7._Exhibit_B_BDPP.pdf

California Department of Corrections and Rehabilitation (CDCR)/ Bid Number: SD23-00088 California Correctional Health Care Services (CCHCS) Exhibit B Budget Detail and Payment Provisions

Rev.8/25/2024 1 of 5

OCULAR PROSTHESIS SERVICES AND DEVICES

ARTICLE I

BUDGET DETAIL AND PAYMENT PROVISIONS

1. Invoices/Claims and Payment

For services satisfactorily rendered, and upon receipt and approval of Contractor’s invoices/claims, California Department of Corrections and Rehabilitation/California Correctional Health Care Services (CDCR/CCHCS) agrees to compensate Contractor for completed services in accordance with the rates specified in Exhibit B-1 Bid Rate Sheet, which is included as part of this Agreement. Except for emergency care, CDCR/CCHCS shall not compensate Contractor for services which did not receive prior authorization in accordance with Exhibit A Scope of Work, and/or Exhibit A-1 Service Specifications, and/or exceed the services as defined in California Code of Regulations (CCR), Title 15, Section 3999.98 and 3999.200.

a. Services shall be completed as set forth in Exhibit A Scope of Work, and/or Exhibit A-1 Service Specifications, and in accordance with prior authorization provisions, and all other terms and conditions of this Agreement.

b. Invoices/claims shall be reimbursed in accordance with Exhibit B-1 Bid Rate Sheet and with the following terms: no CDCR/CCHCS employee may independently negotiate or implement a rate increase on behalf of CDCR/CCHCS. Rate increases must be formalized by Direct Care Contracts Section (DCCS) through a formal amendment. Any invoice/claim that is sent to CDCR/CCHCS with reimbursement rates above the specified rates by CDCR/CCHCS in writing within the contract shall be invalid. Payment of an erroneous invoice/claim does not constitute acceptance of the erroneous pricing and CDCR/CCHCS may seek reimbursement of the overpayment or may withhold such overpayment from future invoices/claims.

c. CDCR/CCHCS will not accept requests for early payment, down payment or partial payment.

2. Budget Contingency Clause

a. It is mutually agreed that if the California State Budget Act for the current fiscal year and/or any subsequent fiscal years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force 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.

b. If funding for the purposes of this program is reduced or deleted for any fiscal year by the California State Budget Act, 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.

3. Prompt Payment Clause

Payment will be made in accordance with, and within the time specified in, California Government Code (GC) Section 927 et seq. Payment to a small business or microbusiness shall be made in accordance with, and within the time specified in, GC Section 927 et seq.

CDCR/CCHCS Bid Number: SD23-00088 Budget Detail and Payment Provisions Exhibit B

Rev. 8/25/2024 2 of 5

4. Subcontractors

For all Agreements, with the exception of Interagency Agreements and other governmental entities/auxiliaries that are exempt from bidding, nothing contained in this Agreement, or otherwise, shall create any contractual relationship between the state and any subcontractors, and no subcontract shall relieve Contractor of Contractor’s responsibilities and obligations hereunder. Contractor agrees to be as fully responsible to the state for the acts and omissions of its subcontractors and of persons either directly or indirectly employed by any of them, as it is for the acts and omissions of persons directly employed by Contractor. Contractor’s obligation to pay its subcontractors is an independent obligation from the state’s obligation to make payments to Contractor. As a result, the state shall have no obligation to pay or to enforce the payment of any monies to any subcontractor.

ARTICLE II

SPECIAL BUDGET DETAIL AND PAYMENT PROVISIONS

1. Orientation and Training Requirements

At the discretion of each institution, Contractor shall ensure that on-site health care service providers complete orientation as specified in Exhibit A Scope of Work.

a. On-Site Institution Orientation/Training

Contractor agrees that all providers shall attend on-site orientation and any other required training (i.e.

annual block training and Learning Management System [LMS]) prior to reporting to work at the institution. Orientation/training is designed to assist providers to become familiar with the operations of the institution, its medical facilities, Title 15 of the CCRs that may apply to the institution. To maintain continuity of services and ensure safety for all workers, Contractor shall make available to the institution only those providers who have completed the orientation.

b. Self-Certification Orientation Process

This process may be utilized in place of attending an on-site institution orientation based on institution approval. The parties agree that there will be no reimbursement for assigned providers who have been approved to utilize the Self-Certification Orientation Process.

