HomeMy WebLinkAbout121018_ca09TO:
FROM:
DATE:
615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
Consent Agenda
November 27, 2018
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
Board of County Commissioners
Philip Morley, County Administrator
Vicki Kirkpatrick, Director
Julia Danskin, Community Health Supervisor
SUBJECT: Agenda Item— WA State Health Care Authority for Medicaid
Administrative Claiming #K3066; January 1, 2019 — December 31,
2020; fee for service
STATEMENT OF ISSUE:
Jefferson County Public Health, Community Health, is requesting Board approval of the professional services
contract with the WA State Health Care Authority for Medicaid Administrative Claiming #K3066; January 1,
2019 — December 31, 2020; fee for service.
ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S:
This contract covers reimbursement for a portion of expenses incurred when performing Medicaid related
administrative activities. The reimbursed activities support the goals and objectives of the state Medicaid
program, and include: 1) identifying potential Medicaid clients, 2) providing information about Medicaid to
low income, uninsured, or inadequately insured individuals, 3) facilitating the enrollment of potential clients,
and 5) referral of clients to medical providers for health services.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Reimbursement for services provided are based on Federal Financial formula that includes County wide
Medicaid Enrollments Rates (MER), JCPH Community Health Clinics MER and at 50% except skilled
Professional Medical Personnel, which is reimbursed at 75%. This revenue is estimated and budgeted in the
2019 Jefferson County Public Health Budget to benefit Community Health.
RECOMMENDATION:
JCPH management request approval of of the professional services contract with the WA State Health Care
Authority for Medicaid Administrative Claiming #K3066; January 1, 2019 — December 31, 2020; fee for
service.
REVIEWED BY:
Philip Morley, County%Admini r
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f) Always working for a safer and healthier community
Date
Environmental Health
Water Quality
360-385-9444
(f) 360-379-4487
Washington StatePROFESSIONAL SERVICES
CONTRACT for HCA Contract Number: K3066
Health CareVutho7ri MEDICAID ADMINISTRATIVE
CLAIMING
THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and Jefferson
County Health/Human Services, (Contractor).
CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA)
Jefferson County Health/Human Services
CONTRACTOR ADDRESS I Street City State Zip Code
615 Sheridan Port Townsend WA 98368
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS
Vicki Kirkpatrick (360) 395 9420 1 vkirkpatrick@co.jefferson.wa.us
Is Contractor a Subrecioient under this Contract? CFDA NUMBER(S): FFATA Form Reauired
®YES [--]NO 93.778; ®YES ❑NO
HCA PROGRAM
Medicaid Administrative Claiming (MAC)
HCA DIVISION/SECTION
MPOI/CS
HCA CONTACT NAME AND TITLE
HCA CONTACT ADDRESS
00l90 -M $carol O. OWnk6Mr1niS8fWX�S
Health Care Authority
Jon Brogger
626 8th Avenue SE
Medical Assistance Program Specialist
PO Box 45506
Olympia, WA 98504-5506
HCA CONTACT TELEPHONE
HCA CONTACT E-MAIL ADDRESS
(360) 725-1647
jon.brogger@hca.wa.gov
CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT l
January 1, 2019 December 31, 2020 No Maximum I
PURPOSE OF CONTRACT:
The purpose of this Contract is to support Medicaid related outreach and linkage activities performed by Local Health
Jurisdictions (LHJ) to Washington State residents who live within its jurisdiction. These activities assist residents who
have no or inadequate medical coverage, and includes explaining the benefits of the Medicaid program, assisting them
in the Medicaid application and renewal processes, and linking them to Medicaid covered services. This Agreement
provides a process for partially reimbursing the Contractor for allowable and reasonable expenses associated with the
time its staff spend performing Medicaid Administrative Claiming (MAC) activities.
The parties signing below warrant that they have read and understand this Contract, and have authority to
execute this Contract. This Contract will be binding on HCA only upon signature by HCA.
CONTRACTOR SIGNATURE
PRINT D NAME AND TITLEDATE
DOU 3 Sul l i vow , cy%r 04'4e-l'Soo
SIGNED
00l90 -M $carol O. OWnk6Mr1niS8fWX�S
HCA SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Ap ved a to oyn:
Date
Philip C. hi nsucker, Chief Civil Deputy Prosecuting Attorney
Jefferson, County Prosecuting Attorney's Office
Rev 4/20/2017
TABLE OF CONTENTS
Recitals.......................................................................................................................................... 4
1. STATEMENT OF WORK (SOW).................................................................................................. 4
2. DEFINITIONS............................................................................................................................... 4
3. SPECIAL TERMS AND CONDITIONS....................................................................................... 11
3.1 TERM................................................................................................................................. 11
3.2 COMPENSATION.............................................................................................................. 11
3.3 BILLING AND INVOICE...................................................................................................... 12
3.4 CONTRACTOR and HCA CONTRACT MANAGERS......................................................... 13
3.5 LEGAL NOTICES............................................................................................................... 13
3.6 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE .......................... 14
3.7 INSURANCE...................................................................................................................... 14
4. GENERAL TERMS AND CONDITIONS..................................................................................... 17
4.1
ACCESS TO DATA............................................................................................................
17
4.2
ADVANCE PAYMENT PROHIBITED................................................................................
17
4.3
AMENDMENTS..................................................................................................................17
4.4
ASSIGNMENT....................................................................................................................17
4.5
ATTORNEYS' FEES..........................................................................................................
17
4.6
CHANGE IN STATUS.........................................................................................................
18
4.7
CONFIDENTIAL INFORMATION PROTECTION...............................................................
18
4.8
CONFIDENTIAL INFORMATION BREACH - REQUIRED NOTIFICATION .......................
18
4.9
CONTRACTOR'S PROPRIETARY INFORMATION...........................................................
19
4.10
COVENANT AGAINST CONTINGENT FEES....................................................................
19
4.11
DEBARMENT.....................................................................................................................20
4.12
DISPUTES.......................................................................................................................-
20
4.13
ENTIRE AGREEMENT.......................................................................................................
21
4.14
FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA) ..................
21
4.15
FORCE MAJEURE.............................................................................................................21
4.16
FUNDING WITHDRAWN, REDUCED OR LIMITED...........................................................
22
4.17
GOVERNING LAW...........................................................................................................-
22
4.18
HCA NETWORK SECURITY..............................................................................................
23
4.19
INDEMNIFICATION............................................................................................................
23
4.20
INDEPENDENT CAPACITY OF THE CONTRACTOR.......................................................
23
4.21
INDUSTRIAL INSURANCE COVERAGE...........................................................................
23
Local Health Jurisdiction Page 2 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
4.22
LEGAL AND REGULATORY COMPLIANCE...................................................................... 23
4.23
LIMITATION OF AUTHORITY............................................................................................
24
4.24
NO THIRD -PARTY BENEFICIARIES.................................................................................
24
4.25
NONDISCRIMINATION......................................................................................................
24
4.26
OVERPAYMENTS TO CONTRACTOR..............................................................................
24
4.27
PAY Equity.........................................................................................................................
24
4.28
PUBLICITY.........................................................................................................................25
4.29
RECORDS AND DOCUMENTS REVIEW..........................................................................
25
4.30
REMEDIES NON-EXCLUSIVE...........................................................................................
26
4.31
RIGHT OF INSPECTION....................................................................................................
26
4.32
RIGHTS IN DATA/OWNERSHIP........................................................................................26
4.33
RIGHTS OF STATE AND FEDERAL GOVERNMENTS.... . ................................................
27
4.34
SEVERABILITY..................................................................................................................27
4.35
SITE SECURITY................................................................................................................
27
4.36
SUBCONTRACTING..........................................................................................................28
4.37
SUBRECIPIENT............................................................................................•....................28
4.38
SURVIVAL..........................................................................................................................30
4.39
TAXES...............................................................................................................................
30
4.40
TERMINATION...................................................................................................................30
4.41
TERMINATION PROCEDURES.........................................................................................
31
4.42
WAIVER.............................................................................................................................
32
4.43
WARRANTIES....................................................................................................................33
Attachments
Attachment 1: Federal Compliance, Certifications and Assurances
Attachment 2: Federal Funding Accountability and Transparency Act Data Collection
Form
Schedules
Schedule A: Statement of Work (SOW) Medicaid Administrative Claiming
Local Health Jurisdiction Page 3 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
Contract #K3066 for Medicaid Administrative Claiming
Recitals
This contract, number K3066, supersedes and replaces contract number K1404 in its entirety.
IN CONSIDERATION of the mutual promises as set forth in this Contract, the parties agree as
follows:
1. STATEMENT OF WORK (SOW)
The Contractor will provide the services and staff as described in Schedule A: Statement of
Work.
2. DEFINITIONS
"A19-1 A" or "A19" means the State of Washington Invoice Voucher used by contractors
and vendors to submit claims for payment in return for goods and/or services provided to
HCA or its Clients.
"Activity Code" or "Code" means the code assigned to the daily activities performed by
Contractor staff in order to identify the percentage of time spent on any given activity.
"Administrative Fee" means the dollar amount charged to the Contractor by HCA based
on a percentage of each Contractor's billing for Federal Financial Participation claimed at
the federally approved match rate, to offset HCA's costs incurred in administering this
Agreement.
"Allocated" or "Allocated Cost" means an Operating Expense that is allocated across
more than one cost pool.
"Allowable Expense" means an expenditure which meets the test of the appropriate OMB
Circular (see Attachment 1, Federal Compliance, Section 0. The most significant factors
affecting allowability of expenses are: 1) they must be necessary and reasonable, 2) they must
be allocable, 3) they must be authorized or not published under state or local laws and
regulations, and 4) they must be documented.
"Authorized Representative" means a person to whom signature authority has been
delegated in writing acting within the limits of his/her authority.
"Billing Quarter" means a calendar quarter consisting of three (3) consecutive calendar
months beginning with the first date of the calendar quarter during which this Agreement starts.
The Contractor shall use Billing Quarters as the time periods for which claims for Federal
Financial Participation are made.
Local Health Jurisdiction Page 4 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
"Breach" means the unauthorized acquisition, access, use, or disclosure of Confidential
Information that compromises the security, confidentiality, or integrity of the Confidential
Information.
"Budgeting, Accounting and Reporting System" or "BARS" or "BARS Manual" The BARS
Manual prescribes accounting and reporting for local governments in accordance with RCW
43.09.200 and found at this website htt ://www.sao.wa. ov/local/Pa es/BarsMaiival.as x.
"Business Associate" means a Business Associate as defined in 45 CFR 160.103, who
performs or assists in the performance of an activity for or on behalf of HCA, a Covered Entity,
that involves the use or disclosure of protected health information (PHI). Any reference to
Business Associate in this DSA includes Business Associate's employees, agents, officers,
Subcontractors, third party contractors, volunteers, or directors.
"Business Days and Hours" means Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific
Time, except for holidays observed by the state of Washington.
"Centers for Medicare and Medicaid Services" or "CMS" means the federal office under the
Secretary of the United States Department of Health and Human Services, responsible for the
Medicare and Medicaid programs.
"Centers for Medicare and Medicaid Services School -Based Administrative Claiming
Guide" or "CMS Guide" or "Guide" means the document issued by CMS in 2003 and any
supplements, amendments or successor; incorporated herein by reference which provides
guidance to States for developing and managing Medicaid Administrative Claiming programs.
"Certified Public Expenditure" or "CPE" means the sources of funds certified as actual
expenditures by a local or public governmental entity and used as the State share in order to
receive federal matching Medicaid funds, or Federal Financial Participation (FFP).
"CFR" means the Code of Federal Regulations. All references in this Contract to CFR
chapters or sections include any successor, amended, or replacement regulation. The CFR
may be accessed at htto:f/www.ecf(�.gov/cgi-biii/ECF1:�?nape=browse:
"Claiming Unit" means the individual contractor eligible to submit a claim for reimbursement
to HCA, and includes all of its subunits.
"Client" means an individual served within budget unit or cost center of the Contractor.
"Cognizant Agency" means the federal agency responsible for reviewing, negotiating, and
approving Indirect Cost Rates.
"Confidential Information" means information that may be exempt from disclosure to the
public or other unauthorized persons under chapter 42.56 RCW or chapter 70.02 RCW or other
state or federal statutes or regulations. Confidential Information includes, but is not limited to,
any information identifiable to an individual that relates to a natural person's health, (see also
Protected Health Information); finances, education, business, use or receipt of governmental
services, names, addresses, telephone numbers, social security numbers, driver license
Local Health Jurisdiction Page 5 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
numbers, financial profiles, credit card numbers, financial identifiers and any other identifying
numbers, law enforcement records, HCA source code or object code, or HCA or State security
information.
"Contract" means this Contract document and all schedules, exhibits, attachments,
incorporated documents and amendments.
"Contractor" means Jefferson County Health/Human Services, its employees and agents.
Contractor includes any firm, provider, organization, individual or other entity performing
services under this Contract. It also includes any Subcontractor retained by Contractor as
permitted under the terms of this Contract.
"Coordinator Manual" or "Manual" means the HCA document or its successor including
any updates, that describes how the Contractor must manage their MAC program and
provides program guidance.
"Corrective Action Plan" or "Corrective Action" means the written description of the plan
the Contractor will complete in order to correct any finding or deficiency as identified by
HCA or government entity.
"Cost Allocation Plan" or "CAP" means the HCA document that describes the
allocation methodology that includes a description of the procedures HCA will use to
identify and measure costs for a MAC program and must be approved by CMS.
"Covered entity" means a health plan, a health care clearinghouse or a health care provider
who transmits any health information in electronic form to carry out financial or administrative
activities related to health care, as defined in 45 CFR 160.103.
"CPE Local Match Certification" means HCA's form the Contractor must submit with
each quarterly invoice to report the source of funds certified as public expenditures and
therefore eligible to be used as match for the MAC program.
"Data" means information produced, furnished, acquired, or used by Contractor in meeting
requirements under this Contract.
"Direct Charge Method" means the method of accounting for Direct Costs without a
stepdown allocation for single funding sources expenses wholly attributed to the MAC
program.
"Direct Cost" means an Operating Expense that is wholly attributable to the MAC program
and is not included in an Indirect Cost Rate. Direct costs must be a single cost objective,
and must be certified quarterly.
"Direct Medical Service" means the provision of a medical, dental, vision, mental health,
family planning, pharmacy, substance abuse or a Medicaid covered service and all
related activities, administrative or otherwise, that integral to, or an extension of the
healthcare service."
Local Health Jurisdiction Page 6 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
"Effective Date" means the first date this Contract is in full force and effect. It may be a
specific date agreed to by the parties; or, if not so specified, the date of the last signature of a
party to this Contract.
"Eligible Staff" or "Participant" or "RMTS Participant" means an employee of the
Contractor that is in compliance with all federal, state, and HCA regulations including this
agreement, the CAP, the Manual, CMS guidance, and any other requirements for
participation in the Medicaid Administrative Claiming program and whose costs are eligible
for claiming their staff time costs for conducting Medicaid Administrative Claiming
activities.
"Federal Financial Participation" or "FFP" means the federal payment (or federal
"match") that is available at a rate of 50% for amounts expended by a state "as found
necessary by the Secretary for the proper and efficient administration of the state plan"
per 42 CFR § 433.15(b)(7). An enhanced FFP rate of seventy five percent (75%) is
available for certain SPMP or interpretation administrative costs. Only permissible, non-
federal funding sources are allowed to be used as the state match for FFP.
