Molina Medicaid Solutions - DHHR

exv10w24• This reimbursement methodology is not intended to imply any governance or regulations set forth by Centers of Medicare and MedicaidServices (CMS), but is used to describe the type of mathematical reimbursement formula agreed upon by Provider and Health Plan.• Provider uses its Fiscal Intermediary to administer their Medicare program. The Fiscal Intermediary calculates and updates factors used in thecalculation of the Medicare reimbursement formulas, which will be adopted for use in this Agreement. Any change in the reimbursementformula factors, including, but not limited to, changes in DRG definitions to comply with industry mandated standards, will be applicable to thereimbursement set forth in this Agreement, effective concurrently with the effective date of updates to the Inpatient PPS PC Pricer.OUTPATIENT SERVICES• Health Plan agrees to reimburse Provider at one hundred percent (100%) of the prevailing Medicare Ambulatory Payment Classification(APC) in effect at the time services are rendered.HSA — Hospital Services AgreementMolina ECMS ref# 729 Provider or authorizedMHC v122706 / MHI v091707 representative’s initials:Pacific Hospital of Long BeachPage 26 of 40ARTICLE FIVE — NOTATIONS6.1 Capitalized terms utilized in this Attachment, which are not otherwise defined in this Attachment, if any, shall have the same meaning set forthin the definitions to this Agreement.6.2 Unless otherwise set forth above, the stipulated Hospital Provider payment rates shall apply to all Professional Clean Claims submitted byHospital Providers.4/16/09HSA — Hospital Services AgreementMolina ECMS ref# 729 Provider or authorizedMHC v122706 / MHI v091707 representative’s initials:Pacific Hospital of Long BeachPage 27 of 40ATTACHMENT EREQUIRED PROVISIONS(Health Care Service Plans)The following provisions are required by (i) federal statutes and regulations applicable to Health Plan, or (ii) state statutes and regulationsapplicable to health care service plans. Any purported modifications to these provisions inconsistent with such statutes, regulations, andagreements shall be null and void.DMHC Provisions1. In the event that Health Plan fails to pay Provider for Covered Services, the Member or subscriber shall not be liable to Provider for any sumsowed by Health Plan. Provider shall not collect or attempt to collect from a Member or subscriber any sums owed to Provider by the HealthPlan. Provider may not and will not maintain any action at law against a Member or subscriber to collect sums owed to the Provider by Healthhttp://sec.gov/Archives/edgar/data/1179929/000095012310025132/a55407exv10w24.htm[1/6/2012 11:13:06 AM]