Disallowed Expenditures and Financial Repayments. In the event that the MDHHS, the PAYOR, the State of Michigan, or the federal government ever determines in any final revenue and expenditure reconciliation and/or any final finance or service audit that the PROVIDER has been paid inappropriately per the PAYOR’s expenditures of federal, State, and/or local funds pursuant to this Agreement for Medicaid or non-Medicaid program services claims and/or cost claims which are later disallowed, the PROVIDER shall fully repay the PAYOR for such disallowed payments within sixty (60) days of the PAYOR’s final disposition notification of the disallowed payment. Attachment C - RECIPIENT RIGHTS POLICIES & ATTESTATION In accordance with MCL 330.1752 Section 752, each community mental health services program, each licensed hospital, and each service provider under contract with the department, a community mental health services program, or a licensed hospital shall establish written policies and procedures concerning recipient rights and the operation of an office of recipient rights. PROVIDER attests to the following policies and procedures providing for the safeguarding of the rights of CONSUMERs.
Disallowed Expenditures and Financial Repayments. In the event that the MDHHS, the PAYOR, the State of Michigan, or the federal government ever determines in any final revenue and expenditure reconciliation and/or any final finance or service audit that the PROVIDER has been paid inappropriately per the PAYOR’s expenditures of federal, state, and/or local funds under this Agreement for Medicaid or non-Medicaid program supports/services claims, and/or cost claims which are later disallowed, the PROVIDER shall fully repay the PAYOR for such disallowed payments within sixty (60) days of the PAYOR’s final disposition notification of the disallowances, unless the PAYOR authorizes, in writing, additional time for repayment. Commented [BG130R129]: Agreed. Commented [PF129]: Add U5. Modifier should be reported for behavior identification assessments completed on ABA enrollees. Commented [KJ131R129]: PNMC: Agreed; add U5 modifier Commented [KJ132R129]: Added Commented [BG127]: U5 has been added back to 97151 for autism enrollees Commented [AD128R127]: Noted below on Attachment B Attachment B – Service Codes and Rates Code Service Description Modifiers Reporting Units PROVIDER Type BCBA BCaBA QBHP LP/LLP BT Notes 97151 ABA AH, HN, Per 15 BCBA, Behavior Identification Assessment HO, HP, ST, U5 minutes BCaBA, QBHP, or LP/LLP 0362T Behavior Follow-Up Assessment AF, AG, AH, HN, HO, HP, SA Per 15 minutes BCBA, BCaBA, QBHP, or LP/LLP 97153 ABA Adaptive Behavior Treatment, individual AF, AG, AH, HM, HN, HO, HP, SA, TD Per 15 minutes BCBA, BCaBA, QBHP, LP/LLP, or BT 97154 ABA Adaptive Behavior treatment, group AF, AG, AH, HM, HN, HO, HP, TD, SA Per 15 minutes BCBA, BCaBA, QBHP, LP/LLP, or BT 97155 Clinical Observation and Supervision AH, HN, HO, HP Per 15 minutes BCBA, BCaBA, QBHP, or LP/LLP 97156 Family training AH, HN, HO, HP Per 15 minutes BCBA, BCaBA, QBHP, or LP/LLP 97157 Family training, multiple families AH, HN, HO, HP Per 15 minutes BCBA, BCaBA, QBHP, or LP/LLP 97158 Adaptive Behavior Treatment Social skills group AH, HN, HO, HP Per 15 minutes BCBA, BCaBA, QBHP, or LP/LLP 0373T Direct treatment, requiring two or more technicians AF, AG, AH, HM, HN, HO, HP, SA Per 15 minutes BCBA, BCaBA, QBHP, LP/LLP, or BT Commented [PF133]: Remove. GT modifier is obsolete effective May 11, 2023. Commented [BG134R133]: agreed. Commented [KJ135R133]: PNMC: Agreed GT can be removed MODIFIERS: Modifier Description Applies To AF Specialty Physician 97153-54; 0362T; 0373T AG Physician 97153-54; 0362T; 0373T AH Clinical Psychologist prov...
Disallowed Expenditures and Financial Repayments. In the event that CMS, MDHHS, Authority, the State of Michigan, or the federal government ever determines in any final revenue and expenditure reconciliation and/or any final finance or service audit that Service Provider has been paid inappropriately per Authority’s expenditures of federal or State funds pursuant to this Agreement for services claims and/or cost claims which are later disallowed, Service Provider shall fully repay Authority for such disallowed payments within sixty (60) calendar days of Authority’s final disposition notification of the disallowances, unless Authority authorizes, in writing, additional time for repayment.
Disallowed Expenditures and Financial Repayments. In the event that the MDHHS, the Payor, the State of Michigan, or the Federal government ever determines in any final revenue and expenditure reconciliation and/or any final finance or service audit that the Provider has been paid inappropriately per the Payor’s expenditures of Medicaid (Federal share and/or State share) funds pursuant to this Agreement for services claims and/or cost claims of the Provider which are later disallowed, the Provider shall repay the Payor for such disallowed payments within sixty (60) days of the Payor’s final disposition notification of the disallowances, unless the Payor authorizes, in writing, additional time for repayment.
