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ACCESS Patient Consent

If you are joining FitOn Care through the CMS ACCESS Model, this Patient Consent form tells you what the program is, what we will do with your information, and your rights. Please read it before you enroll. The program is voluntary.

  1. What is ACCESS? The Advancing Chronic Care with Effective, Scalable Solutions Model (“ACCESS” or “ACCESS Model”) is a Medicare payment model run by the Centers for Medicare & Medicaid Services’ (“CMS”) Center for Medicare and Medicaid Innovation (“CMMI”). CMS reimburses healthcare organizations like FitOn Care (each, a “Participant”), that are offering technology-driven care options to patients with chronic conditions, under a new payment approach designed to improve outcomes for such patients. FitOn Care is an accepted ACCESS Participant.

  2. What we will share with CMS. As part of the ACCESS Model, we will share information about your care with CMS through secure digital connections. This includes baseline measurements, your progress over time, and outcome information. CMS may also send us your Medicare claims data through a secure system (the Beneficiary Claims Data API) to help us coordinate your care. We may also share information with the federal evaluators CMS hires to study the model. All data sharing is done in compliance with HIPAA, federal privacy and security rules, and the legal authority of the ACCESS Model. We will not share more than is needed.

  3. Possible random assignment. CMS is testing the ACCESS Model. Some people who try to enroll will be randomly assigned to a comparison group rather than the program. If that happens to you, you will not be able to enroll in this clinical track for 12 months, but it will not affect your Medicare benefits, rights, or coverage. You will be able to see your other doctors and receive all of your usual Medicare services.

  4. Your enrollment is voluntary. You do not have to enroll, and only one ACCESS Participant can serve you for a given clinical track at a time. After your first 90 days, you can switch to a different ACCESS Participant or leave ACCESS for any reason.

  5. Cost. FitOn Care has chosen not to collect cost-sharing from you for the ACCESS services we provide. We apply this choice to every ACCESS patient in the same clinical track. Your usual Medicare rules continue to apply for any other services you receive from any other provider.

  6. How Medicare billing works. While you are enrolled with us in an ACCESS track, FitOn Care and our affiliated medical groups will not bill Medicare fee-for-service for services we provide to you, not only for services that treat the condition you enrolled for, but for any other Medicare service we might otherwise provide to you. Instead, Medicare pays FitOn Care under the ACCESS Model. This does not limit your choice. You remain free to see any other Medicare provider you choose, and they will bill Medicare for their services in the usual way.

  7. Sharing updates with your other doctors. We would like to send short, standardized care updates to your primary care physician and any doctor on your care team, at the start of your care, at major milestones, and at the end of your care. You can withdraw permission at any time, in writing, without affecting your care. By agreeing, you give us permission to share care updates with your PCP and other members of your care team. If you decline, we will not share updates without asking you.

  8. What you'll need. To participate in the ACCESS program, you'll need access to certain items for measurements during your care; for example, a blood pressure cuff and a digital scale, depending on your track. You can use items you already own, items at your primary care physician's office, or other sources of your choice. Some measurements may need to come from a clinical source (such as a lab result or a reading taken at a clinician's office). We will let you know in advance when that applies. FitOn Care does not provide these items.

  9. If FitOn Care withdraws from the ACCESS Model. If we decide to withdraw from the ACCESS Model, we will give you written notice and help you find another provider so your care continues.

  10. Your Medicare rights are not changed. Joining ACCESS does not change your Medicare appeal, grievance, or complaint rights. You can use the Medicare appeals process, contact the Medicare Beneficiary Ombudsman, or contact your State Health Insurance Assistance Program (“SHIP”) at any time. Nothing in this Addendum, our Terms of Use, or any other agreement with FitOn Care limits those rights.

  11. Who is accountable. The legal entity accountable for your care depends on the state where you receive services. For most patients this is FitOn Care, P.A. Our Medical Director is Bobby Malik, MD. For non-emergency care questions, contact us at care@fitoncare.com. We typically respond within 1–2 business days. For emergencies, call 911.

If you have additional questions, please email us at care@fitoncare.com.