"Fiscal Coordinator" means the Contractor's employee who is assigned to be the liaison
between HCA and the Contractor for the accounting purposes of this Agreement. The
contractor may assign the fiscal and RMTS coordinator roles to the same staff if desired.
"HCA Contract Manager" means the individual identified on the cover page of this Contract
who will provide oversight of the Contractor's activities conducted under this Contract.
"Health Care Authority" or "HCA" means the Washington State Health Care Authority, any
division, section, office, unit or other entity of HCA, or any of the officers or other officials
lawfully representing HCA.
"Indirect Cost" means an Operating Expense that is allocated across more than one
program. Indirect costs are only allowable for FFP reimbursement by the application of an
Indirect Cost Rate approved by the Contractor's Cognizant Agency. The indirect cost must
be certified by the Contractor annually using the HCA Certificate of Indirect Costs form.
"Indirect Cost Rate" means the ratio, expressed as a percentage, of the indirect costs to
a direct cost base as approved by the Contractor's Cognizant Agency.
"Integral Activity" or "Extension Activity" means an activity that is necessary for or
incidental to the provision of a direct medical service.
"MAC Activity" or "Allowable Activity" or "Reimbursable Activity" or "Claimable
Activity" means an activity that is administrative in nature, and necessary for the proper
and efficient administration for the Medicaid state plan which must be in compliance as
described in applicable federal, state, HCA and CMS Regulations, the CAP, Manual, and
this Agreement.
"Manual" or "Coordinator Manual" means the document that describes how the
Contractor must implement the CAP locally and includes detailed instructions for
implementing and monitoring the MAC program at the local level. The Manual is
incorporated into this Agreement by reference.
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Washington State Health Care Authority Contract # K3066
"Medicaid Administrative Claiminct" or "MAC" means the source of funding for
reimbursements provided in this agreement is shared between the contractor and the
Federal Financial Participation (FFP).
"Medicaid Eligibility Rate" or "MER" means the proportional share of Medicaid
individuals to the total number of individuals in the target population (Contractor's
jurisdiction) as defined in the CAP, Manual and this Agreement.
"Medicaid Outreach Unit" means the unit within HCA's Health Care Services division
that administers and monitors Washington State's MAC program.
"National Institutional Reimbursement Team (NIRT)" means the group of individuals
comprised from both the CMS central office and regional offices who are responsible for
providing technical assistance to the states on Medicaid institutional reimbursement issues
and the development and promulgation of all Medicaid institutional reimbursement
regulations and policies including review and approval of donated funds Certified as Public
Expenditures.
"Operating Expense" means those costs incurred by the Contractor to perform business
activities and includes both Direct Costs and Indirect Costs. Only operating expenses
necessary to operate the Contractor's MAC program are allowable for FFP
reimbursement.
"Overpayment" means any payment or benefit to the Contractor in excess of that to which the
Contractor is entitled by law, rule, or this Contract, including amounts in dispute.
"Potential Medicaid Client" means a Washington resident who may be determined by
HCA to meet the eligibility criteria for enrollment in Medicaid.
"Proprietary Information" means information owned by Contractor to which Contractor claims
a protectable interest under law. Proprietary Information includes, but is not limited to,
information protected by copyright, patent, trademark, or trade secret laws.
"Protected Health Information" or "PHI" means individually identifiable information that
relates to the provision of health care to an individual; the past, present, or future physical or
mental health or condition of an individual; or past, present, or future payment for provision of
health care to an individual, as defined in 45 CFR 160.103. Individually identifiable information
is information that identifies the individual or about which there is a reasonable basis to believe
it can be used to identify the individual, and includes demographic information. PHI is
information transmitted, maintained, or stored in any form or medium. 45 CFR 164.501. PHI
does not include education records covered by the Family Educational Rights and Privacy Act,
as amended, 20 USC 1232g(a)(4)(b)(iv).
"Random Moment Time Study (RMTS)" or "System" or "Time Study" means an
electronic System that quantifies the daily activities of eligible time study Participants
through a statistically valid sampling methodology and allocates allowable participant
costs to the MAC program. The System calculates the amount of FFP reimbursement
based on the Contractors RMTS results, staff costs, MER, costs and other applicable
calculations as described in the CAP, Manual and this Agreement.
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Washington State Health Care Authority Contract # K3066
"RCW" means the Revised Code of Washington. All references in this Contract to RCW
chapters or sections include any successor, amended, or replacement statute. Pertinent RCW
chapters can be accessed at: htta:11apps.leg.wa.cjov/rcw/.
"Regulation" means any federal, state, or local Regulation, rule, or ordinance.
"RMTS Consortium" "RMTS Consortia" or "Consortium" or "Consortia" means a
group of Contractors who have organized together based on similar duties their staff
perform, organizational structure, type of programs, scope of work, or regional working
relationships and will participate in a single time study together in order to achieve
statistical validity.
"RMTS Coordinator" means an employee of the Contractor who is assigned to be the
time study liaison between HCA and the Contractor for purposes of this Agreement. The
contractor may assign the fiscal and RMTS coordinator roles to the same staff if desired.
"Skilled Professional Medical Personnel" or "SPMP" means an individual who has
completed a two -or -more -year program leading to an academic degree or certificate in a
medically related profession, demonstrated by possession of a medical license, certificate
or other document issued by a recognized National or State medical licensure or certifying
organization or a degree in a medical field issued by a college or university certified by a
professional medical organization.
"State Fiscal Year" or "SFY" means a twelve-month period beginning on July 1st of one
calendar year and ending on June 30th of the following calendar year.
"State Medicaid Plan" means the comprehensive written commitment by HCA, submitted
under 1902(a) of the Social Security Act and approved by the Centers for Medicare and
Medicaid Services, to administer or supervise administration of a Medicaid program in
accordance with Federal and state requirements.
"Statement of Work" or "SOW" means a detailed description of the work activities the
Contractor is required to perform under the terms and conditions of this Contract, including the
deliverables and timeline, and is Schedule A hereto.
"Subcontract" means any separate agreement or contract between the Contractor and an
individual third party or entity ("Subcontractor") to perform all or a portion of the duties and
obligations that the Contractor is obligated to perform pursuant to this Contract.
"Subcontractor" means a person or entity that is not in the employment of the Contractor,
who is performing all or part of the business activities under this Contract under a separate
contract with Contractor. The term "Subcontractor" means subcontractor(s) of any tier.
"Subrecipient" means a contractor operating a federal or state assistance program receiving
federal funds and having the authority to determine both the services rendered and disposition
of program. See OMB Super Circular, 2 CFR 200.501, and 45 CFR 75.501, "Uniform
Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards" for
additional detail.
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Washington State Health Care Authority Contract # K3066
"Subunit" means an individual cost center or budget unit within a claiming unit (LHJ).
"Successor" means any entity or individual which, through amalgamation, consolidation, or
other legal succession becomes invested with rights and assumes burdens of the first
contractor/vendor or any person who succeeds to the office, rights, responsibilities or place of
another.
"USC" means the United States Code. All references in this Contract to USC chapters or
sections shall include any successor, amended, or replacement statute. The USC may be
accessed at htti):I/uscode.house.gov/.
Local Health Jurisdiction Page 10 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
3. SPECIAL TERMS AND CONDITIONS
3.1 TERM
3.1.1 The initial term of the Contract will commence on January 1, 2019, and continue
through December 31, 2020, unless terminated sooner as provided herein.
3.1.2 This Contract may be extended through December 31, 2023 in whatever time
increments HCA deems appropriate. No change in terms and conditions will be
permitted during these extensions unless specifically agreed to in writing.
3.1.3 Work performed without a contract or amendment signed by the authorized
representatives of both parties will be at the sole risk of the Contractor. HCA will not
pay any costs incurred before a contract or any subsequent amendment(s) is fully
executed.
3.2 COMPENSATION
Compensation payable to the Contractor for satisfactory performance of the work under
this Agreement will be made on a cost reimbursement bases and shall be based on the
following:
3.2.1 There is no maximum consideration payable to the Contractor under the
Agreement;
3.2.2 The Federal Financial Participation Rate shall be:
3.2.2.1 50%, except;
3.2.2.2 75% for appropriately documented Skilled Professional Medical
Personnel and appropriately documented Interpreter staff. See Schedule
A, Section 7, d and g, and Section 8.
3.2.3 Federal funds disbursed through this Contract were received by HCA through OMB
Catalogue of Federal Domestic Assistance (CFDA) Number: 93.778, Medical
Assistance Program, Contractor agrees to comply with applicable rules and
regulations associated with these federal funds and has signed Attachment 2:
Federal Compliance, Certification and Assurances, attached.
3.2.4 HCA will not issue reimbursement for any quarters where HCA receives credible
evidence or suspected evidence of a system failure that has the potential to impact
the integrity of the reimbursement request. This includes but is not limited to failures
related to the time study, MER calculation, claim calculation, or reconciliation.
3.2.4.1 HCA will pursue corrective action as needed, and will restore payment
after any issues related to the reimbursement request are resolved, and
the requested amount is acurate.
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Washington State Health Care Authority Contract # K3066
3.3 BILLING AND INVOICE
3.3.1 Contractor shall submit correct invoices to the HCA Contract Manager for all
amounts to be paid by the HCA hereunder.
All invoices submitted must meet with the approval of the HCA Contract Manager or
his/her designee prior to payment, which approval shall not be unreasonably
withheld.
Contractor shall only submit invoices for Services or Deliverables as permitted by
this section of the Contract. The Contractor shall not bill the HCA for services
performed under this Contract, and the HCA shall not pay the Contractor if the
Contractor is entitled to payment or has been or will be paid by any other source,
including grants, for such services/deliverables.
Contractor shall submit properly itemized invoices to include the following
information, as applicable:
3.3.1.1 HCA Contract number K3066;
3.3.1.2 Contractor name, address, phone number;
3.3.1.3 Description of Services;
3.3.1.4 Date(s) of delivery;
3.3.1.5 Net invoice price for each item;
3.3.1.6 Applicable taxes;
3.3.1.7 Total invoice price; and
3.3.1.8 Payment terms and any available prompt payment discount.
3.3.2 HCA will return incorrect or incomplete invoices to the Contractor for correction and
reissue. The Contract Number must appear on all invoices, bills of lading,
packages, and correspondence relating to this Contract.
3.3.3 In order to receive payment for services or products provided to a state agency,
Contractor must register with the Statewide Payee Desk at
https:/Ides wa gov/services/contracting- urchasinci/doing-business-state/receiKtg-
a meat-statelstatewide- a ee-desk, Payment will be considered timely if made by
HCA within thirty (30) calendar days of receipt of properly completed invoices.
Payment will be directly deposited in the bank account or sent to the address
Contractor designated in its registration.
3.3.4 Upon expiration of the Contract, any claims for payment for costs due and payable
under this Contract that are incurred prior to the expiration date must be submitted
by the Contractor to HCA within sixty (60) calendar days after the Contract
expiration date. HCA is under no obligation to pay any claims that are submitted
sixty-one (61) or more calendar days after the Contract expiration date ("Belated
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Washington State Health Care Authority Contract # K3066
Claims"). HCA will pay Belated Claims at its sole discretion, and any such potential
payment is contingent upon the availability of funds.
3.4 CONTRACTOR AND HCA CONTRACT MANAGERS
3.4.1 Contractor's Contract Manager will have prime responsibility and final authority for
the services provided under this Contract and be the principal point of contact for
the HCA Contract Manager for all business matters, performance matters, and
administrative activities.
3.4.2 HCA's Contract Manager is responsible for monitoring the Contractor's performance
and will be the contact person for all communications regarding contract
performance and deliverables. The HCA Contract Manager has the authority to
accept or reject the services provided and must approve Contractor's invoices prior
to payment.
3.4.3 The contact information provided below may be changed by written notice of the
change (email acceptable) to the other party.
CONTRACTOR
Contract Manager Information
Name: I Vicki Kirkpatrick
Title:
Health Care Authority
Contract Manager Information
Name: I Jon Brogger
Title: I Program Manager
PO Box 45506
Address: 615 Sheridan Address:
Olympia, WA 98501
Phone: (360) 395 9420 Phone: 360-725-1647
Email: vkirkpatrick@co.jefferson.wa.us Email: jon.brogger@hca.wa.gov
3.5 LEGAL NOTICES
Any notice or demand or other communication required or permitted to be given under this
Contract or applicable law is effective only if it is in writing and signed by the applicable
party, properly addressed, and delivered in person, via email, or by a recognized courier
service, or deposited with the United States Postal Service as first-class mail, postage
prepaid certified mail, return receipt requested, to the parties at the addresses provided in
this section.
3.5.1 In the case of notice to the Contractor:
Attention: Vicki Kirkpatrick
Jefferson County Health/Human Services
615 Sheridan
Port Townsend, WA 98368
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3.5.2 In the case of notice to HCA:
Attention: Contracts Administrator
Health Care Authority
Division of Legal Services
Post Office Box 42702
Olympia, WA 98504-2702
3.5.3 Notices are effective upon receipt or four (4) Business Days after mailing, whichever
is earlier.
3.5.4 The notice address and information provided above may be changed by written
notice of the change given as provided above.
3.6 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE
Each of the documents listed below is by this reference incorporated into this Contract. In
the event of an inconsistency, the inconsistency will be resolved in the following order of
precedence:
3.6.1 Applicable Federal and State of Washington statutes and regulations;
3.6.2 Recitals
3.6.3 Special Terms and Conditions;
3.6.4 General Terms and Conditions;
3.6.5 Attachment 1: Federal Compliance, Certifications and Assurances;
3.6.6 Attachment 2: Federal Funding Accountability and Transparency Act Data
Collection Form;
3.6.7 MAC Coordinator Manual;
3.6.8 Schedule A: Statement of Work; and
3.6.9 Any other provision, term or material incorporated herein by reference or otherwise
incorporated.
3.7 INSURANCE
Contractor must provide insurance coverage as set out in this section. The intent of the
required insurance is to protect the State should there be any claims, suits, actions, costs,
damages or expenses arising from any negligent or intentional act or omission of
Contractor or Subcontractor, or agents of either, while performing under the terms of this
Contract. Contractor must provide insurance coverage that is maintained in full force and
effect during the term of this Contract, as follows:
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3.7.1 Commercial General Liability Insurance Policy - Provide a Commercial General
Liability Insurance Policy, including contractual liability, in adequate quantity to
protect against legal liability arising out of contract activity but no less than
$1 million per occurrence/$2 million general aggregate. Additionally, Contractor is
responsible for ensuring that any Subcontractors provide adequate insurance
coverage for the activities arising out of subcontracts.
3.7.2 Business Automobile Liability. In the event that services delivered pursuant to this
Contract involve the use of vehicles, either owned, hired, or non -owned by the
Contractor, automobile liability insurance is required covering the risks of bodily
injury (including death) and property damage, including coverage for contractual
liability. The minimum limit for automobile liability is $1,000,000 per occurrence,
using a Combined Single Limit for bodily injury and property damage.
3.7.3 Professional Liability Errors and Omissions — Provide a policy with coverage of not
less than $1 million per claim/$2 million general aggregate.