(1) Contractor shall obtain a copy of the Health Care On-Site Contractor’s Orientation Handbook from institution and return the signed copy of the CCHCS Orientation Acknowledgement form once complete.

(2) Contractor shall be responsible for ensuring that all providers complete the orientation and sign the Self-Certification Acknowledgement.

(3) Contractor shall maintain the signed copies (new and renewed) of the CCHCS Orientation

Acknowledgement and provide to CDCR/CCHCS upon request.

2. Submission of Invoices/Claims

a. In order to ensure prompt and accurate payment, all invoices/claims shall be submitted according to the applicable directions listed below. It is the responsibility of Contractor to ensure that invoices/claims are sent to the correct address as set forth below according to service type. Invoices/claims sent to the incorrect address will be deemed not submitted, will not be processed for payment, and will not be subject to late payment penalties per GC Sections 927.2, subdivision (j) and 927.4.

Budget Detail and Payment Provisions Exhibit B

Rev. 8/25/2024 3 of 5

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

c. 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 CDCR/CCHCS office and shall not require an Agreement amendment.

d. Invoices/claims submitted shall include the information listed in section 3(f) and must be legible in order to be considered complete and acceptable for processing or the invoice/claim will be returned and disputed back to Contractor. Disputed/returned invoices/claims shall not be subject to late payment penalties, as set forth in GC Section 927.4

3. Submission of Claims for Services/Procedures

a. Information concerning claims adjudicated for CDCR/CCHCS by CorrectCare Integrated Health (CCIH), CDCR/CCHCS’ Third Party Administrator may be accessed through the CCIH Web Portal.

Instructions for registration and use of the web portal, can be obtained by calling the CDCR/CCHCS Healthcare Invoicing Section (HIS) Help Desk at (916) 691-0699 or at:

https://tpa.correctcare.com/pp_reg/portal/

b. Pursuant to the California Prompt Payment Act, GC Section 927 et seq., undisputed claims shall be paid within 45 days of the date of receipt. If you do not have access to the CCIH Web Portal, contact the HIS Help Desk at (916) 691-0699 or via electronic mail (email) at m_HISProgramSupport@cdcr.ca.gov to verify receipt of claims.

c. CDCR/CCHCS shall render payment in accordance with and within the time specified in GC Section 927 et seq. CDCR/CCHCS reserves the right to deny Contractor’s claim if Contractor fails to submit it in the appropriate format or within the appropriate time frame specified in this section. CDCR/CCHCS will provide an explanation along with the claim denial and the basis for claim rejection. Contractor will have the right to appeal or otherwise resubmit the claim with the reasonably required documentation.

d. Claims submitted for payment must be typewritten, legible, accurate, and submitted within 12 months and/or one year after the provision of services. Claims submitted after 12 months and/or one year may not receive payment for these claims. Claims older than 12 months and/or one year shall be submitted in accordance with Exhibit D, Special Terms and Conditions & Additional Provisions, Section 2, Dispute Resolution, (b)(3) First Level Appeal.

e. Claims submitted for payment of on-site ocular prosthesis services/procedures shall be on a Center for Medicare & Medicaid Services (CMS) CMS-1500 form or its successor(s) (if applicable) and shall itemize each service provided.

f. Claims submitted for payment of ocular prosthesis services/procedures shall include all applicable information listed below:

1. Patient’s CDCR number

2. Name of patient

3. Patient date of birth

4. Gender of patient

5. Patient housing institution acronym, city, state, and zip code https://tpa.correctcare.com/pp_reg/portal/ mailto:m_HISProgramSupport@cdcr.ca.gov

Budget Detail and Payment Provisions Exhibit B

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6. All required diagnosis codes

7. Date(s) of service

8. Place of service

9. All required Current Procedure Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) codes

10. Any required CMS codes, if applicable

11. Service units

12. Billed charges for services rendered (including total billed charges)

13. Contractor or provider’s National Provider Identifier (NPI) number

14. Contractor Federal Employer Identification Number (FEIN)/Federal Tax ID

15. Patient account number (as assigned by the billing entity)

16. First and last name of Contractor or provider performing services (In the event that Contractor or provider is a medical group, list the group name. The NPI number should reflect this listing.)

