Valuing Rewards and Incentives

100.4 – Valuing Rewards and Incentives (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) Rewards and incentives for each RI Program must have values that are expected to elicit intended enrollee behavior but may not exceed the value of the health related service or activity (§422.134(C)(1)(iii)). At this time, CMS has not identified the monetary values that exceed what is necessary to influence enrollee behavior. There is also no express limit on how often rewards and/or incentives may be offered to enrollees throughout a contract year. Instead, MA plans are to establish reasonable and appropriate values for rewards and/or incentives that comply with §422.134. If necessary, in the future, we may issue additional guidance applying the regulation standards to specify limits on the value of rewards and incentives.