Common use of Rate Setting Clause in Contracts

Rate Setting. i. The Contractor shall propose county-specific fee-for-service (FFS) provider rates for all modalities except the OTP/NTP modality. DHCS shall approve or deny those proposed rates to determine if the rates are sufficient to ensure access to available DMC-ODS services. a. If DHCS denies the Contractor’s proposed rates, the Contractor shall have an opportunity to adjust the rates and resubmit them to DHCS to determine if the adjusted rates are sufficient to ensure access to available DMC- ODS services. The Contractor shall receive DHCS approval of its rates prior to providing any covered DMC- ODS program services. ii. The DHCS Rate Setting Work Group pursuant to the process set forth in W&I Code, Section 14021.51 shall set OTP/NTP reimbursement rate. The Contractor shall reimburse all OTP/NTP providers at this rate. a. The Contractor shall ensure that all of its contracted OTP/NTP providers provide it with financial data on an annual basis. The Contractor shall collect and submit this data to the DHCS Rates Setting Work Group upon its request for the purpose of setting the OTP/NTP rates after the expiration of the DMC-ODS. i. The DHCS Rates Setting Workgroup shall propose a recommended format for this annual financial data and DHCS shall approve a final format. iii. Pursuant to W&I Code, Section 14124.24(h), the Contractor shall not require OTP/NTP providers to submit cost reports to the Contractor for the purpose of cost settlement.

Rate Setting. i. The Contractor shall propose county-specific fee-for-service (FFS) provider rates for all modalities except the OTP/NTP modality. DHCS shall approve or deny those proposed rates to determine if the rates are sufficient to ensure access to available DMC-ODS services. a. If DHCS denies the Contractor’s proposed rates, the Contractor shall have an opportunity to adjust the rates and resubmit them to DHCS to determine if the adjusted rates are sufficient to ensure access to available DMC- DMC-ODS services. The Contractor shall receive DHCS approval of its rates prior to providing any covered DMC- DMC-ODS program services. ii. The DHCS Rate Setting Work Group pursuant to the process set forth in W&I Code, Section WIC 14021.51 shall set the OTP/NTP reimbursement rate. The Contractor shall reimburse all OTP/NTP providers at this rate. a. The Contractor shall ensure that all of its contracted OTP/NTP providers provide it with financial data on an annual basis. The Contractor shall collect and submit this data to the DHCS Rates Setting Work Group upon its request for the purpose of setting the OTP/NTP rates after the expiration of the DMC-ODS. i. The DHCS Rates Setting Workgroup shall propose a recommended format for this annual financial data and DHCS shall approve a final format. iii. Pursuant to W&I Code, Section WIC 14124.24(h), the Contractor shall not require OTP/NTP providers to submit cost reports to the Contractor for the purpose of cost settlement.

Rate Setting. i. The Contractor shall propose county-specific fee-for-service (FFS) provider rates for all modalities except the OTP/NTP modality. DHCS shall approve or deny those proposed rates to determine if the rates are sufficient to ensure access to available DMC-ODS services. a. If DHCS denies the Contractor’s proposed rates, the Contractor shall have an opportunity to adjust the rates and resubmit them to DHCS to determine if the adjusted rates are sufficient to ensure access to available DMC- DMC-ODS services. The Contractor shall receive DHCS approval of its rates prior to providing any covered DMC- DMC-ODS program services. ii. The DHCS Rate Setting Work Group pursuant to the process set forth in W&I Code, Section 14021.51 shall set OTP/NTP reimbursement rate. The Contractor shall reimburse all OTP/NTP providers at this rate. a. The Contractor shall ensure that all of its contracted OTP/NTP providers provide it with financial data on an annual basis. The Contractor shall collect and submit this data to the DHCS Rates Setting Work Group upon its request for the purpose of setting the OTP/NTP rates after the expiration of the DMC-ODS. i. The DHCS Rates Setting Workgroup shall propose a recommended format for this annual financial data and DHCS shall approve a final format. iii. Pursuant to W&I Code, Section 14124.24(h), the Contractor shall not require OTP/NTP providers to submit cost reports to the Contractor for the purpose of cost settlement.

Rate Setting. i. The Contractor shall propose county-specific fee-for-service (FFS) provider rates for all modalities except the OTP/NTP modality. DHCS shall approve or deny those proposed rates to determine if the rates are sufficient to ensure access to available DMC-ODS services. a. If DHCS denies the Contractor’s proposed rates, the Contractor shall have an opportunity to adjust the rates and resubmit them to DHCS to determine if the adjusted rates are sufficient to ensure access to available DMC- DMC-ODS services. The Contractor shall receive DHCS approval of its rates prior to providing any covered DMC- DMC-ODS program services. ii. The DHCS Rate Setting Work Group Group, pursuant to the process set forth in W&I Code, Section WIC 14021.51 shall set the OTP/NTP reimbursement rate. The Contractor shall reimburse all OTP/NTP providers at this rate. a. The Contractor shall ensure that all of its contracted OTP/NTP providers provide it with financial data on an annual basis. The Contractor shall collect and submit this data to the DHCS Rates Setting Work Group upon its request for the purpose of setting the OTP/NTP rates after the expiration of the DMC-ODS. i. The DHCS Rates Setting Workgroup shall propose a recommended format for this annual financial data and DHCS shall approve a final format. iii. Pursuant to W&I Code, Section WIC 14124.24(h), the Contractor shall not require OTP/NTP providers to submit cost reports to the Contractor for the purpose of cost settlementsettlement DHCS.