Approving a contract with the Washington State Health Care Authority (HCA) BEFORE THE BOARD OF COUNTY COMMISSIONERS
OF LEWIS COUNTY, WASHINGTON
IN RE:
Approve Contract between Washington State )
Health Care Authority (HCA) and Lewis County ) Resolution No. 15- lJ
WHEREAS, the Board of County Commissioners (BOCC), Lewis County,
Washington, has reviewed the Medicaid Administrative Claiming Contract between Lewis
County and HCA for the period of April 1, 2015 through March 31, 2017; AND
WHEREAS, Lewis County will participate in the Medicaid Administrative Claiming
program and receive reimbursement for time providing services HCA is unable to
provide; AND
WHEREAS, there is no maximum reimbursement amount Lewis County may
receive; AND
WHEREAS, it appears to be in the best public interest to authorize the execution
of said contract for Lewis County;
NOW, THEREFORE BE IT RESOLVED that the Medicaid Administrative Claiming
Contract between HCA and Lewis County from April 1, 2015 through March 31, 2017 is
hereby approved and the Director of Public Health & Social Services is authorized to sign
the same.
DONE IN OPEN SESSION this ?k,114 day of V 2015.
APPROVED AS TO FORM: BOARD OF COUNTY COMMISSIONERS
Jonathan Meyer, P r-ecuting Attorney LEWIS COUNTY, WASHINGTON
By: Dt vid Fin,. _ ` AcNCE .
Edna J
Fu i L
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Deputy * • ` n •
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ATTEST: 1845 f 1 °_ P. fr. Schulte, Vice Chair
4 .1
arri Muir, CMC, Clerk of the Board Gary Stomper; Member
Lewis County
Details of Budget or Request For Budget Amendment
Fund 190 Type of appropriation:
F
Department 621 0 Supplemental-has new offsetting revenue
Program j 622&632 0 Emergency-using fund balance
Please Discuss Current Budget Uses or Describe a Need ForAdditional Funding
This budget detail goes with the Health Care Authority(HCA)contract for Medicaid Administrative
Claiming program(MAC). The contract does not stipulate a maximum allowed reimbursement but based
on past program years we budget to receive$22,000 annually through the program.
Use of Funds
❑ New Expenditure ❑ New Transfer Out or El Currently Budgeted
Account Description BARS Account Number Amount
Salaries&Wages 190 621 622 000 562 22 10 00 11,000
Salaries&Wages 190 621 632 000 562 32 10 00 11,000
Total Use of Funds: $22,000
Source of Funds
❑ New Revenue ❑ Use of Fund Balance ❑ New Transfer In or U Currently Budgeted
Account Description BARS Account Number Amount
HHS/Medical Assistan(MAC) _ 190 621 622 000 333 93 77 80 11,000
HHS/Medical Assistan(MAC) 190 621 632 000 333 93 77 80 11,000
Total Source of Funds: $22,000
Elected/Director a4 �/� Date ",,Z3//S" BD 1510
TABLE OF CONTENTS
1 OVERVIEW 4
1.1 PURPOSE 4
1.2 STATEMENT OF WORK (SOW) 4
2 SPECIAL TERMS AND CONDITIONS 4
2.1 TERM 4
2.2 COMPENSATION AND PAYMENT 4
2.3 BILLING AND INVOICE 5
2.4 CONTRACT MANAGER CONTACT INFORMATION 6
2.5 NOTICES 6
2.6 ORDER OF PRECEDENCE 7
3 GENERAL TERMS AND CONDITIONS 8
3.1 DEFINITIONS 8
3.2 ACCESS TO DATA 9
3.3 ADVANCE PAYMENT PROHIBITED 9
3.4 AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, also
referred to as the "ADA" 28 CFR Part 35 9
3.5 ASSIGNMENT 9
3.6 ATTORNEYS' FEES 10
3.7 CHANGE IN STATUS 10
3.8 CONFIDENTIAL INFORMATION PROTECTION 10
3.9 CONFIDENTIAL BREACH - REQUIRED NOTIFICATION 11
3.10 CONFLICT OF INTEREST 11
3.11 CONFORMANCE 11
3.12 COVENANT AGAINST CONTINGENT FEES 12
3.13 DEBARMENT 12
3.14 DISPUTES 12
3.15 FORCE MAJEURE 13
3.16 GOVERNING LAW 13
3.17 INDEMNIFICATION 13
3.18 INDEPENDENT CAPACITY OF THE CONTRACTOR 13
3.19 INDUSTRIAL INSURANCE COVERAGE 13
3.20 INSURANCE 14
3.21 LEGAL AND REGULATORY COMPLIANCE 14
3.22 LICENSING, ACCREDITATION AND REGISTRATION 14
