25WS0022_-_Exhibit_B.pdf

California Department of Veterans Affairs Agreement Number: 25WS0022 Exhibit B - Budget Detail and Payment Provisions TBD

1. STANDARD BUDGET DETAIL AND PAYMENT PROVISIONS

A. Invoicing and Payment

1. For services satisfactorily rendered, and upon receipt and approval of the itemized invoices, the State agrees to compensate the Contractor for services rendered in accordance with Medicare and Medi- Cal reimbursement fee schedules and any additional terms or conditions specified herein.

2. Invoices shall include the Agreement Number and shall be submitted not more frequently than monthly in arrears to:

Original Invoice Approval Copy

California Department of Veterans Affairs CalVet Accounting Office 1227 “O” Street Room 402 Sacramento, CA 95814

Veterans Home of California – West Los Angeles Attn: TBD 11500 Nimitz Avenue Los Angeles, CA 90049

B. Budget Contingency Clause

1. it is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further form and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement.

2. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an Agreement amendment to Contractor to reflect the reduced amount.

C. Prompt Payment Clause

Payment will be made in accordance with, and within the time specified in, Government Code, Chapter 4.5, commencing with Section 927.

2. SPECIAL BUDGET DETAIL AND PAYMENT PROVISIONS

A. Submissions of Invoices/Claims

1. All invoices/claims must be completed accurately, thoroughly, and legibly, with all applicable fields completed. Invoices/claims that are submitted to the appropriate location but have been altered, or are inaccurate, or do not provide all necessary information will not be accepted and will be returned to the Contractor for correction.

2. Any changes to this provision relating to the invoice/claim submittal process, including but not limited to an address, form, or process change, shall be an administrative change managed through the appropriate designated CalVet office and shall not require a contract amendment.

3. Invoices/claims submitted shall include the following information in order to be considered complete and acceptable for processing, or the invoice/claim will be returned:

a) Contractor’s Company name exactly as it appears on the STD 204

b) Company address, phone number and e-mail

c) Contractor Federal Employer Identification Number

d) Agreement Number

e) First and Last name of Contractor or Provider performing services, if applicable

f) Contractor’s or Provider’s Classification, whichever is applicable

California Department of Veterans Affairs Agreement Number: 25WS0022 Exhibit B - Budget Detail and Payment Provisions TBD

g) Contractor’s or Provider’s National (Medicare/Medi-Cal) Provider Identifier Number

h) Date of invoice/claim

i) Invoice/claim number

j) CalVet Home where services were performed

k) Resident’s name, date of birth, and social security number (as the unique identifier)

l) Date(s) of Service

m) Type(s) of Service – itemize each service provided and rate of reimbursement

n) Copy of the prior authorization referral form, including the prior authorization number, signed by Home CMO or his/her designated representative, if applicable

o) Medicare and Medi-Cal Remittance Advice, or documentation confirming the resident is not eligible, if applicable

p) Explanation of Benefits, if applicable

q) Denial documentation by the USDVA, if applicable

r) Private insurance payment information, if applicable

s) Total dollar amount being billed

B. USDVA, Medicare, Medi-Cal, Private Insurance and Various Billing Information

The Contractor shall verify the CalVet Resident’s USDVA, private insurance, Medicare, and/or Medi-Cal eligibility. The Contractor shall bill for health care services rendered to residents in accordance with the Medicare and/or Medi-Cal reimbursement fee schedules and, if applicable, shall be responsible for obtaining required Medicare and Medi-Cal authorization. Contractor or Contractor’s contract/referral providers shall use their own National Provider Identification Number to bill USDVA, private insurance, Medicare, and Medi-Cal prior to billing CalVet.

Contractor shall bill CalVet for the resident’s USDVA, private insurance, Medicare, or Medi-Cal health care services deductible, co-payment, or share-of-cost. Contractor shall collect and assemble Contractor’s contract/referral provider invoices and forward to CalVet. Each invoice must provide the information specified in this Agreement.

Contractor shall accept and treat residents who do not have medical insurance or have exhausted their Medicare/Medi-Cal benefits in accordance with Medicare/Medi-Cal healthcare standards and reimbursement fee schedules.

CalVet shall make every effort to inform the Contractor when a resident is eligible for treatment of a service-connected illness. Contractor shall request treatment authorization from USDVA within seventy-two (72) hours of resident’s admission. If treatment authorization is granted by USDVA, Contractor shall bill USDVA prior to billing Medicare, Medi-Cal, or CalVet.

Contractor shall submit bills on the appropriate claim form adopted by Health Care Financing Administration for Contractor billing. Medicare, Medi-Cal or insurance denials due to improper claim information shall be the responsibility of the Contractor.

Invoices shall never be submitted to the resident(s) of the Home under any circumstances when a referral has been received from the Home. Contractor shall not, under any circumstances, including the Home’s non-payment, insolvency, breach or termination of this contract, seek compensation from, have any recourse against, or impose any additional charges on any resident(s). Contractor shall look only to the State for payment. If the State receives notice the Contractor has billed or collected monies from a Home resident(s), the Contractor shall refund that amount to the Veterans Home resident(s).

Contractor or Contractor’s Providers, Agents, Trustees, or Assignees, shall not maintain any action at law against a Home resident to collect funds owed by the Home.