3.7.4 The insurance required must be issued by an insurance company/ies authorized to
do business within the state of Washington, and must name HCA and the state of
Washington, its agents and employees as additional insured's under any
Commercial General and/or Business Automobile Liability policy/ies. All policies
must be primary to any other valid and collectable insurance. In the event of
cancellation, non -renewal, revocation or other termination of any insurance
coverage required by this Contract, Contractor must provide written notice of such
to HCA within one (1) Business Day of Contractor's receipt of such notice. Failure to
buy and maintain the required insurance may, at HCA's sole option, result in this
Contract's termination
3.7.5 For public agencies, the Receiving Party certifies that it is self-insured, is a member
of a risk pool, or maintains the types and amounts of insurance identified above and
will provide certificates of insurance to that effect to HCA upon request.
Upon request, Contractor must submit to HCA a certificate of insurance that outlines the
coverage and limits defined in the Insurance Section. If a certificate of insurance is
requested, Contractor must submit renewal certificates as appropriate during the term of
the contract.
3.7.6 Privacy Breach Response Coverage. Contractor must maintain insurance to cover
costs incurred in connection with a Breach, or potential Breach, including:
3.7.6.1 Computer forensics assistance to assess the impact of the Breach or
potential Breach, determine root cause, and help determine whether and
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the extent to which notification must be provided to comply with Breach
notification laws.
3.7.6.2 Notification and call center services for individuals affected by a Breach.
3.7.6.3 Breach resolution and mitigation services for individuals affected by a
Breach, including fraud prevention, credit monitoring and identity theft
assistance.
3.7.6.4 Regulatory defense, fines and penalties from any claim in the form of a
regulatory proceeding resulting from a violation of any applicable privacy
or security law(s) or regulation(s).
The policy must be maintained for the term of this Agreement and three (3) years following
its termination.
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4. GENERAL TERMS AND CONDITIONS
4.1 ACCESS TO DATA
In compliance with RCW 39.26.180 (2) and federal rules, the Contractor must provide
access to any data generated under this Contract to HCA, the Joint Legislative Audit and
Review Committee, the State Auditor, and any other state or federal officials so authorized
by law, rule, regulation, or agreement at no additional cost. This includes access to all
information that supports the findings, conclusions, and recommendations of the
Contractor's reports, including computer models and methodology for those models.
4.2 ADVANCE PAYMENT PROHIBITED
No advance payment will be made for services furnished by the Contractor pursuant to
this Contract.
4.3 AMENDMENTS
This Contract may be amended by mutual agreement of the parties. Such amendments
will not be binding unless they are in writing and signed by personnel authorized to bind
each of the parties.
4.4 ASSIGNMENT
4.4.1 Contractor may not assign or transfer all or any portion of this Contract or any of its
rights hereunder, or delegate any of its duties hereunder, except delegations as set
forth in Section 4.36, Subcontracting, without the prior written consent of HCA. Any
permitted assignment will not operate to relieve Contractor of any of its duties and
obligations hereunder, nor will such assignment affect any remedies available to
HCA that may arise from any breach of the provisions of this Contract or warranties
made herein, including but not limited to, rights of setoff. Any attempted assignment,
transfer or delegation in contravention of this Subsection 4.4.1 of the Contract will
be null and void.
4.4.2 HCA may assign this Contract to any public agency, commission, board, or the like,
within the political boundaries of the State of Washington, with written notice of thirty
(30) calendar days to Contractor.
4.4.3 This Contract will inure to the benefit of and be binding on the parties hereto and
their permitted successors and assigns.
4.5 ATTORNEYS' FEES
In the event of litigation or other action brought to enforce the terms of this Contract, each
party agrees to bear its own attorneys' fees and costs.
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4.6 CHANGE IN STATUS
In the event of any substantive change in its legal status, organizational structure, or fiscal
reporting responsibility, Contractor will notify HCA of the change. Contractor must provide
notice as soon as practicable, but no later than thirty (30) calendar days after such a
change takes effect.
4.7 CONFIDENTIAL INFORMATION PROTECTION
4.7.1 Contractor acknowledges that some of the material and information that may come
into its possession or knowledge in connection with this Contract or its performance
may consist of Confidential Information. Contractor agrees to hold Confidential
Information in strictest confidence and not to make use of Confidential Information
for any purpose other than the performance of this Contract, to release it only to
authorized employees or Subcontractors requiring such information for the
purposes of carrying out this Contract, and not to release, divulge, publish, transfer,
sell, disclose, or otherwise make the information known to any other party without
HCA's express written consent or as provided by law. Contractor agrees to
implement physical, electronic, and managerial safeguards to prevent unauthorized
access to Confidential Information
4.7.2 Contractors that come into contact with Protected Health Information may be
required to enter into a Business Associate Agreement with HCA in compliance with
the requirements of the Health Insurance Portability and Accountability Act of 1996,
Pub. L. 104-191, as modified by the American Recovery and Reinvestment Act of
2009 ("ARRA"), Sec. 13400 — 13424, H.R. 1 (2009) (HITECH Act) (HIPAA).
4.7.3 HCA reserves the right to monitor, audit, or investigate the use of Confidential
Information collected, used, or acquired by Contractor through this Contract.
Violation of this section by Contractor or its Subcontractors may result in termination
of this Contract and demand for return of all Confidential Information, monetary
damages, or penalties.
4.7.4 The obligations set forth in this section will survive completion, cancellation,
expiration, or termination of this Contract.
4.8 CONFIDENTIAL INFORMATION BREACH — REQUIRED NOTIFICATION
4.8.1 Contractor must notify the HCA Privacy Officer (hcaprivacyofficer@hca.wa.gov
within five Business Days of discovery of any Breach or suspected Breach of
Confidential Information.
4.8.2 Contractor will take steps necessary to mitigate any known harmful effects of such
unauthorized access including, but not limited to, sanctioning employees and taking
steps necessary to stop further unauthorized access. Contractor agrees to
indemnify and hold HCA harmless for any damages related to unauthorized use or
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disclosure of Confidential Information by Contractor, its officers, directors,
employees, Subcontractors or agents.
4.8.3 If notification of the Breach or possible Breach must (in the judgment of HCA) be
made under the HIPAA Breach Notification Rule, or RCW 42.56.590 or RCW
19.255.010, or other law or rule, then:
4.8.3.1 HCA may choose to make any required notifications to the individuals, to
the U.S. Department of Health and Human Services Secretary (DHHS)
Secretary, and to the media, or direct Contractor to make them or any of
them.
4.8.3.2 In any case, Contractor will pay the reasonable costs of notification to
individuals, media, and governmental agencies and of other actions HCA
reasonably considers appropriate to protect HCA clients (such as paying
for regular credit watches in some cases).
4.8.3.3 Contractor will compensate HCA clients for harms caused to them by any
Breach or possible Breach.
4.8.4 Any breach of this clause may result in termination of the Contract and the demand
for return or disposition of all Confidential Information.
4.8.5 Contractor's obligations regarding Breach notification survive the termination of this
Contract and continue for as long as Contractor maintains the Confidential
Information and for any breach or possible breach at any time.
4.9 CONTRACTOR'S PROPRIETARY INFORMATION
Contractor acknowledges that HCA is subject to chapter 42.56 RCW, the Public Records
Act, and that this Contract will be a public record as defined in chapter 42.56 RCW. Any
specific information that is claimed by Contractor to be Proprietary Information must be
clearly identified as such by Contractor. To the extent consistent with chapter 42.56 RCW,
HCA will maintain the confidentiality of Contractor's information in its possession that is
marked Proprietary. If a public disclosure request is made to view Contractor's Proprietary
Information, HCA will notify Contractor of the request and of the date that such records will
be released to the requester unless Contractor obtains a court order from a court of
competent jurisdiction enjoining that disclosure. If Contractor fails to obtain the court order
enjoining disclosure, HCA will release the requested information on the date specified.
4.10 COVENANT AGAINST CONTINGENT FEES
Contractor warrants that no person or selling agent has been employed or retained to
solicit or secure this Contract upon an agreement or understanding for a commission,
percentage, brokerage or contingent fee, excepting bona fide employees or bona fide
established agents maintained by the Contractor for the purpose of securing business.
HCA will have the right, in the event of breach of this clause by the Contractor, to annul
this Contract without liability or, in its discretion, to deduct from the contract price or
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consideration or recover by other means the full amount of such commission, percentage,
brokerage or contingent fee.
4.11 DEBARMENT
By signing this Contract, Contractor certifies that it is not presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded in any Washington
State or Federal department or agency from participating in transactions (debarred).
Contractor agrees to include the above requirement in any and all subcontracts into which
it enters, and also agrees that it will not employ debarred individuals. Contractor must
immediately notify HCA if, during the term of this Contract, Contractor becomes debarred.
HCA may immediately terminate this Contract by providing Contractor written notice, if
Contractor becomes debarred during the term hereof.
4.12 DISPUTES
The parties will use their best, good faith efforts to cooperatively resolve disputes and
problems that arise in connection with this Contract. Both parties will continue without
delay to carry out their respective responsibilities under this Contract while attempting to
resolve any dispute. When a genuine dispute arises between HCA and the Contractor
regarding the terms of this Contract or the responsibilities imposed herein and it cannot be
resolved between the parties' Contract Managers, either party may initiate the following
dispute resolution process.
4.12.1 The initiating party will reduce its description of the dispute to writing and deliver it to
the responding party (email acceptable). The responding party will respond in
writing within five (5) Business Days (email acceptable). If the initiating party is not
satisfied with the response of the responding party, then the initiating party may
request that the HCA Director review the dispute. Any such request from the
initiating party must be submitted in writing to the HCA Director within five (5)
Business Days after receiving the response of the responding party. The HCA
Director will have sole discretion in determining the procedural manner in which he
or she will review the dispute. The HCA Director will inform the parties in writing
within five (5) Business Days of the procedural manner in which he or she will
review the dispute, including a timeframe in which he or she will issue a written
decision.
4.12.2 A party's request for a dispute resolution must:
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4.12.2.1 Be in writing;
4.12.2.2 Include a written description of the dispute;
4.12.2.3 State the relative positions of the parties and the remedy sought;
4.12.2.4 State the Contract Number and the names and contact information for the
parties;
4.12.3 This dispute resolution process constitutes the sole administrative remedy available
under this Contract. The parties agree that this resolution process will precede any
action in a judicial or quasi-judicial tribunal.
4.13 ENTIRE AGREEMENT
HCA and Contractor agree that the Contract is the complete and exclusive statement of
the agreement between the parties relating to the subject matter of the Contract and
supersedes all letters of intent or prior contracts, oral or written, between the parties
relating to the subject matter of the Contract, except as provided in Section 4.43
Warranties.
4.14 FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA)
4.14.1 This Contract is supported by federal funds that require compliance with the Federal
Funding Accountability and Transparency Act (FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the
public can see how federal funds are spent.
4.14.2 To comply with the act and be eligible to enter into this Contract, Contractor must
have a Data Universal Numbering System (DUNSO) number. A DUNS@ number
provides a method to verify data about your organization. If Contractor does not
already have one, a DUNS@ number is available free of charge by contacting Dun
and Bradstreet at www.dnb.com.
4.14.3 Information about Contractor and this Contract will be made available on
www,uscontractorMgistration.com by HCA as required by P.L. 109-282. HCA's
Attachment 2: Federal Funding Accountability and Transparency Act Data
Collection Form, is considered part of this Contract and must be completed and
returned along with the Contract.
4.15 FORCE MAJEURE
A party will not be liable for any failure of or delay in the performance of this Contract for
the period that such failure or delay is due to causes beyond its reasonable control,
including but not limited to acts of God, war, strikes or labor disputes, embargoes,
government orders or any other force majeure event.
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4.16 FUNDING WITHDRAWN, REDUCED OR LIMITED
If HCA determines in its sole discretion that the funds it relied upon to establish this
Contract have been withdrawn, reduced or limited, or if additional or modified conditions
are placed on such funding after the effective date of this contract but prior to the normal
completion of this Contract, then HCA, at its sole discretion, may:
4.16.1 Terminate this Contract pursuant to Section 4.40.3, Termination for Non -Allocation
of Funds;
4.16.2 Renegotiate the Contract under the revised funding conditions; or
4.16.3 Suspend Contractor's performance under the Contract upon five (5) Business Days'
advance written notice to Contractor. HCA will use this option only when HCA
determines that there is reasonable likelihood that the funding insufficiency may be
resolved in a timeframe that would allow Contractor's performance to be resumed
prior to the normal completion date of this Contract.
4.16.3.1 During the period of suspension of performance, each party will inform
the other of any conditions that may reasonably affect the potential for
resumption of performance.
4.16.3.2 When HCA determines in its sole discretion that the funding insufficiency
is resolved, it will give Contractor written notice to resume performance.
Upon the receipt of this notice, Contractor will provide written notice to
HCA informing HCA whether it can resume performance and, if so, the
date of resumption. For purposes of this subsection, "written notice" may
include email.
4.16.3.3 If the Contractor's proposed resumption date is not acceptable to HCA
and an acceptable date cannot be negotiated, HCA may terminate the
contract by giving written notice to Contractor. The parties agree that the
Contract will be terminated retroactive to the date of the notice of
suspension. HCA will be liable only for payment in accordance with the
terms of this Contract for services rendered prior to the retroactive date of
termination.
4.17 GOVERNING LAW
This Contract is governed in all respects by the laws of the state of Washington, without
reference to conflict of law principles. The jurisdiction for any action hereunder is
exclusively in the Superior Court for the state of Washington, and the venue of any action
hereunder is in the Superior Court for Thurston County, Washington. Nothing in this
Contract will be construed as a waiver by HCA of the State's immunity under the 11th
Amendment to the United States Constitution.
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4.18 HCA NETWORK SECURITY
Contractor agrees not to attach any Contractor -supplied computers, peripherals or
software to the HCA Network without prior written authorization from HCA's Chief
Information Officer. Unauthorized access to HCA networks and systems is a violation of
HCA Policy and constitutes computer trespass in the first degree pursuant to RCW
9A.52.110. Violation of any of these laws or policies could result in termination of the
contract and other penalties.
Contractor will have access to the HCA visitor Wi-Fi Internet connection while on site.
4.19 INDEMNIFICATION
Contractor must defend, indemnify, and save HCA harmless from and against all claims,
including reasonable attorneys' fees resulting from such claims, for any or all injuries to
persons or damage to property, or Breach of its confidentiality and notification obligations
under Section 4.7 Confidential Information Protection and Section 4.8 Confidentiality
Breach -Required Notification, arising from intentional or negligent acts or omissions of
Contractor, its officers, employees, or agents, or Subcontractors, their officers, employees,
or agents, in the performance of this Contract.
4.20 INDEPENDENT CAPACITY OF THE CONTRACTOR
The parties intend that an independent contractor relationship will be created by this
Contract. Contractor and its employees or agents performing under this Contract are not
employees or agents of HCA. Contractor will not hold itself out as or claim to be an officer
or employee of HCA or of the State of Washington by reason hereof, nor will Contractor
make any claim of right, privilege or benefit that would accrue to such employee under
law. Conduct and control of the work will be solely with Contractor.
