Methodology for Payment Clause Samples
Methodology for Payment. 3.1. APM Year 1
i. Historical Contractor inpatient utilization incurred by the Department of Mental Health (DMH) and DVHA;
ii. Projected Contractor inpatient utilization in APM Year 1;
iii. Recent cost-per-day values incurred by Contractor for direct care, fixed and administrative costs; and
iv. 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. 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
3.2. APM Year 2
i. Historical Contractor inpatient utilization incurred by DMH and DVHA;
ii. Projected Contractor inpatient utilization in APM Year 2;
iii. Recent cost-per-day values incurred by Contractor for direct care, fixed and administrative costs; and
iv. 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. 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 The per diem amount in the APM Payment for APM Year 3 was derived using the following factors:
i. Historical Contractor inpatient utilization incurred by DMH and DVHA;
ii. Projected Contractor inpatient utilization in APM Year 3;
iii. Recent cost-per-day values incurred by Contractor for direct care, fixed and administrative costs; and
iv. A negotiated allowance for annual changes for direct care, fixed and administrative costs. The APM Payment for APM Year 3 is ...
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 ▇▇▇ 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
Methodology for Payment. APM Year 1 Month Expected Inpatient Days Monthly Payment Amount Total 15,576 $28,633,834 APM Year 2 Month Expected Inpatient Days Expected Beds per Day Monthly Payment Amount Totals 16,806 - $48,016,500 4. Claims Submission Requirements