3.23 LIMITATION OF AUTHORITY 14
3.24 NO THIRD-PARTY BENEFICIARIES 14
3.25 NONDISCRIMINATION 14
3.26 OVERPAYMENT AND ASSERTION OF LIEN 15
3.27 PUBLICITY 15
3.28 RECORDS, DOCUMENTS, AND REPORTS 15
3.29 REGISTRATION WITH DEPARTMENT OF REVENUE 15
3.30 REMEDIES NON-EXCLUSIVE 15
3.31 RIGHT OF INSPECTION 15
3.32 RIGHTS IN DATA/COPYRIGHT 16
3.33 SAFEGUARDING OF INFORMATION 16
3.34 SEVERABILITY 16
3.35 SITE SECURITY 17
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3.36 SUBCONTRACTING 17
3.37 SUBRECIPIENT 17
3.38 SURVIVABILITY 19
3.39 SYSTEM SECURITY 19
3.40 TAXES 19
3.41 TERMINATION 19
3.42 WAIVER 22
Schedules
Schedule A: Statement of Work(SOW)
Attachments
Attachment 1 — Federal Compliance, Certification and Assurances
Attachment 2 — MAC Coordinator Manual (Incorporated by reference)
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1 OVERVIEW
1.1 PURPOSE
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 the
time its staff spend performing Medicaid Administrative Claiming (MAC) activities.
1.2 STATEMENT OF WORK (SOW)
The Contractor shall provide the goods and/or services and staff as described in Schedule
A, Statement of Work.
2 SPECIAL TERMS AND CONDITIONS
2.1 TERM
Subject to its other provisions, the Term under this Contract shall be from April 1, 2015
through March 31, 2017 unless terminated sooner as provided herein.
HCA, at its sole discretion, may extend this Contract for two (2) additional one-year periods
unless terminated sooner as provided herein.
Work performed without a contract or amendment, signed by authorized representative of
both parties, shall be at the sole risk of the Contractor. HCA shall not pay any costs incurred
before a contract or any subsequent amendment is fully executed.
2.2 COMPENSATION AND PAYMENT
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:
2.2.1 There is no maximum consideration payable to the Contractor under the Agreement;
2.2.2 The Federal Financial Participation Rate shall be:
2.2.2.1 50%, except;
2.2.2.2 75% for appropriately documented Skilled Professional Medical Personnel
and appropriately documented Interpreter staff. See Schedule A, Section
9, d and g, and Section 10.
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2.2.3 Federal funds disbursed through this Contract were received by HCA through OMB
Catalogue of Federal Domestic Assistance (CFDA) Number: 93.778. Contractor
agrees to comply with applicable rules and regulations associated with these federal
funds and has signed Attachment 1, Federal Compliance, Certification and
Assurances, attached.
2.3 BILLING AND INVOICE
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 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:
2.3.1 HCA Contract number K1409;
2.3.2 Contractor name, address, phone number;
2.3.3 Description of Services;
2.3.4 Date(s) of delivery;
2.3.5 Net invoice price for each item;
2.3.6 Applicable taxes;
2.3.7 Total invoice price; and
2.3.8 Payment terms and any available prompt payment discount.
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.
Invoices shall describe and document to the HCA's satisfaction, a description of the work
performed; the progress of the project; and fees. If expenses are invoiced, provide a
detailed breakdown of each type.
Payment shall be considered timely if made by the HCA within thirty(30) days of receipt of
properly completed invoices. Payment shall be sent to the address designated by the
Contractor. (Note: Failure to submit a properly completed IRS form W-9 may result in
delayed payments.)
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) days after the Contract expiration date. Belated claims
shall be paid at the discretion of the HCA and are contingent upon the availability of funds.
