Common use of FUNDING AND PAYMENTS Clause in Contracts

FUNDING AND PAYMENTS. 5 A. COUNTY shall pay the Intermediary an amount sufficient to reimburse Hospital Claims in 6 accordance with Exhibit B to this Agreement. 7 1. Payment by the Intermediary to CONTRACTOR for Hospital Services shall be contingent 8 upon ADMINISTRATOR’s receipt or confirmation of receipt of a fully executed Agreement and Rate 9 Certification Form from CONTRACTOR in accordance with Paragraph III.B of this Exhibit A to this 10 Agreement for Period One. Payment by the Intermediary to CONTRACTOR for Period Two, Period 11 Three, Period Four, and Period Five shall be contingent upon receipt of an updated Rate Certification 12 Form in accordance with Paragraph VI.B of Exhibit B to this Agreement. 13 2. Any Hospital that does not become a Contracting ED Hospital or Contracting Hospital and 14 elects to provide any Hospital Services to any MSN Enrollee shall be reimbursed by COUNTY at the 15 Non-Contract Hospital rates. 16 B. Sub-Acute Services – COUNTY shall pay the Intermediary the amount necessary to cover 17 reimbursement for Sub-Acute Services in accordance with letter(s) of agreement as may be negotiated 18 by ADMINISTRATOR for such services. These services may include, but are not limited to, Sub-Acute 19 and Skilled Nursing Facility Services. 20 C. Special Permit Transfer – COUNTY shall pay Intermediary the amount necessary to cover 21 reimbursement for Special Permit Transfer Services as allowed in Paragraph III.C.12 of this Exhibit A to 22 the Agreement. This Agreement shall not obligate CONTRACTOR to accept a transfer from, nor to 23 provide compensation to, any other health care facility, subject to requirements of applicable law. 24 D. COUNTY shall not reimburse CONTRACTOR for services provided to Transfer Patients. 25 E. ADMINISTRATOR may withhold or delay any payment due CONTRACTOR for failure to 26 comply with any of the terms of this Agreement. 27 F. CONTRACTOR and ADMINISTRATOR may mutually agree, in writing, to modify the 28 Funding and Payment Paragraph of this Exhibit A to the Agreement. 29

FUNDING AND PAYMENTS. 5 30 A. COUNTY shall pay the Intermediary an amount sufficient to reimburse Hospital Claims in 6 31 accordance with Exhibit B to this AgreementContract. 7 32 1. Payment by the Intermediary to CONTRACTOR for Hospital Services shall be contingent 8 33 upon ADMINISTRATOR’s receipt or confirmation of receipt of a fully executed Agreement Contract and Rate 9 34 Certification Form from CONTRACTOR in accordance with Paragraph III.B VI.B of this Exhibit A B to this 10 Agreement the Contract 35 for Period One. Payment by the Intermediary to CONTRACTOR for Period Two, Period 11 Three, Period Four, and Period Five Three shall 36 be contingent upon receipt of an updated Rate Certification 12 Form in accordance with Paragraph subparagraph VI.B 37 of Exhibit B to this AgreementContract. 13 1 2. Any Hospital that does not become a Contracting ED Hospital or Contracting Network 2 Hospital and 14 elects to provide any Hospital Services to any MSN Enrollee shall be reimbursed by 3 COUNTY at the 15 Non-Contract Hospital rates. 16 4 B. Sub-Acute Services – COUNTY shall pay the Intermediary the amount necessary to cover 17 5 reimbursement for Sub-Acute Services in accordance with letter(s) of agreement as may be negotiated 18 by 6 ADMINISTRATOR for such services. These services may include, but are not limited to, Sub-Acute 19 and 7 Skilled Nursing Facility Services. 20 8 C. Special Permit Transfer – COUNTY shall pay Intermediary the amount necessary to cover 21 9 reimbursement for Special Permit Transfer Services as allowed in Paragraph III.C.12 subparagraph III.K.12 of this Exhibit 10 A to 22 the AgreementContract. This Agreement Contract shall not obligate CONTRACTOR to accept a transfer from, nor to 23 11 provide compensation to, any other health care facility, subject to requirements of applicable law. 24 12 D. COUNTY shall not reimburse CONTRACTOR for services provided to Transfer Patients. 25 13 E. ADMINISTRATOR may withhold or delay any payment due CONTRACTOR for failure to 26 14 comply with any of the terms of this AgreementContract. 27 15 F. CONTRACTOR and ADMINISTRATOR may mutually agree, in writing, to modify the 28 Funding 16 and Payment Payments Paragraph of this Exhibit A to the Agreement. 2917

