Common use of Financial Assistance Calculation, Disbursement, Confirmation of Performance and Reporting Requirements Clause in Contracts

Financial Assistance Calculation, Disbursement, Confirmation of Performance and Reporting Requirements. Provider Audit Procedures (a) OHA will provide financial assistance for A&D 81 Services identified in a particular line of Exhibit C, “Financial Assistance Award,” as specified in the PGS Procedure Codes and Rates for Treatment Providers rate sheet, located at xxxxx://xxx.xxxxxx.xxx/oha/HSD/Problem- Gambling/Pages/Treatment.aspx, as it may be revised from time to time. (b) OHA will not make multiple financial assistance disbursements for a single clinical activity, except for group therapy. For example, OHA will not provide financial assistance for an individual treatment session for both an Individual and his or her spouse when the treatment was delivered in a single marital session. (c) Providers of A&D 81 Services shall not charge Individuals whose Services are paid through this Agreement any co-pay or other fees for such Services. (d) Provider Audits: Providers receiving funds under this Agreement, for A&D 81 Services, are subject to audits of all funds applicable to A&D 81 Services rendered. The purpose of these audits is to: i. Require proper disbursements were made for covered A&D 81 Services; ii. Recover over-payments; iii. Discover any potential or actual instances of fraud and abuse; and iv. Verify that encounter data submissions are documented in the client file, as required and described in the “Special Reporting Requirements” above. (e) OHA’s obligation to provide assistance under this Agreement is subject to the satisfaction of the County delivering the anticipated level of A&D 81 Services, upon which the allotments were calculated. If, for a period of 3 consecutive months during the term of this Agreement, County delivers less than the anticipated level of Services, upon which allotments were calculated in a particular line of Exhibit C, “Financial Assistance Award,” OHA may amend the amount of funds awarded for A&D 81 Services in proportion to the under-utilization during that period, including but not limited to reducing the amount of future funds awarded for A&D 81 Services in an amount equal to funds reduced under that line of the Financial Assistance Award for under-utilization. An amendment shall be prepared and executed between OHA and County to reflect this reduction.