Contract Reconciliation. Upon conclusion of each fiscal year of this Agreement, a final contract reconciliation shall be completed as a net cost settlement wherein the Medicaid subcapitated funding and SUD funding prepaid by the Payor to the Provider, and the total of the Provider’s expenditures pursuant to this Agreement shall be reviewed and reconciled in direct accordance with the service and financial provisions hereunder in order to assure that the Payor’s payments to the Provider have not exceeded the Payor’s obligations under this Agreement. (1.) Within the earlier of one hundred eighty (180) days after the conclusion of each fiscal year of this Agreement or ten (10) business days prior to the MDHHS due date, the Provider shall furnish the Payor with any service and financial reports, detailed revenue and expenditure summaries, service and/or financial records, and related source documents required by the Payor for the purposes hereunder. (2.) The Provider shall submit a preliminary fiscal year end reconciliation proposal to the Payor no later than ten (10) business days prior to the MDHHS due date. (3.) Within five (5) business days of receipt by the Payor of the MDHHS response to the fiscal year end preliminary reconciliation proposal, the Payor shall provide the Provider with a formal response to the reconciliation proposal. (4.) Within the earlier of ten (10) business days prior to the MDHHS due date or one hundred eighty (180) days after the end of each fiscal year of this Agreement the Provider shall submit a final reconciliation proposal to the Payor (5.) The Payor shall make a final determination of the final contract reconciliation within forty-five (45) business days of the submission to MDHHS of the fiscal year end reports. This determination is subject to adjustment should the final reports require re-submission for any reason. (6.) Any amount due to the Payor or to the Provider as a final contract reconciliation of each fiscal year of this Agreement shall be paid within thirty (30) days after notification of the Payor’s final determination hereunder. (7.) Upon notification of the acceptance of the final cost settlement between the PIHP and MDHHS, the Payor shall determine if adjustments are necessary to the final cost reconciliations with the Provider as determined in subsection (5) above. Any adjustments shall be paid as required within 30 days of Provider notification.
Appears in 4 contracts
Samples: Medicaid Managed Specialty Supports and Services Agreement, Medicaid Managed Specialty Supports and Services Agreement, Medicaid Managed Specialty Supports and Services Agreement
