations, requirements and procedures, as may be amended from time to time, relating to the CCM Services.
    10. Client (not DAS) is the “directing” party with regard to CMS’s guidelines specifying the need for CCM services to be directed by a physician or other qualified health care provider.
  7. EHR system requirements. In order to continue to qualify for billing CMS for provision of CRM services under CPT Code 99490, Client must continue to satisfy CMS’s criteria of using certified Electronic Health Record (EHR) technology. This means a version of certified EHR that is acceptable under the EHR Incentive Programs as of December 31st of the calendar year preceding each Medicare PFS payment year. Client’s EHR system must therefore continue to: 
    1. Include patient demographics, problem list, medication list, and medication allergy list [consistent with 45 CFR 170.314(a)(3)(7)]
    2. Allow for the creation of a structured clinical summary record [consistent with 45 CFR 170.314(e)(2)]
    3. Allow provider to transmit the care coordination document for purposes of care coordination
    4. House the patient’s consent for participation in the CCM Services
    5. House the patient receipt of care plan (electronic/hard copy)
    6. Document communications to and from home and community-based providers
  8. Payment. CCM services are Services Billed in Arrears. All other charges shall be billed and paid pursuant to one of the available Payment Options as stated on the Program Agreement or herein. If Client terminates CCM Services prior to the end of the then current Term (including as a result of non-compliance with the terms of this Addendum, or if DAS terminates CCM Services for cause (including as a result of failure to use reasonable commercial efforts to enroll at least 10% of eligible patients), then Client shall be immediately liable for payment of, in addition to any other Early Termination fees, an Early Termination Fee equal to (a) $5,000 per Provider, plus (b) the average monthly payment over the prior six months (or number of months of active participation if less than six), times the number of months remaining in the then current Term (plus renewal if the Notice period has already passed).
  9. The CCM Services are not a substitute for independent medical judgment and should not be relied upon by Client for any type of diagnosis or treatment plan for any condition. Notwithstanding anything contained herein, the Client shall remain the sole responsible and liable party for the appropriate and reasonable medical treatment and/or care of their patients. Physicians and other health care providers should always exercise their own clinical judgment for any given situation. 
  10. The DAS Health XL EULA  is available at https://DAShealth.com/documents, and is specifically incorporated by reference and made a part of this Agreement. 
  11. All CCM Services may, at DAS’s sole discretion, and without any notice to Client, be subcontracted by DAS to another vendor. 
  12. Any dispute related to a patient denial by a payer for CCM Services, must be reported within 30 days following the receipt of billing details by DAS. Such requests must be accompanied by an Explanation of Benefits (EOB) document outlining the reason for the denial. Failure to report any disputes or provide the necessary documentation within this time frame will result in the waiver of any rights to raise such disputes in the future.