Reimbursement Criteria Sample Clauses

Reimbursement Criteria a. The HMO’s NICU reimbursement amount is calculated by contract period and by county. For NICU risk sharing, a “contract period” is defined as one calendar year. b. The Department will reimburse the HMO for 90% of the HMO’s NICU cost per day, not to exceed a reimbursement of $1,443 per day, for each day that the HMO’s average number of NICU days per thousand member years exceeds 75 NICU days per thousand member years per county during the contract period. c. The HMO’s NICU cost per day includes the HMO’s NICU inpatient payment per day and the HMO’s associated physician payments. Associated physician payments refer to the total HMO payments made by the HMO to the physician(s) for services provided to the infant during the NICU stay. Associated physician payments are divided by the number of days reported for the NICU stay to determine the HMO’s payment per day of associated physician payments. Amounts paid must include payments for all physician and hospital services that were provided during the report period regardless of the HMO’s actual payment date. d. The Department makes the NICU reimbursement to the HMO after the end of the contract year, after the HMO has submitted all needed NICU data. The Department will reimburse the HMO within 60 days of receipt of all necessary data from the HMO. The Department may make a final adjustment to the NICU reimbursement amount one year after the initial payment. This adjustment will be based on adjustments to eligible months and, updated information from the HMO such as the number of NICU days, inpatient payments, associated physician payments and amounts recovered from third parties. e. The number of eligible months for the NICU calculation includes Healthy Start Pregnant Women, AFDC and Healthy Start Children (refer to the NICU worksheet in Addendum VIII, E). The Department will make the final determination regarding the number of eligible months for the NICU calculation by HMO, by county and by year, using the Medicaid Management Information System Recipient Eligibility File. f. Costs for care provided to NICU enrollees who are retroactively disenrolled under Article VIII of this Contract are not payable. The HMO must back out the costs of the care provided during the backdated period from their NICU reports.

Reimbursement Criteria. 1. Reimbursement for attendance at conventions, conferences, workshops or meetings shall be contingent upon the amount of the registration fees; room, board and transportation incurred during such attendance and shall be consistent with Board established criteria (Regulation #4133 effective March 3, 1991). 2. The maximum reimbursement permitted for each union member per fiscal year shall be two thousand dollars ($2000), funds permitting. 3. The maximum reimbursement shall be subject to change at the inception of each fiscal year. It shall be contingent upon the availability of funds and upon consent of the Professional Improvement Committee. 4. In the event that the allotted funds have been expended, The Newark Public Schools may grant professional time off in lieu of Professional Improvement Fund reimbursement for attendance at conventions, conferences, workshops or meetings.

Reimbursement Criteria. 22.4.4.1 Reimbursement is limited to a maximum of $350 per employee per fiscal year (July 1-June 30). 22.4.4.2 Reimbursements by the District shall be limited to a maximum of $5,000 per fiscal year. 22.4.4.3 Reimbursement shall be limited to the actual cost of tuition and/or books. 22.4.4.4 The employee shall pay the first $50.00 (co-payment) of the cost of books and/or tuition. 22.4.4.5 The employee shall submit evidence of successful completion of the approved course along with the original receipts. 22.4.4.6 An employee may be approved for more than one class/course per year up to the maximum annual reimbursement of $350 per employee per fiscal year (July 1-June 30). 22.4.4.7 An employee whose class/course is approved after the fund cap of $5,000 per fiscal year has been reached shall be the first to be reimbursed in the next fiscal year.

Reimbursement Criteria. The CUPE PD Committee will review and make a determination if the course/activity to be undertaken is eligible for reimbursement by considering the following. Does the course/activity add specific skills, knowledge, and/or competencies that the employee can apply to her current position? Does the course/activity add skills, knowledge and/or competencies for the employee’s career advancement within the College?

Reimbursement Criteria