4.21 INDUSTRIAL INSURANCE COVERAGE
Prior to performing work under this Contract, Contractor must provide or purchase
industrial insurance coverage for the Contractor's employees, as may be required of an
"employer" as defined in Title 51 RCW, and must maintain full compliance with Title 51
RCW during the course of this Contract.
4.22 LEGAL AND REGULATORY COMPLIANCE
4.22.1 During the term of this Contract, Contractor must comply with all local, state, and
federal licensing, accreditation and registration requirements/standards, necessary
for the performance of this Contract and all other applicable federal, state and local
laws, rules, and regulations.
4.22.2 While on the HCA premises, Contractor must comply with HCA operations and
process standards and policies (e.g., ethics, internet / email usage, data, network
and building security, harassment, as applicable). HCA will make an electronic copy
of all such policies available to Contractor.
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4.22.3 Failure to comply with any provisions of this section may result in Contract
termination.
4.23 LIMITATION OF AUTHORITY
Only the HCA Authorized Representative has the express, implied, or apparent authority
to alter, amend, modify, or waive any clause or condition of this Contract. Furthermore,
any alteration, amendment, modification, or waiver or any clause or condition of this
Contract is not effective or binding unless made in writing and signed by the HCA
Authorized Representative.
4.24 NO THIRD -PARTY BENEFICIARIES
HCA and Contractor are the only parties to this contract. Nothing in this Contract gives or
is intended to give any benefit of this Contract to any third parties.
4.25 NONDISCRIMINATION
During the performance of this Contract, the Contractor must comply with all federal and
state nondiscrimination laws, regulations and policies, including but not limited to: Title VII
of the Civil Rights Act, 42 U.S.C. §12101 et seq.; the Americans with Disabilities Act of
1990 (ADA), 42 U.S.C. §12101 et seq., 28 CFR Part 35; and Title 49.60 RCW,
Washington Law Against Discrimination. In the event of Contractor's noncompliance or
refusal to comply with any nondiscrimination law, regulation or policy, this Contract may be
rescinded, canceled, or terminated in whole or in part under the Termination for Default
sections, and Contractor may be declared ineligible for further contracts with HCA.
4.26 OVERPAYMENTS TO CONTRACTOR
In the event that overpayments or erroneous payments have been made to the Contractor
under this Contract, HCA will provide written notice to Contractor and Contractor shall
refund the full amount to HCA within thirty (30) calendar days of the notice. If Contractor
fails to make timely refund, HCA may charge Contractor one percent (1%) per month on
the amount due, until paid in full. If the Contractor disagrees with HCA's actions under this
section, then it may invoke the dispute resolution provisions of Section 4.12 Disputes.
4.27 PAY EQUITY
4.27.1 Contractor represents and warrants that, as required by Washington state law
(Laws of 2017, Chap. 1, § 147), during the term of this Contract, it agrees to
equality among its workers by ensuring similarly employed individuals are
compensated as equals. For purposes of this provision, employees are similarly
employed if (i) the individuals work for Contractor, (ii) the performance of the job
requires comparable skill, effort, and responsibility, and (iii) the jobs are performed
under similar working conditions. Job titles alone are not determinative of whether
employees are similarly employed.
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4.27.2 Contractor may allow differentials in compensation for its workers based in good
faith on any of the following: (i) a seniority system; (ii) a merit system; (iii) a system
that measures earnings by quantity or quality of production; (iv) bona fide job-
related factor(s); or (v) a bona fide regional difference in compensation levels.
4.27.3 Bona fide job-related factor(s)" may include, but not be limited to,
education, training, or experience, that is: (i) consistent with business necessity; (ii)
not based on or derived from a gender-based differential; and (iii) accounts for the
entire differential.
4.27.4 A "bona fide regional difference in compensation level" must be (i) consistent with
business necessity; (ii) not based on or derived from a gender-based differential;
and (iii) account for the entire differential.
4.27.5 Notwithstanding any provision to the contrary, upon breach of warranty and
Contractor's failure to provide satisfactory evidence of compliance within thirty (30)
Days of RCA's request for such evidence, HCA may suspend or terminate this
Contract.
4.28 PUBLICITY
4.28.1 The award of this Contract to Contractor is not in any way an endorsement of
Contractor or Contractor's Services by HCA and must not be so construed by
Contractor in any advertising or other publicity materials.
4.28.2 Contractor agrees to submit to HCA, all advertising, sales promotion, and other
publicity materials relating to this Contract or any Service furnished by Contractor in
which HCA's name is mentioned, language is used, or Internet links are provided
from which the connection of HCA's name with Contractor's Services may, in HCA's
judgment, be inferred or implied. Contractor further agrees not to publish or use
such advertising, marketing, sales promotion materials, publicity or the like through
print, voice, the Web, and other communication media in existence or hereinafter
developed without the express written consent of HCA prior to such use.
4.29 RECORDS AND DOCUMENTS REVIEW
4.29.1 The Contractor must maintain books, records, documents, magnetic media,
receipts, invoices or other evidence relating to this Contract and the performance of
the services rendered, along with accounting procedures and practices, all of which
sufficiently and properly reflect all direct and indirect costs of any nature expended
in the performance of this Contract. At no additional cost, these records, including
materials generated under this Contract, are subject at all reasonable times to
inspection, review, or audit by HCA, the Office of the State Auditor, and state and
federal officials so authorized by law, rule, regulation, or agreement [See 42 USC
1396a(a)(27)(B); 42 USC 1396a(a)(37)(B); 42 USC 1396a(a)(42(A); 42 CFR 431,
Subpart Q; and 42 CFR 447.202].
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4.29.2 The Contractor must retain such records for a period of six (6) years after the date
of final payment under this Contract.
4.29.3 If any litigation, claim or audit is started before the expiration of the six (6) year
period, the records must be retained until all litigation, claims, or audit findings
involving the records have been resolved.
4.30 REMEDIES NON-EXCLUSIVE
The remedies provided in this Contract are not exclusive, but are in addition to all other
remedies available under law.
4.31 RIGHT OF INSPECTION
The Contractor must provide right of access to its facilities to HCA, or any of its officers, or
to any other authorized agent or official of the state of Washington or the federal
government, at all reasonable times, in order to monitor and evaluate performance,
compliance, and/or quality assurance under this Contract.
4.32 RIGHTS IN DATA/OWNERSHIP
4.32.1 HCA and Contractor agree that all data and work products (collectively "Work
Product") produced pursuant to this Contract will be considered a work for hire
under the U.S. Copyright Act, 17 U.S.C. §101 et seq, and will be owned by HCA.
Contractor is hereby commissioned to create the Work Product. Work Product
includes, but is not limited to, discoveries, formulae, ideas, improvements,
inventions, methods, models, processes, techniques, findings, conclusions,
recommendations, reports, designs, plans, diagrams, drawings, Software,
databases, documents, pamphlets, advertisements, books, magazines, surveys,
studies, computer programs, films, tapes, and/or sound reproductions, to the extent
provided by law. Ownership includes the right to copyright, patent, register and the
ability to transfer these rights and all information used to formulate such Work
Product.
4.32.2 If for any reason the Work Product would not be considered a work for hire under
applicable law, Contractor assigns and transfers to HCA, the entire right, title and
interest in and to all rights in the Work Product and any registrations and copyright
applications relating thereto and any renewals and extensions thereof.
4.32.3 Contractor will execute all documents and perform such other proper acts as HCA
may deem necessary to secure for HCA the rights pursuant to this section.
4.32.4 Contractor will not use or in any manner disseminate any Work Product to any third
party, or represent in any way Contractor ownership of any Work Product, without
the prior written permission of HCA. Contractor shall take all reasonable steps
necessary to ensure that its agents, employees, or Subcontractors will not copy or
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disclose, transmit or perform any Work Product or any portion thereof, in any form,
to any third party.
4.32.5 Material that is delivered under this Contract, but that does not originate therefrom
("Preexisting Material'), must be transferred to HCA with a nonexclusive, royalty -
free, irrevocable license to publish, translate, reproduce, deliver, perform, display,
and dispose of such Preexisting Material, and to authorize others to do so.
Contractor agrees to obtain, at its own expense, express written consent of the
copyright holder for the inclusion of Preexisting Material. HCA will have the right to
modify or remove any restrictive markings placed upon the Preexisting Material by
Contractor.
4.32.6 Contractor must identify all Preexisting Material when it is delivered under this
Contract and must advise HCA of any and all known or potential infringements of
publicity, privacy or of intellectual property affecting any Preexisting Material at the
time of delivery of such Preexisting Material. Contractor must provide HCA with
prompt written notice of each notice or claim of copyright infringement or
infringement of other intellectual property right worldwide received by Contractor
with respect to any Preexisting Material delivered under this Contract.
4.33 RIGHTS OF STATE AND FEDERAL GOVERNMENTS
In accordance with 45 CFR 95.617, all appropriate state and federal agencies, including
but not limited to the Centers for Medicare and Medicaid Services (CMS), will have a
royalty -free, nonexclusive, and irrevocable license to reproduce, publish, translate, or
otherwise use, and to authorize others to use for Federal Government purposes: (i)
software, modifications, and documentation designed, developed or installed with Federal
Financial Participation (FFP) under 45 CFR Part 95, subpart F; (ii) the Custom Software
and modifications of the Custom Software, and associated Documentation designed,
developed, or installed with FFP under this Contract; (iii) the copyright in any work
developed under this Contract; and (iv) any rights of copyright to which Contractor
purchases ownership under this Contract.
4.34 SEVERABILITY
If any provision of this Contract or the application thereof to any person(s) or
circumstances is held invalid, such invalidity will not affect the other provisions or
applications of this Contract that can be given effect without the invalid provision, and to
this end the provisions or application of this Contract are declared severable.
4.35 SITE SECURITY
While on HCA premises, Contractor, its agents, employees, or Subcontractors must
conform in all respects with physical, fire or other security policies or regulations. Failure to
comply with these regulations may be grounds for revoking or suspending security access
to these facilities. HCA reserves the right and authority to immediately revoke security
access to Contractor staff for any real or threatened breach of this provision. Upon
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reassignment or termination of any Contractor staff, Contractor agrees to promptly notify
HCA.
4.36 SUBCONTRACTING
4.36.1 Neither Contractor, nor any Subcontractors, may enter into subcontracts for any of
the work contemplated under this Contract without prior written approval of HCA.
HCA has sole discretion to determine whether or not to approve any such
subcontract. In no event will the existence of the subcontract operate to release or
reduce the liability of Contractor to HCA for any breach in the performance of
Contractor's duties.
4.36.2 Contractor is responsible for ensuring that all terms, conditions, assurances and
certifications set forth in this Contract are included in any subcontracts.
4.36.3 If at any time during the progress of the work HCA determines in its sole judgment
that any Subcontractor is incompetent or undesirable, HCA will notify Contractor,
and Contractor must take immediate steps to terminate the Subcontractor's
involvement in the work.
4.36.4 The rejection or approval by the HCA of any Subcontractor or the termination of a
Subcontractor will not relieve Contractor of any of its responsibilities under the
Contract, nor be the basis for additional charges to HCA.
4.36.5 HCA has no contractual obligations to any Subcontractor or vendor under contract
to the Contractor. Contractor is fully responsible for all contractual obligations,
financial or otherwise, to its Subcontractors
4.36.6 The Contractor is prohibited from entering into subrecipient subcontracts for the
purpose of participating in the MAC program..
4.37 SUBRECIPIENT
4.37.1 General
If the Contractor is a subrecipient (as defined in 45 CFR 75.2 and 2 CFR 200.93) of
federal awards, then the Contractor, in accordance with 2 CFR 200.501 and 45
CFR 75.501, shall:
4.37.1.1 Maintain records that identify, in its accounts, all federal awards received
and expended and the federal programs under which they were received,
by Catalog of Federal Domestic Assistance (CFDA) title and number,
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award number and year, name of the federal agency, and name of the
pass-through entity;
4.37.1.2 Maintain internal controls that provide reasonable assurance that the
Contractor is managing federal awards in compliance with laws,
regulations, and provisions of contracts or grant agreements that could
have a material effect on each of its federal programs;
4.37.1.3 Prepare appropriate financial statements, including a schedule of
expenditures of federal awards;
4.37.1.4 Incorporate OMB Super Circular, 2 CFR 200.501, and 45 CFR 75.501
audit requirements into all agreements between the Contractor and its
Subcontractors who are subrecipients;
4.37.1.5 Comply with any future amendments to OMB Super Circular, 2 CFR
200.501, and 45 CFR 75.501 and any successor or replacement Circular
or regulation;Comply with the applicable requirements of OMB Super
Circular 2 CFR 200.501 and 45 CFR 75.501 and any future amendments
to OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, and any
successor or replacement Circular or regulation; and
4.37.1.6 Comply with the Omnibus Crime Control and Safe streets Act of 1968,
Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation
Act of 1973, Title II of the Americans with Disabilities Act of 1990, Title IX
of the Education Amendments of 1972, The Age Discrimination Act of
1975, and The Department of Justice Non -Discrimination Regulations, 28
CFR Part 42, Subparts C, D, E, and G, and 28 CFR Part 35 and 39. (Go
to http://oip.govlaboui/offices/ocr.htm for additional information and
access to the aforementioned Federal laws and regulations.)
4.37.2 Single Audit Act Compliance
If the Contractor is a subrecipient and expends $750,000 or more in federal awards
from any and/or all sources in any fiscal year, the Contractor shall procure and pay
for a single audit or a program -specific audit for that fiscal year. Upon completion
of each audit, the Contractor shall:
4.37.2.1 Submit to the Authority contact person the data collection form and
reporting package specified in OMB Super Circular 2 CFR 200.501 and
45 CFR 75.501, reports required by the program -specific audit guide (if
applicable), and a copy of any management letters issued by the auditor;
4.37.2.2 Follow-up and develop corrective action for all audit findings; in
accordance with OMB Super Circular 2 CFR 200.501 and 45 CFR
75.501, prepare a "Summary Schedule of Prior Audit Findings."
4.37.3 Overpayments
4.37.3.1 If it is determined by HCA, or during the course of a required audit, that
Contractor has been paid unallowable costs under this or any Program
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Agreement, Contractor shall refund the full amount to HCA as provided in
Section 4.26 Overpayments to Contractors.
4.38 SURVIVAL
The terms and conditions contained in this Contract that, by their sense and context, are
intended to survive the completion, cancellation, termination, or expiration of the Contract
will survive. In addition, the terms of the Sections titled Confidential Information Protection,
Confidential Information Breach — Required Notification, Contractoes Proprietary
Information, Disputes, Overpayments to Contractor, Publicity, Records and Documents
Review, Rights in Data/Ownership, and Rights of State and Federal Governments will
survive the termination of this Contract. The right of HCA to recover any overpayments
will also survive the termination of this Contract.
4.39 TAXES
HCA will pay sales or use taxes, if any, imposed on the services acquired hereunder.
Contractor must pay all other taxes including, but not limited to, Washington Business and
Occupation Tax, other taxes based on Contractor's income or gross receipts, or personal
property taxes levied or assessed on Contractor's personal property. HCA, as an agency
of Washington State government, is exempt from property tax.
Contractor must complete registration with the Washington State Department of Revenue
and be responsible for payment of all taxes due on payments made under this Contract.
