Common use of Reimbursement Terms Clause in Contracts

Reimbursement Terms. The Department shall reimburse the Contractor for Suitable Representative Functions under the following limitations. a. The Department will reimburse: 1. Up to thirty-two (32) units per Calculated Budget appeal in connection with the Client’s initial Calculated Budget determination or Calculated Budget determination for purposes of annual redetermination, billable for an assigned initial referral commencing from the Contractor’s first contact with the Client. In case of documented attempts by the Contractor to contact the Client that resulted in initial referral closure due to inability to establish or maintain contact with the Client, the Department will pay one (1) unit. Following initial contact, appeal assistance will commence with the first fifteen (15) minute unit of billable activity. Appeal assistance services include, but are not limited to: i. Helping the Client submit an Appeal Request Form to begin the process to appeal the Client’s Calculated Budget. ii. Helping the Client prepare for Informal Review, Extended Informal Review, and Fair Hearings for Calculated Budget appeals. iii. Participating in an Informal Review, Extended Informal review, Fair Hearing, or one or more of these reviews or hearings, to advocate for the Client regarding the Client’s Calculated Budget.