; and (5) must have four or more chronic conditions as defined by the Secretary or had a qualified hospitalization stay, as defined by the Secretary, in the last 30 days. (e) Other eligibility requirements The Secretary may consider other eligibility requirements that are known to, based on evaluation and research, improve value of care and coordination of care. For example, the beneficiary could be required to attend an annual wellness visit or be aligned with a primary care provider or specialist who functions as a primary care provider. (f) Benefit determination process The Secretary shall establish a process to validate beneficiary eligibility for the Benefit through a determination process. Additionally, the Secretary shall put in place an appeals process to review possible wrongful determinations. (g) Coinsurance After 30 days of personal care services, a 20 percent coinsurance shall apply for the remaining Benefit period. (h) Reimbursement The Secretary will establish an hourly rate for personal care services through the annual physician fee schedule. The hourly rate should be based on a blend of the Department of Veterans Affairs fee schedule for the homemaker/home health aide service (G0156) and averages for private sector home care. (i) Value-Based care reimbursement The Secretary should establish a value-based component to the reimbursement of the Benefit that focuses on reducing medical needs. For example, a portion of the fee-for-service reimbursement could be withheld and if certain quality measures (e.g., avoiding unnecessary hospitalizations) are achieved, the remaining portion of the reimbursement would be paid. (j) Oversight The Secretary shall establish a process to certify personal care agencies, for example requirements for Federal background checks, and other appropriate oversight. Personal care aides shall be employed by an agency. To ensure sufficient number of providers, Agencies providing solely personal care services as defined in this section shall not be required to comply with