4.40 TERMINATION
4.40.1 TERMINATION FOR DEFAULT
In the event HCA determines that Contractor has failed to comply with the terms
and conditions of this Contract, HCA has the right to suspend or terminate this
Contract. HCA will notify Contractor in writing of the need to take corrective action.
If corrective action is not taken within five (5) Business Days, or other time period
agreed to in writing by both parties, the Contract may be terminated. HCA reserves
the right to suspend all or part of the Contract, withhold further payments, or
prohibit Contractor from incurring additional obligations of funds during
investigation of the alleged compliance breach and pending corrective action by
Contractor or a decision by HCA to terminate the Contract.
In the event of termination for default, Contractor will be liable for damages as
authorized by law including, but not limited to, any cost difference between the
original Contract and the replacement or cover Contract and all administrative
costs directly related to the replacement Contract, e.g., cost of the competitive
bidding, mailing, advertising, and staff time.
If it is determined that Contractor: (i) was not in default, or (ii) its failure to perform
was outside of its control, fault or negligence, the termination will be deemed a
"Termination for Convenience."
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4.40.2 TERMINATION FOR CONVENIENCE
When, at HCA's sole discretion, it is in the best interest of the State, HCA may
terminate this Contract in whole or in part by providing ten (10) calendar days'
written notice. If this Contract is so terminated, HCA will be liable only for payment
in accordance with the terms of this Contract for services rendered prior to the
effective date of termination. No penalty will accrue to HCA in the event the
termination option in this section is exercised.
4.40.3 TERMINATION FOR NONALLOCATION OF FUNDS
If funds are not allocated to continue this Contract in any future period, HCA may
immediately terminate this Contract by providing written notice to the Contractor.
The termination will be effective on the date specified in the termination notice.
HCA will be liable only for payment in accordance with the terms of this Contract
for services rendered prior to the effective date of termination. HCA agrees to
notify Contractor of such nonallocation at the earliest possible time. No penalty will
accrue to HCA in the event the termination option in this section is exercised.
4.40.4 TERMINATION FOR WITHDRAWAL OF AUTHORITY
In the event that the authority of HCA to perform any of its duties is withdrawn,
reduced, or limited in any way after the commencement of this Contract and prior
to normal completion, HCA may immediately terminate this Contract by providing
written notice to the Contractor. The termination will be effective on the date
specified in the termination notice. HCA will be liable only for payment in
accordance with the terms of this Contract for services rendered prior to the
effective date of termination. HCA agrees to notify Contractor of such withdrawal of
authority at the earliest possible time. No penalty will accrue to HCA in the event
the termination option in this section is exercised.
4.40.5 TERMINATION FOR CONFLICT OF INTEREST
HCA may terminate this Contract by written notice to the Contractor if HCA
determines, after due notice and examination, that there is a violation of the Ethics
in Public Service Act, Chapter 42.52 RCW, or any other laws regarding ethics in
public acquisitions and procurement and performance of contracts. In the event
this Contract is so terminated, HCA will be entitled to pursue the same remedies
against the Contractor as it could pursue in the event Contractor breaches the
contract.
4.41 TERMINATION PROCEDURES
4.41.1 Upon termination of this Contract, HCA, in addition to any other rights provided in
this Contract, may require Contractor to deliver to HCA any property specifically
produced or acquired for the performance of such part of this Contract as has been
terminated.
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4.41.2 HCA will pay Contractor the agreed-upon price, if separately stated, for completed
work and services accepted by HCA and the amount agreed upon by the Contractor
and HCA for (i) completed work and services for which no separate price is stated;
(ii) partially completed work and services; (iii) other property or services that are
accepted by HCA; and (iv) the protection and preservation of property, unless the
termination is for default, in which case HCA will determine the extent of the liability.
Failure to agree with such determination will be a dispute within the meaning of
Section 4.12 Disputes. HCA may withhold from any amounts due the Contractor
such sum as HCA determines to be necessary to protect HCA against potential loss
or liability.
4.41.3 After receipt of notice of termination, and except as otherwise directed by HCA,
Contractor must:
4.41.3.1 Stop work under the Contract on the date of, and to the extent specified
in, the notice;
4.41.3.2 Place no further orders or subcontracts for materials, services, or facilities
except as may be necessary for completion of such portion of the work
under the Contract that is not terminated;
4.41.3.3 Assign to HCA, in the manner, at the times, and to the extent directed by
HCA, all the rights, title, and interest of the Contractor under the orders
and subcontracts so terminated; in which case HCA has the right, at its
discretion, to settle or pay any or all claims arising out of the termination
of such orders and subcontracts;
4.41.4 Settle all outstanding liabilities and all claims arising out of such termination of
orders and subcontracts, with the approval or ratification of HCA to the extent HCA
may require, which approval or ratification will be final for all the purposes of this
clause;
4.41.5 Transfer title to and deliver as directed by HCA any property required to be
furnished to HCA;
4.41.6 Complete performance of any part of the work that was not terminated by HCA;
andTake such action as may be necessary, or as HCA may direct, for the protection
and preservation of the records related to this Contract that are in the possession of
the Contractor and in which HCA has or may acquire an interest.
4.42 WAIVER
Waiver of any breach of any term or condition of this Contract will not be deemed a waiver
of any prior or subsequent breach or default. No term or condition of this Contract will be
held to be waived, modified, or deleted except by a written instrument signed by the
parties. Only the HCA Authorized Representative has the authority to waive any term or
condition of this Contract on behalf of HCA.
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4.43 WARRANTIES
4.43.1 Contractor represents and warrants that it will perform all services pursuant to this
Contract in a professional manner and with high quality and will immediately re-
perform any services that are not in compliance with this representation and
warranty at no cost to HCA.
4.43.2 Contractor represents and warrants that it shall comply with all applicable local,
State, and federal licensing, accreditation and registration requirements and
standards necessary in the performance of the Services.
4.43.3 Any written commitment by Contractor within the scope of this Contract will be
binding upon Contractor. Failure of Contractor to fulfill such a commitment may
constitute breach and will render Contractor liable for damages under the terms of
this Contract. For purposes of this section, a commitment by Contractor includes:
(i) Prices, discounts, and options committed to remain in force over a specified
period of time; and (ii) any warranty or representation made by Contractor to HCA
or contained in any Contractor publications, or descriptions of services in written or
other communication medium, used to influence HCA to enter into this Contract.
Approved as to Form:
This contract format was approved by
the Office of the Attorney General.
Approval on file.
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ATTACHMENT 1
FEDERAL COMPLIANCE, CERTIFICATIONS, AND ASSURANCES
In the event federal funds are included in this agreement, the following sections apply: I. Federal Compliance
and II. Standard Federal Assurances and Certifications. In the instance of inclusion of federal funds, the
Contractor may be designated as a sub -recipient and the effective date of the amendment shall also be the
date at which these requirements go into effect.
FEDERAL COMPLIANCE - The use of federal funds requires additional compliance and control
mechanisms to be in place. The following represents the majority of compliance elements that
may apply to any federal funds provided under this contract. For clarification regarding any of
these elements or details specific to the federal funds in this contract, contact the Health Care
Authority.
a. Source of Funds: Federal funds to support this agreement are identified by the Catalog of
Federal Domestic Assistance (CFDA) number 93.778. The sub-awardee is responsible for
tracking and reporting the cumulative amount expended under HCA IA Contract No. K3066.
b. Period of Availability of Funds: Pursuant to 45 CFR 92.23, Sub-awardee may charge to the
award only costs resulting from obligations of the funding period specified in CFDA 93.778,
unless carryover of unobligated balances is permitted, in which case the carryover balances
may be charged for costs resulting from obligations of the subsequent funding period. All
obligations incurred under the award must be liquidated no later than 90 days after the end
of the funding period.
c. Single Audit Act. A sub-awardee (including private, for-profit hospitals and non-profit
institutions) shall adhere to the federal Office of Management and Budget (OMB) Super
Circular 2 CFR 200.501 and 45 CFR 75.501. A sub-awardee who expends $750,000 or
more in federal awards during a given fiscal year shall have a single or program -specific
audit for that year in accordance with the provisions of OMB Super Circular 2 CFR 200.501
and 45 CFR 75.501.
d. Modifications: This agreement may not be modified or amended, nor may any term or
provision be waived or discharged, including this particular Paragraph, except in writing,
signed upon by both parties.
1. Examples of items requiring Health Care Authority prior written approval include, but are
not limited to, the following:
i. Deviations from the budget and Project plan.
ii. Change in scope or objective of the agreement.
iii. Change in a key person specified in the agreement.
iv. The absence for more than three months or a 25% reduction in time by the Project
Manager/Director.
v. Need for additional funding.
vi. Inclusion of costs that require prior approvals as outlined in the appropriate cost
principles.
vii. Any changes in budget line item(s) of greater than twenty percent (20%) of the total
budget in this agreement.
2. No changes are to be implemented by the Sub-awardee until a written notice of approval
is received from the Health Care Authority.
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e. Sub -Contracting: The sub-awardee shall not enter into a sub -contract for any of the work
performed under this agreement without obtaining the prior written approval of the Health
Care Authority. If sub -contractors are approved by the Health Care Authority, the
subcontract, shall contain, at a minimum, sections of the agreement pertaining to Debarred
and Suspended Vendors, Lobbying certification, Audit requirements, and/or any other
project Federal, state, and local requirements.
f. Condition for Receipt of Health Care Authority Funds: Funds provided by Health Care
Authority to the sub-awardee under this agreement may not be used by the sub-awardee as
a match or cost-sharing provision to secure other federal monies without prior written
approval by the Health Care Authority.
g. Unallowable Costs: The sub-awardees' expenditures shall be subject to reduction for
amounts included in any invoice or prior payment made which determined by HCA not to
constitute allowable costs on the basis of audits, reviews, or monitoring of this agreement.
Citizenship/Alien Verification/Determination: The Personal Responsibility and Work
Opportunity Reconciliation Act (PRWORA) of 1996 (PL 104-193) states that federal public
benefits should be made available only to U.S. citizens and qualified aliens. Entities that
offer a service defined as a "federal public benefit" must make a citizenship/qualified alien
determination/ verification of applicants at the time of application as part of the eligibility
criteria. Non -US citizens and unqualified aliens are not eligible to receive the services. PL
104-193 also includes specific reporting requirements.
i. Federal Compliance: The sub-awardee shall comply with all applicable State and Federal
statutes, laws, rules, and regulations in the performance of this agreement, whether
included specifically in this agreement or not.
Civil Rights and Non -Discrimination Obligations During the performance of this agreement,
the Contractor shall comply with all current and future federal statutes relating to
nondiscrimination. These include but are not limited to: Title VI of the Civil Rights Act of
1964 (PL 88-352), Title IX of the Education Amendments of 1972 (20 U.S.C. §§ 1681-1683
and 1685-1686), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), the Age
Discrimination Act of 1975 (42 U.S.C. §§ 6101-6107), the Drug Abuse Office and Treatment
Act of 1972 (PL 92-255), the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (PL 91-616), §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290dd-3 and 290ee-3), Title VIII of the Civil Rights Act of
1968 (42 U.S.C. §§3601 et seq.), and the Americans with Disability Act (42 U.S.C., Section
12101 et seq.) http://www.hhs.goviocr/civilrights
HCA Federal Compliance Contact Information
Federal Grants and Budget Specialist
Health Care Policy
Washington State Health Care Authority
Post Office Box 42710
Olympia, Washington 98504-2710
CIRCULARS `COMPLIANCE MATRIX- The following compliance matrix identifies the OMB
Circulars that contain the requirements which govern expenditure of federal funds. These
requirements apply to the Washington State Health Care Authority (HCA), as the primary
recipient of federal funds and then follow the funds to the sub-awardee, Jefferson County
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Health/Human Services. The federal Circulars which provide the applicable administrative
requirements, cost principles and audit requirements are identified by sub-awardee organization
type.
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OMB CIRCULAR
ENTITY TYPE
ADMINISTRATIVE
COST
�AUDITQUIREMENTS
REQUIREMENTS
PRINCIPLES
State. Local and Indian
OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501
Tribal Governments and
Governmental Hospitals
Non -Profit Organizations
and Non -Profit Hospitals
Colleges or Universities and
Affiliated Hospitals
For -Profit Organizations
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Definitions:
"Sub -recipient"; means the legal entity to which a sub -award is made and which is accountable to the State for the
use of the funds provided in carrying out a portion of the State's programmatic effort under a sponsored project. The
term may include institutions of higher education, for-profit corporations or non -U.S. Based entities.
"Sub -award and Sub -grant' are used interchangeably and mean a lower tier award of financial support from a
prime awardee (e.g., Washington State Health Care Authority) to a Sub -recipient for the performance of a substantive
portion of the program. These requirements do not apply to the procurement of goods and services for the benefit of
the Washington State Health Care Authority.
II. STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES - Following are the Assurances,
Certifications, and Special Conditions that apply to all federally funded (in whole or in part) agreements
administered by the Washington State Health Care Authority.
CERTIFICATIONS
1. CERTIFICATION REGARDING (Federal, State, or local) terminated for cause
DEBARMENT AND SUSPENSION or default.
The undersigned (authorized official signing for
the contracting organization) certifies to the best
of his or her knowledge and belief, that the
contractor, defined as the primary participant in
accordance with 45 CFR Part 76, and its
principals:
a) are not presently debarred, suspended,
proposed for debarment, declared ineligible,
or voluntarily excluded from covered
transactions by any Federal Department or
agency;
b) have not within a 3 -year period preceding this
contract been convicted of or had a civil
judgment rendered against them for
commission of fraud or a criminal offense in
connection with obtaining, attempting to
obtain, or performing a public (Federal, State,
or local) transaction or contract under a
public transaction; violation of Federal or
State antitrust statutes or commission of
embezzlement, theft, forgery, bribery,
falsification or destruction of records, making
false statements, or receiving stolen
property;
c) are not presently indicted or otherwise
criminally or civilly charged by a
governmental entity (Federal, State, or local)
with commission of any of the offenses
enumerated in paragraph (b) of this
certification; and
Should the contractor not be able to provide this
certification, an explanation as to why should be
placed after the assurances page in the contract.
The contractor agrees by signing this contract
that it will include, without modification, the clause
titled "Certification Regarding Debarment,
Suspension, In eligibility, and Voluntary
Exclusion --Lower Tier Covered Transactions" in
all lower tier covered transactions (i.e.,
transactions with sub -grantees and/or
contractors) and in all solicitations for lower tier
covered transactions in accordance with 45 CFR
Part 76.
