Common use of Applicable Fees Clause in Contracts

Applicable Fees. 5.1 Contractor shall not charge any patients or third-party payers any fee for service unless directed to do so by the Local Mental Health Director at the time the patient is referred for services. When directed to charge for services, Contractor shall use the uniform billing and collection guidelines prescribed by the State Department of Health Care Services. Full published charges shall approximate estimated actual cost and shall not be less than the Contract rate as stated in Exhibit “B” of this Contract. 5.2 Contractor will perform eligibility and financial determinations, in accordance with State Department of Health Care Services’ Uniform Method of Determining Ability to Pay (UMDAP), for all patients unless directed otherwise by the Local Mental Health Director. 5.3 Contractor shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health or related administrative services provided under this Contract, except to collect other health insurance coverage, share of cost, and co-payments (Cal. Code Regs., tit. 9, §1810.365(c). 5.4 The Contractor must not bill beneficiaries, for covered services, any amount greater than would be owed if the Contractor provided the services directly as per 42 C.F.R. § 438.106(c).

Applicable Fees. 5.1 Contractor shall not charge any patients or third-party payers any fee for service unless directed to do so by the Local Mental Health Director at the time the patient is referred for services. When directed to charge for services, Contractor shall use the uniform billing and collection guidelines prescribed by the State Department of Health Care Services. Full published charges shall approximate estimated actual cost and shall not be less than the Contract rate as stated in Exhibit “B” of this Contract. 5.2 Contractor will perform eligibility and financial determinations, in accordance with State Department of Health Care Services’ Uniform Method of Determining Ability to Pay (UMDAP), for all patients unless directed otherwise by the Local Mental Health Director. 5.3 Contractor shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health or related administrative services provided under this Contract, except to collect other health insurance coverage, share of cost, and co-payments (Cal. Code Regs., tit. 9, §1810.365(c). 5.4 The Contractor must not bill xxxx beneficiaries, for covered services, any amount greater than would be owed if the Contractor provided the services directly as per 42 C.F.R. § 438.106(c).