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The HCA may, in its sole discretion, terminate the Contract or withhold payments claimed by
the Contractor for services rendered if the Contractor fails to satisfactorily comply with any
term or condition of this Contract. HCA will not make advance payments or payments in
anticipation of services or supplies to be provided under this Contract.
Electronic Payment: The State of Washington prefers to utilize electronic payment in its
transactions. Contractor will be expected to register as a statewide vendor. This allows
Contractors to receive payments from all participating state agencies by direct deposit, which
is the State's preferred method of payment. Forms necessary for registration can be
obtained at www.ofm.wa.qov.
2.4 CONTRACT MANAGER CONTACT INFORMATION
The individuals listed below, or their successors shall be the main points of contact for
services provided under this Contract. HCA's Contract Manager or his/her successor is
responsible for monitoring the Contractor's performance and shall be the contact person for
all communications regarding contract performance, deliverables, and invoices. The
Contract Manager has the authority to accept or reject the services provided and if
satisfactory, certify acceptance of each invoice submitted for payment. Notifications
regarding changes to this section must be in writing (e-mail) and maintained in the project
file, but will not require a formal contract amendment.
The Contract Manager for HCA is:
Name: Jennifer Inman
Title: Program Manager
Address: PO Box 45506
Olympia, WA 98501
Email: Jennifer.inman @hca.wa.gov
Phone: 360-725-1738
The Contract Manager for Contractor is:
Name: John Abplanalp
Address: 360 NW North St MS TRS01
Chehalis, WA 98532
Email: john.abplanalp @lewiscountywa.gov
Phone: 360-740-2787
2.5 NOTICES
Whenever one party is required to give notice to the other under this Contract, it shall be
deemed given if mailed by United States Postal Services, registered or certified mail, return
receipt requested, postage prepaid and addressed as follows:
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2.5.1 In the case of notice to the Contractor, notice will be sent to:
Attention: John Abplanalp
Lewis County Public Health & Social Services
360 NW North St MS TRS01
Chehalis, WA 98532
2.5.2 In the case of notice to HCA, send notice to:
Attention: Contract Administrator
Health Care Authority
Division of Legal and Administrative Services
Contract Services
Post Office Box 42702
Olympia, WA 98504-2702
2.5.3 Notices shall be effective on the date delivered, as evidenced by the return receipt or
the date returned to the sender for non-delivery other than for insufficient postage.
2.5.4 Either party may change its address for notification purposes at any time by mailing a
notice in accord with this Section, stating the change and setting for the new address,
which shall be effective on the tenth (10th) day following the effective date of such
notice unless a later date is specified.
2.6 ORDER OF PRECEDENCE
Each of the items listed below is incorporated by reference into this Contract. In the event of
an inconsistency, the inconsistency shall be resolved by giving precedence in the following
order:
• Applicable Federal and State of Washington statutes and regulations;
• Special Terms and Conditions;
• General Terms and Conditions;
• Schedule A—Statement of Work;
• Attachment 1 — Federal Compliance, Certification and Assurances;
• Attachment 2— MAC Coordinator Manual; and
• Any other provision, term or material incorporated herein by reference or otherwise
incorporated.
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3 GENERAL TERMS AND CONDITIONS
3.1 DEFINITIONS
As used throughout this Contract, the following terms shall have the meaning set forth
below:
"Allowable Expense" means an expenditure which meets the test of the appropriate OMB
Circular(see Section I. Federal Compliance of Attachment 1). 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 the person in HCA to whom signature authority has been
delegated, in writing, acting within the limits of his/her authority.
"Business Associate" is as defined in 45 CFR, Part 160.103 and includes any entity that
performs or assists in performing a function or activity involving the use/disclosure of
Individually Identifiable Health Information or involving any other function or activity regulated
by HIPAA; or provides legal, accounting, actuarial, consulting, data aggregation,
management, accreditation, or financial service where the services involve Individually
Identifiable Health Information.
"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.
"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. Confidential Information includes, but is not limited to, any
information identifiable to an individual that relates to a natural person's health, finances,
education, business, use or receipt of governmental services, names, addresses, telephone
numbers, social security numbers, driver license 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, all schedules, exhibits, attachments, and
amendments.
"Contractor" means that firm, provider, organization, individual or other entity performing
services under this Contract. It shall include any subcontractor retained by the prime
contractor as permitted under the terms of this Contract.
