Methodology for Payment Sample Clauses

Methodology for Payment. 3.1. APM Year 1 The per diem amount in the APM Payment for APM Year 1 was derived using the following factors:
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Methodology for Payment. The per diem amount in the APM PAYMENT for APM Year 1 was derived using the following factors: • Historical Contractor inpatient utilization incurred by the Department of Mental Health (DMH) and DVHA; • Projected Contractor inpatient utilization in APM Year 1; • Recent cost-per-day values incurred by Contractor for direct care, fixed and administrative costs; and • A negotiated allowance for annual changes for direct care, fixed and administrative costs. The APM PAYMENT for APM Year 1 was derived by multiplying the per diem amount of $1,838.33 by the number of expected Inpatient Days. The State shall make a monthly APM PAYMENT to Contractor as shown in Table 1. Table 1. APM Year 1 APM Year 1 March April May June July Aug Sept Oct Nov Dec Expec xxx Inpati ent Days 1,240 1,320 1,426 1,410 1,674 1,674 1,680 1,736 1,680 1,736 Month ly Payme nt Amou nt $2,781, 058 $2,781, 058 $2,781, 058 $2,781, 058 $2,918, 267 $2,918, 267 $2,918, 267 $2,918, 267 $2,918, 267 $2,918, 267
Sample 1
Methodology for Payment. APM Year 1 The per diem amount in the APM Payment for APM Year 1 was derived using the following factors: • Historical Contractor inpatient utilization incurred by the Department of Mental Health (DMH) and DVHA; • Projected Contractor inpatient utilization in APM Year 1; • Recent cost-per-day values incurred by Contractor for direct care, fixed and administrative costs; and • A negotiated allowance for annual changes for direct care, fixed and administrative costs. The APM Payment for APM Year 1 was derived by multiplying the per diem amount of $1,838.33 by the number of expected Inpatient Days. The State shall make a monthly APM Payment to Contractor as shown in Table 1. Table 1. APM Year 1 Month Expected Inpatient Days Monthly Payment Amount March 2021 1,240 $2,781,058 April 2021 1,320 $2,781,058 May 2021 1,426 $2,781,058 June 2021 1,410 $2,781,058 July 2021 1,674 $2,918,267 August 2021 1,674 $2,918,267 September 2021 1,680 $2,918,267 October 2021 1,736 $2,918,267 November 2021 1,680 $2,918,267 December 2021 1,736 $2,918,267 Total 15,576 $28,633,834 APM Year 2 The per diem amount in the APM Payment for APM Year 2 was derived using the following factors: • Historical Contractor inpatient utilization incurred by DMH and DVHA; • Projected Contractor inpatient utilization in APM Year 2; • Recent cost-per-day values incurred by Contractor for direct care, fixed and administrative costs; and • A negotiated allowance for annual changes for direct care, fixed and administrative costs. The APM Payment for APM Year 2 January through June months of services is derived by multiplying the per diem amount of $2,550 by the number of expected Inpatient Days. The APM Payment for July through December months of service is derived by multiplying the per diem amount of $3,100 by the number of expected Inpatient Days. The State shall make a monthly APM Payment to Contractor as shown in Table 2. Table 2. APM Year 2 Month Expected Inpatient Days Expected Beds per Day Monthly Payment Amount January 2022 1,240 40 $3,162,000 February 2022 1,120 40 $2,856,000 March 2022 1,240 40 $3,162,000 April 2022 1,260 42 $3,213,000 May 2022 1,302 42 $3,320,100 June 2022 1,260 42 $3,213,000 July 2022 1,581 51 $4,901,100 August 2022 1,581 51 $4,901,100 September 2022 1,530 51 $4,743,000 October 2022 1,581 51 $4,901,100 November 2022 1,530 51 $4,743,000 December 2022 1,581 51 $4,901,100 Totals 16,806 - $48,016,500 4. Claims Submission Requirements Contractor will submit claims for Inpatient Days...
Sample 1

Related to Methodology for Payment

  • Applications for Payment 9.3.1 At least ten days before the date for each progress payment established in the State- Contractor Agreement, the Contractor shall submit to the Architect an itemized Application for Payment, notarized if required, supported by such data substantiating the Contractor's right to payment as the State or the Architect may require. The application for payment must, at a minimum, reflect retainage and the required waivers of lien and any other support documentation enumerated elsewhere in the Contract Documents.

  • Treatment of Unallowable Costs Previously Submitted for Payment Defendants further agree that within 90 days of the Effective Date of this Agreement they shall identify to applicable Medicare and TRICARE fiscal intermediaries, carriers, and/or contractors, and Medicaid and FEHBP fiscal agents, any Unallowable Costs (as defined in this paragraph) included in payments previously sought from the United States, or any State Medicaid program, including, but not limited to, payments sought in any cost reports, cost statements, information reports, or payment requests already submitted by Defendants or any of their subsidiaries or affiliates, and shall request, and agree, that such cost reports, cost statements, information reports, or payment requests, even if already settled, be adjusted to account for the effect of the inclusion of the Unallowable Costs. Defendants agree that the United States, at a minimum, shall be entitled to recoup from Defendants any overpayment plus applicable interest and penalties as a result of the inclusion of such Unallowable Costs on previously-submitted cost reports, information reports, cost statements, or requests for payment. Any payments due after the adjustments have been made shall be paid to the United States pursuant to the direction of the Department of Justice and/or the affected agencies. The United States reserves its rights to disagree with any calculations submitted by Defendants or any of their subsidiaries or affiliates on the effect of inclusion of Unallowable Costs (as defined in this paragraph) on Defendants or any of their subsidiaries or affiliates’ cost reports, cost statements, or information reports.

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