FUNDING AND PAYMENTS. 5 2 A. COUNTY shall pay the Intermediary an amount sufficient to reimburse Hospital Claims in 6 3 accordance with Exhibit B to this Agreement. 7 4 1. Payment by the Intermediary to CONTRACTOR for Hospital Services shall be contingent 8 5 upon ADMINISTRATOR’s receipt or confirmation of receipt of a fully executed Agreement and Rate 9 6 Certification Form from CONTRACTOR in accordance with Paragraph III.B of this Exhibit A to this 10 the 7 Agreement for Period One. Payment by the Intermediary to CONTRACTOR for Period Two, Period 11 8 Three, Period Four, and Period Five shall be contingent upon receipt of an updated Rate Certification 12 9 Form in accordance with Paragraph subaragraph VI.B of Exhibit B to this Agreement. 13 10 2. Any Hospital that does not become a Contracting ED Hospital or Contracting Network 11 Hospital and 14 elects to provide any Hospital Services to any MSN Enrollee shall be reimbursed by 12 COUNTY at the 15 Non-Contract Hospital rates. 16 13 B. Sub-Acute Services – COUNTY shall pay the Intermediary the amount necessary to cover 17 14 reimbursement for Sub-Acute Services in accordance with letter(s) of agreement as may be negotiated 18 15 by ADMINISTRATOR for such services. These services may include, but are not limited to, Sub-Acute 19 16 and Skilled Nursing Facility Services. 20 17 C. Special Permit Transfer – COUNTY shall pay Intermediary the amount necessary to cover 21 18 reimbursement for Special Permit Transfer Services as allowed in Paragraph III.C.12 subparagraph III.K.12 of this Exhibit 19 A to 22 the Agreement. This Agreement shall not obligate CONTRACTOR to accept a transfer from, nor 20 to 23 provide compensation to, any other health care facility, subject to requirements of applicable law. 24 21 D. COUNTY shall not reimburse CONTRACTOR for services provided to Transfer Patients. 25 22 E. ADMINISTRATOR may withhold or delay any payment due CONTRACTOR for failure to 26 23 comply with any of the terms of this Agreement. 27 24 F. CONTRACTOR and ADMINISTRATOR may mutually agree, in writing, to modify the 28 25 Funding and Payment Paragraph of this Exhibit A to the Agreement. 2926

FUNDING AND PAYMENTS. 5 2 A. COUNTY shall pay the Intermediary an amount sufficient to reimburse Hospital Claims in 6 3 accordance with Exhibit B to this AgreementContract. 7 4 1. Payment by the Intermediary to CONTRACTOR for Hospital Services shall be contingent 8 5 upon ADMINISTRATOR’s receipt or confirmation of receipt of a fully executed Agreement Contract and Rate 9 6 Certification Form from CONTRACTOR in accordance with Paragraph III.B VI.B of this Exhibit A B to this 10 Agreement the Contract 7 for Period One. Payment by the Intermediary to CONTRACTOR for Period Two, Period 11 Three, Period Four, and Period Five Three shall 8 be contingent upon receipt of an updated Rate Certification 12 Form in accordance with Paragraph subparagraph VI.B 9 of Exhibit B to this AgreementContract. 13 10 2. Any Hospital that does not become a Contracting ED Hospital or Contracting Hospital and 14 11 elects to provide any Hospital Services to any MSN Enrollee shall be reimbursed by COUNTY at the 15 12 Non-Contract Hospital rates. 16 13 B. Sub-Acute Services – COUNTY shall pay the Intermediary the amount necessary to cover 17 14 reimbursement for Sub-Acute Services in accordance with letter(s) of agreement contract as may be negotiated 18 by 15 ADMINISTRATOR for such services. These services may include, but are not limited to, Sub-Acute 19 and 16 Skilled Nursing Facility Services. 20 17 C. Special Permit Transfer – COUNTY shall pay Intermediary the amount necessary to cover 21 18 reimbursement for Special Permit Transfer Services as allowed in Paragraph III.C.12 of this Exhibit A to 22 19 the AgreementContract. This Agreement Contract shall not obligate CONTRACTOR to accept a transfer from, nor to 23 provide 20 compensation to, any other health care facility, subject to requirements of applicable law. 24 21 D. COUNTY shall not reimburse CONTRACTOR for services provided to Transfer Patients. 25 22 E. ADMINISTRATOR may withhold or delay any payment due CONTRACTOR for failure to 26 23 comply with any of the terms of this AgreementContract. 27 24 F. CONTRACTOR and ADMINISTRATOR may mutually agree, in writing, to modify the 28 Funding 25 and Payment Payments Paragraph of this Exhibit A to the AgreementContract. 2926