"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.
"Equipment" means an article of non-expendable, tangible property having a useful life of
more than one year and an acquisition cost of$5,000 or more.
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"Health Care Authority"(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.
"Protected Health Information" has the same meaning as in the HIPAA Rules except that in
this Contract the term includes only information created by any of its contractors, or received
from or on behalf of HCA, and relating to Clients. "PHI" means Protected Health Information.
"Statement of Work" or"SOW" means a detailed description that captures and defines the
work activities, deliverables, and timeline the Contractor is required to perform under this
Contract. SOW is usually incorporated in a contract, indirectly be reference or directly as an
attachment.
"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 Circular A-133 for additional detail.
"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.
3.2 ACCESS TO DATA
In compliance with Chapter 39.26 RCW, the Contractor shall provide access to data
generated under this Contract to HCA, the Joint Legislative Audit and Review Committee,
and the State Auditor 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.
3.3 ADVANCE PAYMENT PROHIBITED
No advance payment shall be made for services furnished by the Contractor pursuant to this
Contract.
3.4 AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, also
referred to as the "ADA" 28 CFR Part 35
The Contractor must comply with the ADA, which provides comprehensive civil rights
protection to individuals with disabilities in the areas of employment, public accommodations,
state and local government services, and telecommunications.
3.5 ASSIGNMENT
With the prior written consent of HCA, which consent shall not be unreasonably withheld,
Contractor may assign this Contract including the proceeds hereof, provided that such
assignment shall not operate to relieve Contractor of any of its duties and obligations
hereunder, nor shall such assignment affect any remedies available to HCA that may arise
from any breach of the sections of this Contract, Statements of Work, or warranties made
herein including but not limited to, rights of setoff.
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HCA may assign this Contract or Statements of Work to any public agency, commission,
board, or the like, within the political boundaries of the state of Washington, provided that
such assignment shall not operate to relieve HCA of any of its duties and obligations
hereunder.
3.6 ATTORNEYS' FEES
In the event of litigation or other action brought to enforce contract terms, each party agrees
to bear its own attorney's fees and costs.
3.7 CHANGE IN STATUS
In the event of substantive change in the legal status, organizational structure, or fiscal
reporting responsibility of the Contractor, Contractor agrees to notify the HCA of the change.
Contractor shall provide notice as soon as practicable, but no later than thirty (30) days after
such a change takes effect.
3.8 CONFIDENTIAL INFORMATION PROTECTION
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.
Contractors that may come into contact with Protected Health Information will be required to
complete a Business Associate agreement, as required by federal or state laws, including
HIPAA, prior to the commencement of any work.
Immediately upon expiration or termination of this Contract, Contractor shall, at HCA's
option: (i) certify to HCA that Contractor has destroyed all Confidential Information; or(ii)
return all Confidential Information to HCA; or(iii) take whatever other steps HCA requires of
Contractor to protect HCA's Confidential Information.
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.
The obligations set forth in this Section shall survive completion, cancellation, expiration, or
termination of this Contract.
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3.9 CONFIDENTIAL BREACH — REQUIRED NOTIFICATION
Upon a breach or suspected breach of confidentiality, the Contractor shall immediately notify
the HCA Privacy Officer. For the purposes of this Contract, "immediately "shall mean within
one calendar day.
The Contractor will take steps necessary to mitigate any known harmful effects of such
unauthorized access including, but not limited to, sanctioning employees, notifying subjects,
and taking steps necessary to stop further unauthorized access. The Contractor agrees to
indemnify and hold harmless HCA for any damages related to unauthorized use or
disclosure of Confidential Information by the Contractor, its officers, directors, employees,
Subcontractors or agents.
Any breach of this clause may result in termination of the Contract and the demand for return
of all Confidential Information.
Contractor acknowledges the HCA is subject to chapter 42.56 RCW and that this Contract
and any Work Orders shall 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 shall maintain the confidentiality of all such information marked Proprietary Information
in their possession. 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
3.10 CONFLICT OF INTEREST
HCA may terminate this Contract, by written notice to the Contractor, if it is found, 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 shall be entitled to pursue the same
remedies against the Contractor as it could pursue in the event of a breach of the contract by
the Contractor.
