CMS Pub. 100-16, ch. 4, § 100.3

Activity

(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)

Within an RI Program, rewards and incentives must be earned by completing an entire

service or activity (or combination of services/activities), as established by the MA plan,

and may not be offered for completion of less than any/all required component(s) of the

eligible service or activity. This requirement allows CMS and MA plans to interpret the

value of a reward or incentive in relation to the service or activity for which it is being

offered.

Plans are expected to reasonably define the scope of the “entire service or activity”

within their RI Program design and assign a value of the reward or incentive

accordingly. For example, a plan may decide to offer rewards and/or incentives for

participation in a smoking cessation program. The plan may decide to give smaller

rewards for each class or counseling session attended or may offer a single, larger

reward for completing a pre-determined number of classes or counseling sessions.

Consistent with the requirement that rewards and incentives be of a value that may be

expected to affect enrollees’ behavior, the service or activity for which rewards and/or

incentives are being offered should be at a level that is meaningful.