2. CERTIFICATION REGARDING DRUG-
FREE WORKPLACE REQUIREMENTS
The undersigned (authorized official signing for
the contracting organization) certifies that the
contractor will, or will continue to, provide a drug-
free workplace in accordance with 45 CFR Part
76 by:
a) Publishing a statement notifying employees
that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled
substance is prohibited in the grantee's
workplace and specifying the actions that will
be taken against employees for violation of
such prohibition;
b) Establishing an ongoing drug-free awareness
d) have not within a 3 -year period preceding this program to inform employees about
contract had one or more public transactions (1) The dangers of drug abuse in the
workplace;
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(2) The contractor's policy of maintaining a
drug-free workplace;
(3) Any available drug counseling,
rehabilitation, and employee assistance
programs; and
(4) The penalties that may be imposed upon
employees for drug abuse violations
occurring in the workplace;
c) Making it a requirement that each employee
to be engaged in the performance of the
contract be given a copy of the statement
required by paragraph (a) above;
d) Notifying the employee in the statement
required by paragraph (a), above, that, as a
condition of employment under the contract,
the employee will—
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her
conviction for a violation of a criminal drug
statute occurring in the workplace no later
than five calendar days after such conviction;
e) Notifying the agency in writing within ten
calendar days after receiving notice under
paragraph (d)(2) from an employee or
otherwise receiving actual notice of such
conviction. Employers of convicted
employees must provide notice, including
position title, to every contract officer or other
designee on whose contract activity the
convicted employee was working, unless the
Federal agency has designated a central
point for the receipt of such notices. Notice
shall include the identification number(s) of
each affected grant;
f) Taking one of the following actions, within 30
calendar days of receiving notice under
paragraph (d) (2), with respect to any
employee who is so convicted—
(1) Taking appropriate personnel action
against such an employee, up to
and including termination,
consistent with the requirements of
the Rehabilitation Act of 1973, as
amended; or
(2) Requiring such employee to
participate satisfactorily in a drug
abuse assistance or rehabilitation
program approved for such
purposes by a Federal, State, or
local health, law enforcement, or
other appropriate agency;
g) Making a good faith effort to continue to
maintain a drug-free workplace through
implementation of paragraphs (a), (b), (c),
(d), (e), and (f).
For purposes of paragraph (e) regarding agency
notification of criminal drug convictions, Authority
has designated the following central point for
receipt of such notices:
Legal Services Manager
WA State Health Care Authority
PO Box 42700
Olympia, WA 98504-2700
3. CERTIFICATION REGARDING LOBBYING
Title 31, United States Code, Section 1352,
entitled "Limitation on use of appropriated funds
to influence certain Federal contracting and
financial transactions," generally prohibits
recipients of Federal grants and cooperative
agreements from using Federal (appropriated)
funds for lobbying the Executive or Legislative
Branches of the Federal Government in
connection with a SPECIFIC grant or cooperative
agreement. Section 1352 also requires that each
person who requests or receives a Federal grant
or cooperative agreement must disclose lobbying
undertaken with non -Federal (nonappropriated)
funds. These requirements apply to grants and
cooperative agreements EXCEEDING $100,000
in total costs (45 CFR Part 93).
The undersigned (authorized official signing for
the contracting organization) certifies, to the best
of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been
paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or
attempting to influence an officer or
employee of any agency, a Member of
Congress, an officer or employee of
Congress, or an employee of a Member of
Congress in connection with the awarding of
any Federal contract, the making of any
Federal grant, the making of any Federal
loan, the entering into of any cooperative
agreement, and the extension, continuation,
renewal, amendment, or modification of any
Federal contract, grant, loan, or cooperative
agreement.
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(2) If any funds other than Federally
appropriated funds have been paid or will be
paid to any person for influencing or
attempting to influence an officer or
employee of any agency, a Member of
Congress, an officer or employee of
Congress, or an employee of a Member of
Congress in connection with this Federal
contract, grant, loan, or cooperative
agreement, the undersigned shall complete
and submit Standard Form -LLL, "Disclosure
of Lobbying Activities," in accordance with
its instructions. (If needed, Standard Form -
LLL, "Disclosure of Lobbying Activities," its
instructions, and continuation sheet are
included at the end of this application form.)
(3) The undersigned shall require that the
language of this certification be included in
the award documents for all subcontracts at
all tiers (including subcontracts,
subcontracts, and contracts under grants,
loans and cooperative agreements) and that
all sub -recipients shall certify and disclose
accordingly.
This certification is a material representation of fact
upon which reliance was placed when this
transaction was made or entered into. Submission
of this certification is a prerequisite for making or
entering into this transaction imposed by Section
1352, U.S. Code. Any person who fails to file the
required certification shall be subject to a civil
penalty of not less than $10,000 and not more than
$100,000 for each such failure.
4. CERTIFICATION REGARDING PROGRAM
FRAUD CIVIL REMEDIES ACT (PFCRA)
The undersigned (authorized official signing for
the contracting organization) certifies that the
statements herein are true, complete, and
accurate to the best of his or her knowledge, and
that he or she is aware that any false, fictitious, or
fraudulent statements or claims may subject him
or her to criminal, civil, or administrative
penalties. The undersigned agrees that the
contracting organization will comply with the
Public Health Service terms and conditions of
award if a contract is awarded.
5. CERTIFICATION REGARDING
ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro -
Children Act of 1994 (Act), requires that smoking
not be permitted in any portion of any indoor
facility owned or leased or contracted for by an
entity and used routinely or regularly for the
provision of health, day care, early childhood
development services, education or library
services to children under the age of 18, if the
services are funded by Federal programs either
directly or through State or local governments, by
Federal grant, contract, loan, or loan guarantee.
The law also applies to children's services that
are provided in indoor facilities that are
constructed, operated, or maintained with such
Federal funds. The law does not apply to
children's services provided in private residence,
portions of facilities used for inpatient drug or
alcohol treatment, service providers whose sole
source of applicable Federal funds is Medicare or
Medicaid, or facilities where WIC coupons are
redeemed.
Failure to comply with the provisions of the law
may result in the imposition of a civil monetary
penalty of up to $1,000 for each violation and/or
the imposition of an administrative compliance
order on the responsible entity.
By signing the certification, the undersigned
certifies that the contracting organization will
comply with the requirements of the Act and will
not allow smoking within any portion of any indoor
facility used for the provision of services for
children as defined by the Act.
The contracting organization agrees that it will
require that the language of this certification be
included in any subcontracts which contain
provisions for children's services and that all sub -
recipients shall certify accordingly.
The Public Health Services strongly
encourages all recipients to provide a
smoke-free workplace and promote the non-
use of tobacco products. This is consistent
with the PHS mission to protect and advance
the physical and mental health of the
American people.
6. CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, AND
OTHER RESPONSIBILITY MATTERS
INSTRUCTIONS FOR CERTIFICATION
1) By signing and submitting this proposal, the
prospective contractor is providing the
certification set out below.
2) The inability of a person to provide the
certification required below will not
necessarily result in denial of participation in
Local Health Jurisdiction Page 39 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
this covered transaction. The prospective
contractor shall submit an explanation of why
it cannot provide the certification set out
below. The certification or explanation will be
considered in connection with the department
or agency's determination whether to enter
into this transaction. However, failure of the
prospective contractor to furnish a
certification or an explanation shall disqualify
such person from participation in this
transaction.
3) The certification in this clause is a material
representation of fact upon which reliance
was placed when the department or agency
determined to enter into this transaction. If it
is later determined that the prospective
contractor knowingly rendered an erroneous
certification, in addition to other remedies
available to the Federal Government, the
department or agency may terminate this
transaction for cause of default.
4) The prospective contractor shall provide
immediate written notice to the department or
agency to whom this contract is submitted if
at any time the prospective contractor learns
that its certification was erroneous when
submitted or has become erroneous by
reason of changed circumstances.
5) The terms covered transaction, debarred,
suspended, ineligible, lower tier covered
transaction, participant, person, primary
covered transaction, principal, proposal, and
voluntarily excluded, as used in this clause,
have the meanings set out in the Definitions
and Coverage sections of the rules
implementing Executive Order 12549. You
may contact the person to whom this contract
is submitted for assistance in obtaining a
copy of those regulations.
6) The prospective contractor agrees by
submitting this contract that, should the
proposed covered transaction be entered
into, it shall not knowingly enter into any lower
tier covered transaction with a person who is
debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this
covered transaction, unless authorized by
Authority.
7) The prospective contractor further agrees by
submitting this contract that it will include the
clause titled "Certification Regarding
Debarment, Suspension, Ineligibility and
Voluntary Exclusion -- Lower Tier Covered
Transaction," provided by HHS, without
modification, in all lower tier covered
transactions and in all solicitations for lower
tier covered transactions.
8) A participant in a covered transaction may
rely upon a certification of a prospective
participant in a lower tier covered transaction
that it is not debarred, suspended, ineligible,
or voluntarily excluded from the covered
transaction, unless it knows that the
certification is erroneous. A participant may
decide the method and frequency by which it
determines the eligibility of its principals.
Each participant may, but is not required to,
check the Non -procurement List (of excluded
parties).
9) Nothing contained in the foregoing shall be
construed to require establishment of a
system of records in order to render in good
faith the certification required by this clause.
The knowledge and information of a
participant is not required to exceed that
which is normally possessed by a prudent
person in the ordinary course of business
dealings.
10) Except for transactions authorized under
paragraph 6 of these instructions, if a
participant in a covered transaction
knowingly enters into a lower tier covered
transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded
from participation in this transaction, in
addition to other remedies available to the
Federal Government, Authority may
terminate this transaction for cause or
default.
7. CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, AND
OTHER RESPONSIBILITY MATTERS --
PRIMARY COVERED TRANSACTIONS
1) The prospective contractor certifies to the
best of its knowledge and belief, that it and its
principals:
a) Are not presently debarred, suspended,
proposed for debarment, declared
ineligible, or voluntarily excluded from
covered transactions by any Federal
department or agency;
b) Have not within a three-year period
preceding this contract been convicted of
or had a civil judgment rendered against
them for commission of fraud or a
criminal offense in connection with
obtaining, attempting to obtain, or
performing a public (Federal, State or
local) transaction or contract under a
Local Health Jurisdiction Page 40 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
public transaction; violation of Federal or
State antitrust statutes or commission of
embezzlement, theft, forgery, bribery,
falsification or destruction of records,
making false statements, or receiving
stolen property;
c) Are not presently indicted for or
otherwise criminally or civilly charged by
a governmental entity (Federal, State or
local) with commission of any of the
offenses enumerated in paragraph (1)(b)
of this certification; and
d) Have not within a three-year period
preceding this contract had one or more
public transactions (Federal, State or
local) terminated for cause or default.
2) Where the prospective contractor is unable to
certify to any of the statements in this
certification, such prospective contractor
shall attach an explanation to this proposal.
CONTRACTOR SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING
TITLE
OFFICIAL
CIVIAIx, 54_lgp-) 0_oL4rt4-j BCaZd
o �c,u-r (gym rvr s�r OrZ¢,f
Please also print or type name:
'bav; of &! l var\-,
ORGANIZATION NAME: (if applicable)
DATE
oved a for
. e Date:
Philip C. H nsucl r, W Civil Deputy Prosecut ng ttorney
Jefferson County Prosecuting Attorney's Office torney
Local Health Jurisdiction Page 41 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
Attachment 2
Federal Funding Accountability and Transparency Act (FFATA) Data Collection Form
This Contract is supported by federal funds that require compliance with the Federal Funding Accountability and
Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make
information available online so the public can see how federal funds are spent.
To comply with the act and be eligible to enter into this contract, your organization must have a Data Universal
Numbering System (DUNS®) number. A DUNS® number provides a method to verify data about your
organization. If you do not already have one, you may receive a DUNS® number free of charge by contacting
Dun and Bradstreet at www.dnb.com.
Required Information about your organization and this contract will be made available on USASpending.gov by
the Washington State Health Care Authority (HCA) as required by P.L. 109-282. As a tool to provide the
information, HCA encourages registration with the Central Contractor Registry (CCR) because less data entry
and re-entry is required by both HCA and your organization. You may register with CCR on-line at
https://www.uscontractor!ggistration.com/.
Contractor must complete this form and return it to the Health Care Authority (HCA).
CONTRACTOR
1. Legal Name
I-Vtkf5on
2. DUNS Number
I $
3. rincipl Place of Pe ormance
t1l S shec atto _f 0_,+
3a. City
Pa (-% --Mwyuan (
3b. State
3c. Zip+4 0a 3 (02
3d. Cuos Ary
4. Are you registered in CCR (https://www.uscontractorregistration.comn? vfYES (skip to page 2. Sign, date
and return) ❑NO
5. In the preceding fiscal year did your organization:
a. Receive 80% or more of annual gross revenue from federal contracts, subcontracts, grants, loans,
subgrants, and/or cooperative agreements; and
b. $25,000,000 or more in annual gross revenues from federal contracts, subcontracts, grants, loans,
subgrants, and/or cooperative agreements; and
c. The public does not have access to information about the compensation of the executives through
periodic reports filled with the IRS or the Security and Exchange Commission per 2 CFR Part 170.330
❑ NO (skip the remainder of this section - Sign, date and return)
❑ YES (You must report the names and total compensation of the top 5 highly compensated officials of your
organization).
Name Of Official Total Compensation
1.
2.
3.
4.
5.
Note: "Total compensation" means the cash and noncash dollar value earned by the executive during the sub -
recipient's past fiscal year of the following (for more information see 17 CFR 229.402 (c)(2)).
Local Health Jurisdiction Page 42 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
By signing this document, the Contractor Authorized Representative attests to the information.
Signature of Contractor Authorized Representative Date
HCA will not endorse the Contractor's subaward until this form is completed and returned.
FOR HEALTH CARE AUTHORITY USE ONLY
HCA Contract Number:
Sub -award Project Description (see instructions and examples below)
Instructions for Sub -award Project Description:
In the first line of the description provide a title for the sub -award that captures the main purpose of the
subrecipients work. Then, indicate the name of the subrecipient and provide a brief description that captures
the overall purpose of the sub -award, how the funds will be used, and what will be accomplished.
Example of a Sub -award Project Description:
Increase Healthy Behaviors: Educational Services District XYZ will provide training and technical assistance to
chemical dependency centers to assist the centers to integrate tobacco use into their existing addiction
treatment programs. Funds will also be used to assist centers in creating tobacco free treatment environments.
Local Health Jurisdiction Page 43 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
SCHEDULE A
STATEMENT OF WORK
1. GENERAL
The Contractor shall provide services and deliverables, and otherwise do all things necessary for or
incidental to the performance of work as set forth below. The Contractor must:
a) Provide the necessary staff to perform the allowable MAC activities described in the Cost a)
Allocation Plan (CAP), and perform the work necessary to ensure all applicable laws,
regulations and guidelines specific to the MAC program and this Agreement are in compliance
including, but not limited to:
i. Code of Federal Regulation (CFR) Title 42 and Title 45.
ii. 1903(w)(6)(A) of the Social Security Act.
iii. Medicaid School -Based Administrative Claiming Guide May 2003.
iv. Revised Code of Washington (RCW).
