Common use of REIMBURSEMENT LIMITATIONS Clause in Contracts

REIMBURSEMENT LIMITATIONS. 1. For Emergency Services and Outpatient Hospital Services - No Contracting ED Hospital shall be reimbursed more than seventy-five percent (75%) of CalOptima fee-for-service rates or Allowable Costs, less the required co-payments, whichever is less. 2. For inpatient Hospital Services – No Contracting ED Hospital shall be paid more than seventy-five (75%) of the equivalent CalOptima reimbursement, or Allowable Costs, less applicable co-payments, whichever is less.

REIMBURSEMENT LIMITATIONS. 16 1. For Emergency Services and Outpatient Hospital Services - No Contracting ED Hospital 17 shall be reimbursed more than seventy-five percent (75%) of CalOptima fee-for-service rates or 18 Allowable Costs, less the required co-payments, whichever is less. 19 2. For inpatient Hospital Services – No Contracting ED Hospital shall be paid more than 20 seventy-five (75%75%%) of the equivalent CalOptima reimbursement, or Allowable Costs, less applicable 21 co-payments, whichever is less.