Common use of Federal Disallowance Clause in Contracts

Federal Disallowance. If the federal government recoups money from the State of West Virginia for expenses and/or costs that are deemed unallowable by the federal government, BMS has the right to, in turn, recoup payments made to the MCO for these same expenses and/or costs, even if they had not been previously disallowed by BMS and were incurred by the MCO. Any such expenses and/or costs would then be deemed unallowable by BMS. If BMS retroactively recoups money from the MCO due to a federal disallowance, BMS will recoup the entire amount paid to the MCO for the federally disallowed expenses and/or costs, not just the federal portion. Should any part of the scope of work under this contract relate to a state program that is no longer authorized by law (e.g., which has been vacated by a court of law, or for which CMS has withdrawn federal authority, or which is the subject of a legislative repeal), the MCO must do no work on that part after the effective date of the loss of program authority. The state must adjust capitation rates to remove costs that are specific to any program or activity that is no longer authorized by law. If the MCO works on a program or activity no longer authorized by law after the date the legal authority for the work ends, the MCO will not be paid for that work. If the state paid the MCO in advance to work on a no-longer-authorized program or activity and under the terms of this contract the work was to be performed after the date the legal authority ended, the payment for that work must be returned to the state. However, if the MCO worked on a program or activity prior to the date legal authority ended for that program or activity, and the state included the cost of performing that work in its payments to the MCO, the MCO may keep the payment for that work even if the payment was made after the date the program or activity lost legal authority.

Federal Disallowance. If the federal government recoups money from the State of West Virginia for expenses and/or costs that are deemed unallowable by the federal government, BMS the Department has the right to, in turn, recoup payments made to the MCO for these same expenses and/or costs, even if they had not been previously disallowed by BMS the Department and were incurred by the MCO. Any such expenses and/or costs would then be deemed unallowable by BMSthe Department. If BMS the Department retroactively recoups money from the MCO due to a federal disallowance, BMS the Department will recoup the entire amount paid to the MCO for the federally disallowed expenses and/or costs, not just the federal portion. Should any part of the scope of work under this contract relate to a state program that is no longer authorized by law (e.g., which has been vacated by a court of law, or for which CMS has withdrawn federal authority, or which is the subject of a legislative repeal), the MCO must do no work on that part after the effective date of the loss of program authority. The state must adjust capitation rates to remove costs that are specific to any program or activity that is no longer authorized by law. If the MCO works on a program or activity no longer authorized by law after the date the legal authority for the work ends, the MCO will not be paid for that work. If the state paid the MCO in advance to work on a no-longer-authorized program or activity and under the terms of this contract the work was to be performed after the date the legal authority ended, the payment for that work must should be returned to the state. However, if the MCO worked on a program or activity prior to the date legal authority ended for that program or activity, and the state included the cost of performing that work in its payments to the MCO, the MCO may keep the payment for that work even if the payment was made after the date the program or activity lost legal authority.

Federal Disallowance. If the federal government recoups money from the State of West Virginia for expenses and/or costs that are deemed unallowable by the federal government, BMS has the right to, in turn, recoup payments made to the MCO for these same expenses and/or costs, even if they had not been previously disallowed by BMS and were incurred by the MCO. Any such expenses and/or costs would then be deemed unallowable by BMS. If BMS retroactively recoups money from the MCO due to a federal disallowance, BMS will recoup the entire amount paid to the MCO for the federally disallowed expenses and/or costs, not just the federal portion. Should any part of the scope of work under this contract relate to a state program that is no longer authorized by law (e.g., which has been vacated by a court of law, or for which CMS has withdrawn federal authority, or which is the subject of a legislative repeal), the MCO must do no work on that part after the effective date of the loss of program authority. The state must adjust capitation rates to remove costs that are specific to any program or activity that is no longer authorized by law. If the MCO works on a program or activity no longer authorized by law after 2 Enrollees will only be enrolled on the first of the month and must stay with the MCO until the 30th before changing MCO’s. the date the legal authority for the work ends, the MCO will not be paid for that work. If the state paid the MCO in advance to work on a no-longer-authorized program or activity and under the terms of this contract the work was to be performed after the date the legal authority ended, the payment for that work must be returned to the state. However, if the MCO worked on a program or activity prior to the date legal authority ended for that program or activity, and the state included the cost of performing that work in its payments to the MCO, the MCO may keep the payment for that work even if the payment was made after the date the program or activity lost legal authority.