17. Service facility location information

18. Billing provider information

19. Any other medical information or documentation from external sources reasonably required to verify and substantiate the provision of services and the charges for such services.

g. Claims submitted for on-site services/ocular prosthesis procedures shall be submitted to the Third Party Administrator at the following address:

Correct Care Integrated Health PO Box 349026 Sacramento, CA 95834-9026

4. Reimbursement for Goods/Durable Medical Equipment

a. Agreements that contain a goods component such as, but not limited to: hearing aids, eye glasses, prosthetics, and/or orthotics, shall submit health care service invoices separately (e.g., Contractor or Provider who conducts a hearing test and supplies hearing aids shall submit one invoice for the hearing test and a separate claim for the hearing aid). Invoices shall also include the Agreement Number and the Purchase Order Number.

b. Damaged Equipment: Contractor may seek reimbursement from CDCR/CCHCS for damaged equipment per Exhibit A Section 1(d). Reimbursement for damaged equipment shall be submitted on an invoice with the incident report and vendor purchase cost invoice or proof of payment attached. If the appropriate documentation is not attached, the invoice shall not be reimbursed and will be returned.

c. Invoices submitted shall include all applicable information listed below:

(1) Contractor’s Name

(2) Invoice Number

(3) Agreement Number

(4) Invoice Date

(5) Remit Address (Contractor name, mailing address, phone number)

(6) Total Invoice Amount

(7) Institution and Physical Address

Budget Detail and Payment Provisions Exhibit B

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(8) List patient name and CDCR number

(9) Occurrence Date

(10) Place of service, if different than item 7 above.

(11) Contractor Federal Employer Identification Number (FEIN)/Federal Tax ID, if applicable

(12) Incident report

d. Health care goods and equipment must be reviewed and approved prior to Contractor’s and/or Provider’s submittal of an invoice for payment by the ordering institution. Approved health care goods and equipment invoices shall be mailed to the following address:

Sacramento Regional Accounting Office Attention: Accounts Payable A P.O. Box 187015 Sacramento, CA 95818-7015 Email address: APA.invoices@cdcr.ca.gov

5. Rejection of Contractor’s Invoice/Claim

CDCR/CCHCS reserves the right to reject a Contractor’s invoice/claim if Contractor fails to submit the invoice/claim in the appropriate format or within the appropriate time frame specified within this Agreement. Disputed invoices/claims will be returned to Contractor without payment and will include an explanation of the invoice/claim dispute. Contractor will have the right to appeal or otherwise resubmit the invoice/claim with the pertinent documentation to the address below. Disputed/returned invoices/claims shall not be subject to late payment penalties, as set forth in GC Section 927.4.

6. Invoice/Claim Audits and Refunds

CDCR/CCHCS has the right to review invoices/claims retrospectively to ensure invoices/claims were processed correctly and per the contract terms. Should CDCR/CCHCS determine that invoices/claims resulted in an overpayment; CDCR/CCHCS shall request a refund in the incorrect dollar amounts.

Contractor shall refund any monies found from these retrospective audits. Contractor shall refer to Exhibit D Section 64 for specific information regarding overpayments.

7. Invoice/Claim Payment Inquiry

Should Contractor have questions or concerns regarding the processing and/or payment of invoices/claims, the parties shall make a first attempt in good faith to resolve the question or concern through informal discussion(s).

a. Service/Procedure Claims

Contractor shall contact the HIS Help Desk at (916) 691-0699 or via email at m_HISProgramSupport@cdcr.ca.gov with any questions regarding the health care service/procedure claims submittal or dispute process. If resolution to the patient invoice cannot be resolved via the verbal inquiry process, Contractor shall refer to the formal health care claim appeal process outlined in Exhibit D Special Terms and Conditions & Additional Provisions of this Agreement.

b. Healthcare Goods and Equipment Invoices

Contractor shall contact the Sacramento Regional Accounting Office via email at APA.invoices@cdcr.ca.gov with any questions or concerns regarding the healthcare goods and equipment invoice submittal process.

mailto:APA.invoices@cdcr.ca.gov mailto:m_HISProgramSupport@cdcr.ca.gov mailto:APA.invoices@cdcr.ca.gov