Applicable to APM Year 1 Only. For inpatient stays where the Medicaid patient had service days prior to and after the start of APM Year 1, State will pay any Inpatient Days incurred through February 28, 2021, on a fee-for-service basis. For these patients where the Inpatient Days are for service dates on or after March 1, 2021, no payment will be made through fee-for-service. These days are included in the APM Payment. This payment methodology will require claim processing system modifications to allow for zero-dollar payment on future Inpatient Days claims. These modifications will require additional time to implement after the effective date of this agreement. On an ongoing basis, as needed until the claim processing system is modified, the State will instruct the claims processor to recoup payments made on any days incurred on or after March 1, 2021, for which a fee-for-service payment was made. Parties agree that any fee-for-service payments on claims covered by the APM Payment are an overpayment, and the State is entitled to recoup these payments. This activity will not require Contractor to resubmit claims. To prevent Contractor from having to reimburse the State for duplicate claims payments, State will initiate weekly recoupments. Should the State take longer than sixty (60) days to recoup any such overpayments on properly submitted claims, such delay will not result in those overpayments being treated as false claims.