3.11 CONFORMANCE
If any provision of this Contract violates any statute or rule of law of the State of Washington,
it is considered modified to conform to that statute or rule of law.
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3.12 COVENANT AGAINST CONTINGENT FEES
The 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
shall 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
consideration or recover by other means the full amount of such commission, percentage,
brokerage or contingent fee.
3.13 DEBARMENT
The Contractor, by signing this Contract, certifies that the Contractor 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). The 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.
The Contractor shall 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.
3.14 DISPUTES
The parties shall 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 the dispute under this section. When a genuine dispute arises between HCA and
the Contractor regarding the terms of this Contract or the responsibilities imposed herein that
cannot be resolved at the project management level, either party may submit a request for a
dispute resolution to the HCA Contract Administrator who shall oversee the following Dispute
Resolution Process: HCA shall appoint a representative to a dispute panel; the Contractor
shall appoint a representative to the dispute panel; HCA's and Contractor's representatives
shall mutually agree on a third person to chair the dispute panel. The dispute panel shall
thereafter decide the dispute with the majority prevailing.
A party's request for a dispute resolution must:
3.14.1 Be in writing,
3.14.2 State the disputed issues,
3.14.3 State the relative positions of the parties,
3.14.4 State the remedies sought,
3.14.5 State the Contractor's name, address, and his/her department Contract number,
3.14.6 Be mailed to HCA Contracts Office, PO Box 42702, Olympia, WA 98504-2702 within
thirty (30)calendar days after the party could reasonably be expected to have
knowledge of the issue which he/she now disputes.
This dispute resolution process constitutes the sole administrative remedy available under
this Contract. The parties agree that this resolution process shall precede any action in a
judicial and quasi-judicial tribunal.
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3.15 FORCE MAJEURE
A party shall 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.
3.16 GOVERNING LAW
This Contract shall be governed, in all respects, by the law and statutes of the state of
Washington, without reference to conflict of law principles. The jurisdiction for any action
hereunder shall be exclusively in the Superior Court for the state of Washington and the
venue of any action hereunder shall be in the Superior Court for Thurston County,
Washington.
3.17 INDEMNIFICATION
Contractor shall defend, indemnify, and hold 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 arising from intentional, willful 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. Contractor's obligation to defend,
indemnify, and hold HCA harmless shall not be eliminated or reduced by any alleged
concurrent HCA negligence.
3.18 INDEPENDENT CAPACITY OF THE CONTRACTOR
The parties intend that an independent contractor relationship will be created by this
Contract. The Contractor and his or her employees or agents performing under this Contract
are not employees or agents of HCA. The Contractor will not hold himself/herself out as or
claim to be an officer or employee of HCA or of the State of Washington by reason hereof,
nor will the Contractor make any claim of right, privilege or benefit which would accrue to
such employee under law. Conduct and control of the work will be solely with the
Contractor.
3.19 INDUSTRIAL INSURANCE COVERAGE
Prior to performing work under this Contract, the Contractor shall 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 shall maintain full compliance with Title 51 RCW
during the course of this Contract. Should the Contractor fail to secure industrial insurance
coverage or fail to pay premiums, as may be required under Title 51 RCW, HCA may deduct
the amount of premiums and any penalties owing from the amount payable to the Contractor
under the Contract and transmit the same to the Department of Labor and Industries,
Division of Insurance Services. This provision does not waive any right under RCW
51.12.050 to collect from the Contractor amounts paid by HCA.
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3.20 INSURANCE
The Contractor shall 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 the
Contractor or subcontractor, or agents of either, while performing under the terms of this
Contract.
If the Contractor is self-insured, evidence of its status as a self-insured entity shall be
provided to HCA. If requested by HCA, the Contractor must describe its financial condition
and the self-insured funding mechanism.
Upon request, Contractor shall 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 shall submit renewal certificates as appropriate during the term of the
contract.
3.21 LEGAL AND REGULATORY COMPLIANCE
During the term of this Contract, Contractor shall 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.
3.22 LICENSING, ACCREDITATION AND REGISTRATION
The Contractor shall comply with all applicable local, state, and federal licensing,
accreditation and registration requirements/standards, necessary for the performance of this
Contract.
