Common use of Compliance Monitoring Under the TPR Clause in Contracts

Compliance Monitoring Under the TPR. 1. General and Overall Compliance a) The Hospital will be subject to any rate adjustments that are necessary to bring it into compliance with the Approved Regulated TPR Revenue. If the gross revenue charged by the Hospital exceeds the Approved Regulated TPR Revenue, the difference between the gross revenue charged and the Approved Regulated TPR Revenue, together with any penalties assessed, will be subtracted from the Approved Regulated TPR Revenue that would otherwise have been approved for the Hospital for the subsequent Rate Year. Conversely, if the gross revenue charged by the Hospital is less than the Approved Regulated TPR Revenue, the difference will be added to the Approved Regulated TPR Revenue of the Hospital for the subsequent Rate Year, except that undercharges below the corridors specified in this section of the Agreement and in Section B below will not be added to the Approved Regulated TPR Revenue for the subsequent Rate Year. b) The Hospital agrees that it will not overcharge the limits of the Total Approved Regulated Revenue, and that it will take prompt action to gain compliance. In order to assure compliance, the HSCRC staff will apply penalties for charges exceeding the overall limits of the Approved Regulated TPR revenue, and such penalty amounts will be subtracted from the Approved Regulated TPR Revenue for the succeeding rate year as a one-time adjustment. Overcharge penalties will be applied based on the following tiers: • For charges exceeding the limit up to .5% of the Approved Regulated TPR Revenue, there will be no penalty. • For charges exceeding the limit from .51% up to 1%, there will be a 20% penalty applied, • For charges exceeding the limit by more than 1%, there will be a 50% penalty applied. The penalties will be summed and subtracted from the Approved Regulated TPR Revenue for the succeeding rate year. If the HSCRC staff determines that the Hospital intentionally overcharged, then the overcharge corridor exempting an overcharge of up to .5% will be eliminated, and a 20% penalty will be applied to the overcharge up to .5%. c) Undercharges below the limit for Approved Regulated TPR Revenue will be subject to carryover limits, in order to assure the budgetary constraints of the All-Payer Model on a year-to-year basis. Undercharge limits will be applied as follows: • For charges below the Approved Regulated TPR Revenue amount of up to .5%, there will be no penalty. • For charges below the Approved Regulated TPR Revenue amount of .51% up to 1%, 20% of the underage will not be added back to approved revenues as a one-time increase in revenues for the subsequent rate year. • For charges below the Approved Regulated TPR Revenue amount below 1% and 2%, 50% of the underage will not be added back to approved revenues as a one-time increase in revenues for the subsequent rate year. • For charges below the Approved Regulated TPR Revenue amount below 2%, none of the underage will be added back to approved revenues as a one-time increase in revenues for the subsequent rate year. d) Volume fluctuations near the end of the rate year may affect the Hospital's ability to comply with the overall corridors. The Hospital may submit a request for relief if there are unexpected volume fluctuations in the final months of the year. The HSCRC staff will review the request and make a determination whether to grant relief from the corridor. 2. Unit Rate Flexibility 3. December 31 Target

Compliance Monitoring Under the TPR. 1. General and Overall Compliance a) The Hospital will be subject to any rate adjustments that are necessary to bring it into compliance with the Approved Regulated TPR Revenue. If the gross revenue charged by the Hospital exceeds the Approved Regulated TPR Revenue, the difference between the gross revenue charged and the Approved Regulated TPR Revenue, together with any penalties assessed, will be subtracted from the Approved Regulated TPR Revenue that would otherwise have been approved for the Hospital for the subsequent Rate Year. Conversely, if the gross revenue charged by the Hospital is less than the Approved Regulated TPR Revenue, the difference will be added to the Approved Regulated TPR Revenue of the Hospital for the subsequent Rate Year, except that undercharges below the corridors specified in this section of the Agreement and in Section B below will not be added to the Approved Regulated TPR Revenue for the subsequent Rate Year. b) The Hospital agrees that it will not overcharge the limits of the Total Approved Regulated Revenue, and that it will take prompt action to gain compliance. In order to assure compliance, the HSCRC staff will apply penalties for charges exceeding the overall limits of the Approved Regulated TPR revenue, and such penalty amounts will be subtracted from the Approved Regulated TPR Revenue for the succeeding rate year as a one-time adjustment. Overcharge penalties will be applied based on the following tiers: •  For charges exceeding the limit up to .5% of the Approved Regulated TPR Revenue, there will be no penalty. •  For charges exceeding the limit from .51% up to 1%, there will be a 20% penalty applied, •  For charges exceeding the limit by more than 1%, there will be a 50% penalty applied. The penalties will be summed and subtracted from the Approved Regulated TPR Revenue for the succeeding rate year. If the HSCRC staff determines that the Hospital intentionally overcharged, then the overcharge corridor exempting an overcharge of up to .5% will be eliminated, and a 20% penalty will be applied to the overcharge up to .5%. c) Undercharges below the limit for Approved Regulated TPR Revenue will be subject to carryover limits, in order to assure the budgetary constraints of the All-Payer Model on a year-to-year basis. Undercharge limits will be applied as follows: •  For charges below the Approved Regulated TPR Revenue amount of up to .5%, there will be no penalty. •  For charges below the Approved Regulated TPR Revenue amount of .51% up to 1%, 20% of the underage will not be added back to approved revenues as a one-time increase in revenues for the subsequent rate year. •  For charges below the Approved Regulated TPR Revenue amount below 1% and 2%, 50% of the underage will not be added back to approved revenues as a one-time increase in revenues for the subsequent rate year. •  For charges below the Approved Regulated TPR Revenue amount below 2%, none of the underage will be added back to approved revenues as a one-time increase in revenues for the subsequent rate year. d) Volume fluctuations near the end of the rate year may affect the Hospital's ability to comply with the overall corridors. The Hospital may submit a request for relief if there are unexpected volume fluctuations in the final months of the year. The HSCRC staff will review the request and make a determination whether to grant relief from the corridor. 2. Unit Rate Flexibility 3. December 31 Target