V. The MAC Coordinator Manual.
vi. 2 CFR 225 Cost Principles for State, Local, and Indian Tribal Governments.
vii. OMB Compliance Supplements.
viii. Washington State Medicaid Plan.
ix. Secretary of State (SOS) records retention schedule.
b) Maintain documentation to support each administrative claim submitted to HCA for
reimbursement as required by federal, state, HCA and CMS Regulations, the CAP, the Manual
and this Agreement. The documentation must be sufficiently detailed in order to determine
whether the activities are necessary for the proper and efficient administration of the Medicaid
State Plan and support the appropriateness of the administrative claim. The Contractor must:
Maintain all documentation related to staff participation in the RMTS according to
section 1902(a)(4) of the Act and 42 CFR § 431.17; see also 45 CFR § 74.53 and 42
CFR § 433.32(a) (requiring source documentation to support accounting records) and
45 CFR § 74.20 and 42 CFR § 433.32(b and c) (retention period for records) and as
described in the Medicaid School -Based Administrative Claiming Guide May 2003;
Maintain all documentation related to MAC claiming, according to section 1902(a)(4) of
the Act and 42 CFR § 431.17; see also 45 CFR § 74.53 and 42 CFR § 433.32(a)
(requiring source documentation to support accounting records) and 45 CFR § 74.20
and 42 CFR § 433.32(b and c) (retention period for records) and as described in
Medicaid School -Based Administrative Claiming Guide May 2003;
iii. Comply with the SOS records retention schedule;
iv. Assure all documentation is immediately accessible and available, must be in a useful
and readable format, and must be stored electronically within the System at every
opportunity as determined by HCA;
V, Provide any and all information and documentation requested by HCA within thirty (30)
business days, or within a written, mutually agreed upon time frame; and
Local Health Jurisdiction Page 44 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
vi. Submit any audit related to its MAC program to HCA within thirty (30) business days of
receipt of the final report. This includes but is not limited to SAO Audits, OMB Circular
Compliance Supplement Audits, Federal Reviews or Federal Audits. The contractor
must provide to HCA, any corrective action related to MAC findings and questioned
costs within thirty (30) business days of submission.
c) Abide by all roles, responsibilities, limitations, restrictions, and documentation requirements
including but not limited to those described in the CAP, Manual, and this Agreement.
2. RESPONSIBILITIES
a) The Contractor is responsible for monitoring its MAC program to ensure compliance with all
applicable laws, regulations and guidelines specific to the MAC program as described in this
Agreement and comply with all roles, responsibilities, limitations, restrictions, and
documentation requirements described in the CAP, Manual, associated federal and state
regulations, and this Agreement that includes, but is not limited to, the following. Only
expenses that are in reasonable and allowable, are permitted for reimbursement. HCA expects
the MAC program to be managed similarly to other federal awards and expects the RMTS and
Fiscal coordinators to report to, or work closely, with an administrator assigned oversight
authority of the LHJ. The Contractor must:
i. Only include staff in the claimed reimbursement (through the RMTS or direct charge
method) who are eligible to participate. The Contractor is prohibited from including any
staff in the RMTS or the claimed reimbursement unless their job positions comply with
the criteria described in the CAP, the Manual, and this Agreement. Staff who may be
eligible to be included in the RMTS or claimed reimbursement must:
(1) Not be included in another MAC time study or reimbursement claim;
(2) Be directly employed or contracted by the LHJ, or an HCA approved Subcontractor;
(3) Be reasonably expected to perform MAC related activities;
(4) Have all federal dollars appropriately off -set according to the CAP and Manual;
(5) Not be included in the calculation of an indirect cost rate that is used to calculate
FFP reimbursement;
(6) Not include any Federally Qualified Health Clinic (FQHC) staff (or expenses) whose
costs are included in the FQHC cost report;
(7) Be job positions that fit within these job categories: nurses, other medical
professionals, other professional classifications, community outreach and linkage
classifications, manager/supervisor/administrator classifications, or administrative
support classifications as described in the CAP and Manual; and
ii. Designate staff for each of the following roles: RMTS Coordinator and Fiscal
Coordinator to be responsible for daily oversight and management of the Contractor's
MAC program;
(1) The RMTS and Fiscal Coordinator roles may be assumed by one individual if
desired.
Local Health Jurisdiction Page 45 of 59 Medicaid Administrative Claiming
Washington State Health Care Authority Contract # K3066
(2) The Contractor must submit contact information to the HCA Contract Manager for
each coordinator, including their assigned role, name, telephone number, fax
number, email, and address prior to participation in the MAC program, within seven
(7) calendar days of the change.
(3) The Coordinators must participate in the monthly statewide coordinator conference
calls.
(4) The Coordinators must participate in any scheduled RMTS consortium conference
calls.
(5) The Coordinators must ensure federal, state, and HCA MAC policies are
implemented.
(6) The Contractor must ensure the Coordinators accurately perform all responsibilities
listed in the CAP, Manual and this Agreement.
iii. Certify all data entered into the System is true and accurate, and based on actual
expenditures incurred during the period of performance of the invoice. This certification
must be maintained within the System. This includes, but is not limited to: calendaring,
Staff/Participant lists, salary and benefits, direct charges or other claimed costs,
indirect rate, MER, and any other data used to generate a claim to HCA for
reimbursement;
iv. Verify all data that is determined necessary to be stored electronically within the
System or other associated websites, or databases as described in the CAP, Manual
and this Agreement is physically entered and stored according to the SOS Retention
Schedule. This data includes, but is not limited to: calendaring, Staff/Participant lists,
salary and benefits, direct charges or other claimed costs, indirect rate, MER, and any
other data used to generate a claim to HCA for reimbursement;
V. Prepare an annual MER proposal to include the MER calculation and formula, the data
sources used to determine the MER, the data collection process, the Contractor's
monitoring process to ensure accuracy of the MER and any other relevant information;
(1) The proposal must be submitted to HCA no later than December first of each year.
(2) The proposal must be updated and re -submitted if the data source or collection,
calculations, or monitoring changes thirty (30) business days prior to the change.
vi. Submit a quarterly MER certification with each invoice validating the accuracy of the
MER(this certification may be maintained in the System);
vii. Submit a quarterly CPE certification identifying the revenue account codes as found in
the BARS manual with each invoice validating the accuracy of the CPE;
viii. Submit an annual certificate of indirect costs that certifies the accuracy of indirect cost
rate proposal submitted to their Cognizant Agency each January;
ix. Certify the accuracy of all data used to determine a quarterly MAC reimbursement by
signing the A19 by an authorized representative. This certification extends to all RMTS
data and financial data;
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Washington State Health Care Authority Contract # K3066
X. Complete a one hundred percent (100%) code review of all RMTS moments to ensure
the code and narrative correlate, within forty five (45) calendar days after the end of the
quarter;
(1) Finalize and certify the accuracy of the 10% quality assurance review within 10
(ten) calendar days
A. Monitor the RMTS non response rate and identify any deficiencies in staff responses.
Corrective action must:
(1) Be implemented within ten (10) business days; and
(2) Be documented and available to HCA upon request.
xii. Use a System that is statistically valid and in compliance with all state, and federal laws
and Regulations whether through a third -party or other means as stated in the CAP;
xiii. Not participate in a time study or claiming process for the HCA MAC program with any
entity that does not have an executed agreement with HCA.
xiv. Not participate in an RMTS consortium without prior written approval from HCA;
(1) If identified as a Lead Agency for the RMTS Consortium, the Contractor must
perform the Lead Agency duties described in the CAP and Manual and participate
in the current statewide LHJ Steering Committee.
xv. Ensure all interpreter staff have been tested and certified by Washington State
Department of Social and Health Services (DSHS) as defined by DSHS;
(1) The contractor is prohibited from claiming the enhanced seventy five percent (75%)
rate for any interpretation activities unless the staff has been certified by DSHS;
(2) The contractor is prohibited from claiming the enhanced seventy five percent (75%)
rate for any interpretation activities unless MAC activities performed is part of the
staff's assigned job duties; and
(3) The contractor is prohibited from claiming the enhanced seventy five percent (75%)
rate unless an allowable MAC activity was performed on behalf of children under
twenty one (21).
xvi. Ensure all Coordinators and Participants have completed and have certified their
understanding of the training prior to participating in the MAC program, and annually
thereafter. The contractor is prohibited from allowing any staff to participate in the
program unless they have completed and have certified their understanding of the
training. The Contractor must:
(1) Ensure all Coordinators receive HCA approved training prior to participation;
(2) Ensure all Participants certify completion of the online training before performing
any duties within the System or participating in the RMTS;
(3) Ensure all Participants fully understand each activity code and how to answer
moments according to what activity they are doing exactly at the sampled moment;
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Washington State Health Care Authority Contract # K3066
(4) Train all Participants to maintain proper documentation for MAC related activities;
(5) Only use training materials that have been approved in writing by HCA; and
(6) Track the completion and certification of training within the System, and must be
available upon request by HCA.
xvi. Comply with all HCA revisions and RMTS/claiming requirements as described in
the Manual;
xvii. Only use the activity codes (or their successor) in the Manual as approved by
HCA, for participation in MAC and are responsible for ensuring all Participating
Staff understand each code.
b) Health Care Authorit is responsible for performing oversight of the Contractor's MAC program
to ensure the effective administration of the MAC program and complying with all roles,
responsibilities, limitations, restrictions, and documentation requirements described in the
CAP, Manual, and this Agreement includes, but is not limited to, the following. HCA must:
Maintain oversight of the Contractor's MAC program and monitoring activities including
review of all components of the time study, claiming, training, or anything MAC related.
The contractor is required to monitor its own MAC program to ensure compliance with
all applicable Regulations and facilitating HCA's oversight of the program;
ii. Direct the MAC activities reimbursable at the enhanced seventy five percent (75%)
rate for all Skilled Professional Medical Personnel (SPMP) participating in the
Contractor's MAC program. The contractor is prohibited from claiming the enhanced
rate for any SPMP activities without express, written approval from HCA, see section
8, Skilled Professional Medical Personnel (SPMP) below;
iii. Review the Contractor's monitoring activities to ensure monitoring is occurring and any
identified issues are addressed as deemed appropriate by HCA. This includes, but is
not limited to, review of time study responses, accuracy of coding, appropriateness of
code changes, sufficiency of backup documentation, non -response rates;
iv. Verify the Contractor has entered all necessary data into the System and verify all
data entered was certified by the Contractor as accurate;
V. Review all claimed costs prior to issuing reimbursement to ensure they are allowable,
reasonable, and are supported by documentation that is sufficiently detailed to permit
HCA, CMS, or others to determine whether the costs are necessary for the proper and
efficient administration of the state plan. This includes but is not limited to; source
documentation of staff costs, operating expenses, and subcontracted vendor costs.
vi. Review the RMTS Consortia organization and membership, including the Lead Agency
identified, annually and issuing an official notice of approval or denial. The Contractor is
prohibited from participating in a Consortium without express, written approval of the
Consortia organization and membership;
vii. Review all MAC related training materials prior to their use in the MAC program and
issuing an official notice of approval or denial. This includes multimedia video, audio,
digital or other electronic sources, and paper based training materials. The Contractor
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Washington State Health Care Authority Contract # K3066
is prohibited from using any training materials without express, written approval from
HCA;
viii. Evaluate RMTS and claiming data prior to issuing quarterly reimbursements to ensure
the RMTS results and claimed costs are appropriate according to all applicable laws,
Regulations and guidelines specific to the MAC program. This evaluation will also be
used to identify trends, best practices for the MAC program, quality assurance, training
needs, areas in need of improvement, or other concerns related to the MAC program
and HCA's oversight responsibilities;
ix. Issue corrective action plans as necessary and determined by HCA's oversight
capacity that includes but is not limited to, quarterly reviews of RMTS and claiming
data, the contractor's failure to be in compliance with all applicable laws, Regulations
and guidelines specific to the MAC program and this Agreement, or other quality
assurance needs. The contractor is required to comply with any corrective action plan
issued. Failure to do so will result in sanctions that may include, but is not limited to,
reduced reimbursement and/or termination of this Agreement; and
X, Produce and update the CAP, Manual, contracts, training materials, or other MAC
related documentation as needed and make it available to the Contractor.
3. MINIMUM RESPONSE RATE AND NON -RESPONSES
Non -responses are moments not completed by Participant within five (5) business days, with the
exception of expired moments where the Participant was on paid or unpaid leave. The return rate of
valid responses for the RMTS must be a minimum of eighty five percent (85%). The following
remedial action is required of the Contractor if the RMTS response rate drops below eighty five
percent (85%).
a) Non -response rates greater than fifteen percent (15%):
HCA will send written notification to the Contractor requesting a Corrective Action Plan
to ensure a minimum eighty five percent (85%) compliance rate for the RMTS is
achieved in subsequent quarters.
The Contractor must develop and submit the plan to HCA for approval within thirty (30)
business days of HCA's notification.
iii. Failure to provide a timely corrective action plan within thirty (30) business days may
result in the Contractor being prohibited from participation in MAC for the following
quarter.
iv. An eighty five percent (85%) compliance rate for the RMTS must be met in the following
quarter.
b) Non -response rates greater than fifteen percent (15%) for two (2) consecutive quarters:
i. HCA will reduce reimbursement by thirty five percent (35%) for the second
consecutive quarter.
ii. The Contractor will be notified via Certified Mail of the reduced reimbursement.
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Washington State Health Care Authority Contract # K3066
id. Eighty five percent (85%) compliance rate for the RMTS must be met in the
following quarter.
c) Non -response rates greater than fifteen percent (15%) for three (3) consecutive quarters:
HCA will notify the affected Contractor_via certified mail of the denied reimbursement
for the third consecutive quarter and prohibited participation in MAC.
ii. None of the affected Contractors may claim for any denied or reduced reimbursement
from the three consecutive quarters of non-compliance. The Contractor may be
prohibited from participating in MAC for the following quarter (4th consecutive
quarter), and will be notified as such through the HCA notification.
4. CORRECTIVE ACTION PLANS
HCA will pursue a corrective action plan if a Contractor fails to meet any MAC program requirements
described in the CAP, Manual, this Agreement, or as determined by HCA. HCA will pursue a
corrective action plan if the contractor fails to address or correct any problems timely and sufficiently
as determined by HCA. The Contractor must develop and submit a corrective action plan response
to HCA for approval within thirty (30) days of HCA's notification. If a Contractor fails to meet the
requirements outlined in the corrective action plan, HCA will impose sanctions that may include, but
are not limited to; conducting more frequent reviews, delayed or denied payment of MAC claims,
recoupment of funds, or termination of this Agreement.
Examples of Contractor actions that may result in corrective action and/or sanctions include, but
are not limited to:
a) Repeated and/or uncorrected errors in financial reporting;
b) Failure to maintain adequate documentation;
c) Failure to cooperate with state or federal staff;
d) Failure to provide accurate and timely information to state or federal staff as required;
e) Failure to meet time study minimum response rates;
f) Failure to meet statistical validity requirements; and
g) Failure to comply with the terms and conditions of this agreement.
5. ADMINISTRATIVE FEE
HCA charges MAC contractors an administrative fee to offset HCA's costs for the administration of the
MAC program. The rate is based on the costs associated with the staff effort spent on MAC related
work for an entire State Fiscal Year (SFY) and is billed as a line item on the quarterly claim form A -19-
1A submitted by the MAC contractor. This cost is divided by the dollar amount of administrative claims
submitted by the participating contractors in the MAC program for the same SFY. The calculated rate
is used on the claims for the subsequent SFY. At the end of the period, the rate used will be validated
using the actual claimed expenditures for that period and any variances will be settled with the
contractor during the second quarter of the new SFY.
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Washington State Health Care Authority Contract # K3066
6. TIMELY FILING AND OVERPAYMENT REQUIREMENTS
The Contractor must submit invoices for reimbursement to HCA for review and approval within one
hundred twenty (120) calendar days following the end of each Billing Quarter. Upon approval, the
Contractor must submit a signed A19 -1A invoice voucher within thirty (30) calendar days.
a) Invoices submitted after one hundred twenty (120) calendar days following the end of the
Billing Quarter may result in corrective action.
b) HCA will not offset negative balances against future Al 9s. The contractor must immediately
remit a check to HCA for any funds requiring repayment.
c) HCA is not a recovery agent and any overpayments that are at or beyond the one hundred
eighty (180) calendar day mark will be turned over to the Office of Financial Recovery (OFR).
d) HCA will not seek reimbursement for any invoice received after the 23rd month of the two-
year federal filing deadline.