3.23 LIMITATION OF AUTHORITY
Only the HCA Authorized Representative or his/her designee by writing (delegation to be
made prior to action) shall have 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 Authorized Representative.
3.24 NO THIRD-PARTY BENEFICIARIES
The HCA and the Contractor are the only parties to this contract. Nothing in this Contract
gives or is intended to give any benefit of this contract to third parties or third persons.
3.25 NONDISCRIMINATION
During the performance of this Contract, the Contractor shall comply with all federal and
state nondiscrimination laws, regulations and policies.
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3.26 OVERPAYMENT AND ASSERTION OF LIEN
In the event that overpayments or erroneous payments have been made to the Contractor
under this Contract, HCA shall provide written notice to Contractor and Contractor shall
refund the full amount to HCA within thirty (30) days of the notice. HCA may secure
repayment, plus interest, if any, through the filing of a lien against the Contractor's real
property, or by requiring the posting of a bond, assignment or deposit, or some other form of
security acceptable to HCA.
3.27 PUBLICITY
The Contractor agrees to submit to HCA all advertising and publicity matters relating to this
Contract wherein HCA's name is mentioned or, in HCA's judgment, the language used may
infer or imply a connection with HCA's name. The Contractor agrees not to publish or use
such advertising and publicity matters without the prior written consent of HCA.
3.28 RECORDS, DOCUMENTS, AND REPORTS
The Contractor shall maintain books, records, documents, magnetic media, receipts,
invoices and 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, shall be 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. The Contractor shall retain such records for a period of six(6)
years after the date of final payment.
If any litigation, claim or audit is started before the expiration of the six(6) year period, the
records shall be retained until all litigation, claims, or audit findings involving the records
have been resolved.
3.29 REGISTRATION WITH DEPARTMENT OF REVENUE
The Contractor shall complete registration with the Washington State Department of
Revenue and be responsible for payment of all taxes due on payments made under this
Contract.
3.30 REMEDIES NON-EXCLUSIVE
The remedies provided in this Contract shall not be exclusive, but are in addition to all other
remedies available under law.
3.31 RIGHT OF INSPECTION
The Contractor shall provide access to its facilities to HCA, or any of HCA's 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.
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3.32 RIGHTS IN DATA/COPYRIGHT
Unless otherwise provided, all materials produced exclusively under this Contract shall be
considered "works for hire" as defined by the U.S. Copyright Act and shall be owned by
HCA. HCA shall be considered the author of such Materials. In the event the Materials are
not considered "works for hire" under the U.S. Copyright laws, Contractor hereby irrevocably
assigns all right, title, and interest in Materials, including all intellectual property rights, to
HCA effective from the moment of creation of such Materials.
Materials means all items in any format and includes, but is not limited to, data, reports,
documents, pamphlets, advertisements, books, magazines, surveys, studies, computer
programs, films, tapes, and/or sound reproductions that derive exclusively from the
Contractor's work under this Contract. Ownership includes the right to copyright, patent,
register and the ability to transfer these rights.
For Materials that are delivered under the Contract, but that incorporate pre-existing
materials not produced under the Contract, Contractor hereby grants to HCA a nonexclusive,
royalty-free, irrevocable license (with rights to sublicense others) in such Materials to
translate, reproduce, distribute, prepare derivative works, publicly perform, and publicly
display. The Contractor warrants and represents that Contractor has all rights and
permissions, including intellectual property rights, moral rights and rights of publicity,
necessary to grant such a license to HCA.
The Contractor shall exert all reasonable effort to advise HCA, at the time of delivery of
Materials furnished under this Contract, of all known or potential invasions of privacy
contained therein and of any portion of such document which was not produced in the
performance of this Contract. HCA shall receive prompt written notice of each notice or claim
of copyright infringement received by the Contractor with respect to any data delivered under
this Contract. HCA shall have the right to modify or remove any restrictive markings placed
upon the data by the Contractor.
3.33 SAFEGUARDING OF INFORMATION
The use or disclosure by any party, of any information concerning HCA, for any purpose not
directly connected with the administration of HCA's or the Contractor's responsibilities with
respect to services provided under this Contract, is prohibited except by written consent of
HCA.
3.34 SEVERABILITY
If any provision of this Contract, or the application thereof to any person(s) or circumstances
is held invalid, such invalidity shall 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.
