CMS Pub. 100-16, ch. 4, § 100.2

Any RI Program offered by an MA plan must not discriminate against enrollees based on

race, gender, chronic disease, institutionalization, frailty, health status or other

impairments and must be designed so that all enrollees are able to earn rewards.

The non-discrimination and equal access requirements do not preclude plans from

offering RI Programs that target enrollees with a specific disease or chronic condition as

long as the RI Program does not discriminate against any enrollee who would otherwise

qualify for participation. Thus, any RI Program must accommodate otherwise qualified

enrollees who receive services in an institutional setting or who need a modified

approach to enable effective participation and attainment of designated rewards and

incentives.

For example, while internet-based RI Programs are allowed, an alternate method of

earning and/or claiming rewards and incentives must be offered to those enrollees who

do not have internet access. Another example is an RI Program in which participants

earn a reward for participating in an exercise class. An alternate method of fulfilling an

exercise activity must be offered to those individuals who are unable to attend the class,

perhaps due to institutionalization, lack of transportation, or are disabled or wheelchair

bound.

A caretaker may not participate in place of the enrollee in the services or activities in

order to earn rewards or incentives on behalf of the enrollee. The goal of an RI Program

is to encourage and maintain healthy behaviors that have a positive impact on enrollees;

therefore, the enrollee must participate directly in the RI Program.

All RI Programs must provide the same rewards to all qualifying participants who

perform the same action(s). An RI Program may not distinguish enrollees based on their

medical encounter history. In other words, plans may not reward enrollees who have

historically not utilized appropriate/recommended services at a higher level than other

enrollees for participating in a RI Program activity. While RI Programs may aim to

encourage more participation in preventive care, they may not discriminate against

enrollees who have a good record of participation.