7. CALCULATING THE FFP AND GENERATING AN INVOICE
a) The Contractor is responsible for ensuring all data (including all RMTS and financial data)
used to calculate the amount of FFP submitted to HCA for reimbursement is accurate, based
on actual expenses incurred during the period of performance, and complies with all federal,
state, HCA and CMS Regulations, the CAP, Manual, and this Agreement. The Contractor
must certify the accuracy of all data used to calculate the amount of FFP by an authorized
representative signing the A-19. The Contractor must use a System that is statistically valid
and in compliance with all state, and federal laws and Regulations whether through a third -
party or other means as stated in the CAP to calculate the amount of FFP and generate a
claim.
The Contractor must submit invoices to HCA for FFP on a quarterly basis;
All data used to calculate the FFP must be from the same period of service;
iii. All data used to calculate the FFP must be the actual costlexpenditure and not
approximated;
iv. The FFP is determined by calculating the total adjusted costs, multiplying these costs
by the adjusted RMTS results, and the applicable Medicaid Eligibility Rate (MER),
adding any direct charges, and then applying the appropriate FFP rate;
V. The invoice must be generated within one hundred twenty (120) business days of the
end of the quarter; and
vi. The invoice is generated based on following five components:
(1) Cost pool construction;
(2) Calculating allowable Medicaid administrative time via the System or direct
charge method and documentation;
(3) Calculation and application of the pertinent MER;
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(4) Calculation and application of the indirect cost rate; and
(5) Application of the appropriate FFP rate.
b) Cost pool construction
The Contractor must comply with all federal, state, HCA and CMS Regulations, the
CAP, Manual, and this Agreement when constructing cost pools.
ii. The Contractor is prohibited from including any unallowable costs in any cost pool.
iii. The Contractor must include all costs used to calculate the FFP reimbursement to one
of these six cost pools:
(1) Cost Pool 1: MAC SPMP;
(2) Cost Pool 2: MAC Non-SPMP;
(3) Cost Pool 3a and 3b: Non -MAC;
(4) Cost Pool 4: MAC Direct Charge — enhanced;
(5) Cost Pool 5: MAC Direct Charge — non-enhanced; and
(6) Cost Pool 6: Allocated.
iv. Costs included in the calculation of an indirect cost rate are prohibited from
being assigned to any of the six cost pools except by application of the indirect
cost rate.
V. All costs assigned to each cost pool must be allowable and comply with the
descriptions in the CAP and Manual.
c) Calculating allowable Medicaid Administrative Time
i. The Contractor must only use the RMTS or the Direct Charge method to calculate
the percent of reimbursable time.
ii. The Contractor must use the RMTS for all eligible staff who are not certified as a
Single Cost Objective.
(1) The Contractor must use the RMTS results produced by the System.
(2) The Contractor is prohibited from altering the RMTS results and certifies
the accuracy of the data by signing the A19 by an authorized Contractor
representative.
iii. The Contractor may only use the Direct Charge method for staff who are certified
as a Single Cost Objective.
(1) These staff are required to document their daily work activities in fifteen (15)
minute increments.
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(a) Daily logs must be maintained according to the SOS record's
retention schedule.
(b) All daily logs must have a quarterly summary rolling up all time over
the quarter.
(2) These staff must complete a single cost objective certification quarterly using
an HCA approved form.
(3) Each single cost objective staff must be reported individually on the invoice.
(4) The invoice must report the name, the actual amount of time spent performing
allowable MAC activities, and total dollar amount claimed for reimbursement
for each staff.
d) Direct Charge for Interpretation Service Contracts
The Contractor may only direct charge for a portion of Interpretation Service contracts
for allowable interpretation activities as described in this Agreement.
(1) Services direct charged must be for interpretation activities identified as allowable
activities within the Manual, the CAP, and this Agreement. The Contractor is
prohibited from including any other portion of an Interpretation Services Contract
in the calculation for FFP reimbursement.
(2) Each interpretation activity must be documented to HCA's satisfaction, in fifteen (15)
minute increments, using a patient encounter form that includes, at minimum, the
following data elements:.
(a) Appointment time/duration
(b) Client Name/ID/transaction information
(c) Interpreter Agency
(d) Interpreter Name or Employee ID
(e) Language/communication type
(f) Requestor or nurse name
(g) The forms must be maintained according to SOS Record's retention schedule.
(3) The above data from all patient encounter forms, except Client Name/ID
Information, must be transferred onto a single spreadsheet that is searchable and
sortable. This may be accomplished by direct data entry into the System so long
as the data is extractable into a searchable and sortable spreadsheet.
(4) The invoice must report a summary for each Interpretation Service contract
including the names of the interpreting staff, the total amount of time spent
performing allowable MAC activities, and total dollar amount claimed for
reimbursement.
(5) The contractor is prohibited from altering the information on the patient encounter
forms and certifies the accuracy of the data entered into the spreadsheet and the
System by signing the A19 by an authorized Contractor representative.
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e) Calculation and application of the pertinent MER.
All MERs must be calculated quarterly;
All MERs must be based on the quarter claimed;
iii. All MAC activities that that benefit the Contractors Clients directly and are performed
within a program that identifies Clients must use a Client -based MER as described in
the CAP and Manual;
iv. All MAC activities that benefit the Contractors Clients directly and are performed within
a program that operates a primary care or specialty clinic must use a clinic -based MER
as described in the CAP and Manual;
V, All MAC activities that benefit a larger population in the geographical region served by
the Contractor, or in programs that do not identify Clients or collect demographic data
must use the modified county -wide MER; and
vi. The Contractor is required to collect and maintain demographic data used to determine
Medicaid enrollment for all Clients served within budget units whose costs are included
in the FFP reimbursement. The Contractor is prohibited from including clients from any
budget unit that is not allowable within the MAC program.
(1) All data related to Medicaid enrollment and the MER must be maintained
according to the SOS records retention schedule;
(2) The information collected must be sufficiently detailed to determine Medicaid
enrollment through HCA's ProviderOne System;
(3) The information must be entered in the Contractor's Client information System or
data base;
(4) The Contractor must produce a single electronic list of all unduplicated Clients
served over the quarter within thirty (30) business days of the end of the quarter;
(5) The Contractor is prohibited from including the same Client more than once
(duplicating) on the quarterly list; and
(6) The Contractor must submit the quarterly list to either their third party System
operator or other System operator which calculates the Client -based and clinic -
based MER.
f) Calculation and application of the indirect cost rate
i. All indirect cost rates must be developed in accordance with all applicable
regulations and guidelines including the 2 CFR Chapter I, Chapter II, part 200, et
al (OMNI Circular);
ii. The Contractor is required to have an indirect cost rate proposal approved by their
Cognizant Agency;
iii. The Contractor is required to certify the accuracy of the indirect cost rate annually
using HCA form 02-568 Certificate of Indirect Costs;
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iv. The Contractor is required to verify all costs submitted to HCA for reimbursement
are not duplicated through the indirect rate or any other mechanism; and
v. The Contractor is prohibited from requesting duplicate FFP for any cost.
g) Application of the appropriate FFP rate
The Contractor is:
Permitted to claim seventy five percent (75%) enhanced FFP only for specific
allowable MAC activities accurately reported to SPMP or Interpretation activity codes
as described in the Manual. The Contractor is:
(1) Required to verify the accuracy of activities reported to activity codes 12b and 7d;
and
(2) Prohibited from claiming seventy five percent (75%) FFP for any other activities.
Permitted to claim fifty percent (50%) for all other accurately reported MAC
activity codes; and
iii. Required to certify the accuracy of the FFP claimed for reimbursement by
signing the A19.
h) Certified Public Expenditures
The Contractor is:
Is prohibited from using any source of funds that do not comply with federal, state,
HCA and CMS Regulations, the CAP, Manual, and this Agreement as CPE;
Is required to certify all sources of funds used as for CPE are accurate, allowable,
and in compliance with all federal, state, HCA and CMS Regulations, the CAP,
Manual, and this Agreement quarterly by completing a Certified Public Expenditure
Local Match Certification quarterly and by signing the A19. The quarterly CPE
certification may be completed
iii. Is required to use the Budgeting, Accounting and Reporting System (BARS manual)
prescribed accounting and reporting for local governments to identify and document the
revenue account codes for all local matching funds reported as CPE
iv. Is required to ensure the source of all CPE funds are not federal tax money and are
not used as a match for federal money (by the Contractor or any other agency);
V. Must only use these funds to supplement, not supplant the amount of federal, state
and local funds otherwise expended or services provided under this Agreement;
vi. Must have funds available for MAC activities and the funds must be within the
Contractor's control and budget;
vii. Is prohibited from using provider -related donations or impermissible heath care
related tax source for CPE;
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viii. Is prohibited from using any private donations or non-public funds as a source for
CPE without authorization from CMS' Center for Medicaid and State Operations'
National Institutional Reimbursement Team (NIRT);
ix. Is prohibited from requiring or allowing private non -profits to participate in the
financing of the non-federal share of expenditures;
(1) Is prohibited from allowing non-governmental units to voluntarily provide, or
be contractually required to provide, any portion of the non-federal share of
the Medicaid expenditures.
ix. Is prohibited from using funds payable under this Agreement for lobbying activities of
any nature. The contractor certifies that no state or federal funds payable under this
Agreement shall be paid to any person or organization to influence, or attempt to
influence, either directly or indirectly, an officer or employee of a state or federal
agency, or an officer or member of any state or federal legislative body or committee
regarding the award, amendment, modification, extension, or renewal of a state or
federal contract grant; and
X. Must expend the total computable cost to Subcontractors for performance of allowable
MAC activities.
(1) The Contractor is prohibited from submitting a request for FFP reimbursement
to HCA until they have actually incurred the total computable cost; and
(2) The Contractor is prohibited from requiring the Subcontractor to provide the
non- federal share of the payment, or return any portion of the total computable
cost to the Contractor.
i) Revenue Offset
The Contractor is:
Prohibited from submitting a request for FFP reimbursement to HCA unless all funds
are appropriately offset according to all federal, state, HCA and CMS Regulations, the
CAP, Manual and this Agreement;
Required to certify the accuracy of the funds that are offset and the accuracy of the
requested FFP reimbursement by signing the A19;
iii. Required to ensure there is no duplication in FFP reimbursement between programs
or cost objectives;
iv. Financially responsible for repayment of any duplicated funds;
V. Required to provide documentation that Coordinators have been trained and fully
understands the scope of work and terms of each funding source; and
vi. The Contractor is required to perform an assessment to determine whether each cost
objective contained within the MAC budget unit(s) has potential to overlap with MAC;
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(1) The Contractor is prohibited from using any source of funds contained within
the MAC budget unit until they have been assessed and determined
appropriate;
(2) The Contractor must complete the assessment annually and submit the
assessment to the HCA Contract Manager no later than January 31 st or within
thirty (30) business days of completion, whichever comes soonest;
(3) If the assessment determines any portion of the scope of work overlaps with
MAC activities, the entire cost objective is deemed to overlap and is prohibited
from being used as CPE; and
(4) Required to identify costs that must be offset, and verify the remaining net
costs are allowable for inclusion in the MAC program and eligible for FFP
reimbursement.
8. SKILLED PROFESSIONAL MEDICAL PERSONNEL SPMP
Contractor staff who have completed a two -or -more -year program leading to an academic degree or
certificate in a medically related profession, demonstrated by possession of a medical license,
certificate or other document issued by a recognized National or State medical licensure or certifying
organization, or a degree in a medical field issued by a college or university certified by a
professional medical organization are eligible for a seventy five percent (75%) enhanced
reimbursement for specific MAC activities. Years of experience in the administration, direction, or
implementation of the Medicaid program is not considered the equivalent of professional training in a
field of medical care. The Contractor is permitted to perform SPMP activities as directed by HCA's
Chief Medical Officer (CMO) to assist in achieving HCA's goals and administering the Medicaid State
Plan.
The Contractor must:
a) Monitor and ensure that FFP reimbursement for SPMP activities are in compliance with all
federal, state, HCA and CMS Regulations, the CAP, Manual and this Agreement. Federal
requirements include 42 CFR § 432.2, 432.45, 432.50, and 433.15;
b) Have all forms and documents supporting the designation of an SPMP entered into the
System and retained according to the SOS record's retention schedule;
c) Not, and is prohibited from, requesting seventy five percent (75%) enhanced
reimbursement for:
i. Any staff who are not certified as an SPMP, as stated above;
ii. Any staff whose position descriptions do not require certified SPMP duties or
responsibilities;
iii. Any staff who are not directly employed by the Contractor;
iv. Medical assistance expenditures;
V. Any SPMP activities that are not directed by HCA's CMO and explicitly described in this
Agreement (All other allowable MAC activities performed by an SPMP are eligible for
50% FFP); and
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vi. Any activities that are not directly related to the administration of the State Medicaid
plan.
d) Contribute to a quarterly SPMP report as needed by HCA and/or WSALPHO. Provide details
and additional information needed for the report as requested by HCA and/or WSALPHO ,
within a mutually agreed upon time frame;
e) Participate in program planning and policy development meetings as requested by HCA;
i. The meetings will include discussions related to, but not limited to, reviewing the
SPMP reports and related topics or the effectiveness of the activities performed in
support of HCA's goals and the Medicaid State Plan.
f) Comply with any changes to the allowable SPMP activities as directed by the CMO;
Failure to comply with CMO directives may result in termination of SPMP participation
in the MAC program.
g) Monitor and ensure that all activities reimbursed at the seventy five percent (75%)
enhanced FFP are in support of the Medicaid State Plan and fall within the categories
below. All other allowable MAC activities performed by an SPMP are eligible for fifty
percent (50%) FFP;
h) Comply with any changes to allowable SPMP activities as directed by the CMO that
may include, but is not limited to:
Clinical consultation with medical providers regarding best practices and adequacy
of medical care covered by Medicaid. Includes, but is not limited to the following
areas:
(1) Pediatric immunization issues
(2) Access to Baby and Child Dentistry (ABCD) Emerging treatment/therapies for high
risk populations
ii. Coordination of Medicaid -covered medical services for medically at -risk populations.
(1) Medically fragile children
(2) High risk pregnant women
(3) Homeless individuals
(4) Individuals with multiple medical conditions
iii. Case staffing on the medical aspects of cases requiring Medicaid -covered services.
(1) Medically involved children in foster care
(2) High risk pregnant women
(3) Individual with communicable diseases requiring extraordinary/non-standard
medical care.
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iv. Planning and coordination with local medical providers to facilitate earlier referrals
and treatment for high-risk populations.
(1) Children in foster care
(2) Homeless individuals
(3) Children with developmental delays or behavioral challenges
V, Providing medical consultation to the state regarding the Medicaid state plan.
(1) Consultation with medical providers to improve birth outcomes for Medicaid
children.
(2) Consultation with school personnel to improve health outcomes for children
exhibiting developmental delays or behavioral challenges due to medical
condition, family stress, or other factors.
vi. Pediatric immunizations.
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