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3.35 SITE SECURITY
While on HCA premises, Contractor, its agents, employees, or subcontractors shall 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 reassignment or
termination of any Contractor staff, Contractor agrees to promptly notify HCA.
3.36 SUBCONTRACTING
Neither the Contractor, nor any Subcontractors, shall enter into subcontracts for any of the
work contemplated under this Contract without prior written approval of HCA. In no event
shall the existence of the subcontract operate to release or reduce the liability of the
Contractor to HCA for any breach in the performance of the Contractor's duties.
Additionally, the Contractor is responsible for ensuring that all terms, conditions, assurances
and certifications set forth in this Contract are included in any subcontracts. Contractor and
its subcontractors agree not to release, divulge, publish, transfer, sell or otherwise make
known to unauthorized persons confidential information without the express written consent
of HCA or as provided by law.
If, at any time during the progress of the work, the HCA determines in its sole judgment that
any subcontractor is incompetent or undesirable, the HCA shall notify the Contractor, and
the Contractor shall take immediate steps to terminate the subcontractor's involvement in the
work.
The rejection or approval by the HCA of any subcontractor or the termination of a
subcontractor shall not relieve the Contractor of any of its responsibilities under the Contract,
nor be the basis for additional charges to the HCA.
The HCA has no contractual obligations to any subcontractor or vendor under contract to the
Contractor. The Contractor is fully responsible for all contractual obligations, financial or
otherwise, to their subcontractors.
3.37 SUBRECIPIENT
3.37.1 General
If the Contractor is a sub-recipient of federal awards as defined by Office of
Management and Budget (OMB) Circular A-133 and this Contract, the Contractor
shall:
3.37.1.1 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,
award number and year, name of the federal agency, and name of the
pass-through entity;
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3.37.1.2 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;
3.37.1.3 Prepare appropriate financial statements, including a schedule of
expenditures of federal awards;
3.37.1.4 Incorporate OMB Circular A-133 audit requirements into all agreements
between the Contractor and its Subcontractors who are sub-recipients;
3.37.1.5 Comply with any future amendments to OMB Circular A-133 and any
successor or replacement Circular or regulation;
3.37.1.6 Comply with the applicable requirements of OMB Circular A-87 and any
future amendments to OMB Circular A-87, and any successor or
replacement Circular or regulation; and
3.37.1.7 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
C.F.R. Part 42, Subparts C.D.E. and G, and 28 C.F.R. Part 35 and 39.
(Go to http://ojp.gov/about/offices/ocr.htm for additional information and
access to the aforementioned Federal laws and regulations.)
3.37.2 Single Audit Act Compliance
If the Contractor is a sub-recipient and expends $500,000 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:
3.37.2.1 Submit to the Authority contact person the data collection form and
reporting package specified in OMB Circular A-133, reports required by
the program-specific audit guide (if applicable), and a copy of any
management letters issued by the auditor;
3.37.2.2 Follow-up and develop corrective action for all audit findings; in
accordance with OMB Circular A-133, prepare a "Summary Schedule of
Prior Audit Findings."
3.37.3 Overpayments
If it is determined by the Authority, or during the course of a required audit, that the
Contractor has been paid unallowable costs under this or any Program Agreement,
the Authority may require the Contractor to reimburse the Authority in accordance
with OMB Circular A-87.
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3.38 SURVIVABILITY
The terms and conditions contained in this Contract, which by their sense and context are
intended to survive the completion, cancellation, termination, or expiration of the Contract,
shall survive.
3.39 SYSTEM SECURITY
Contractor agrees not to attach any Contractor-supplied computers, peripherals or software
to the HCA Network without prior written authorization from HCA's Information Systems
Manager. Contractor-supplied computer equipment, including both hardware and software,
must be reviewed by the HCA Information Services prior to being connected to any HCA
network connection and that it must have up to date anti-virus software and personal firewall
software installed and activated on it.
Unauthorized access to HCA networks and systems is a violation of HCA Policy 06-03 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.
3.40 TAXES
Unless otherwise indicated, HCA will pay sales and 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.
3.41 TERMINATION
3.41.1 TERMINATION FOR CAUSE
In the event the Contractor violates any material term or condition of this Contract or
any Work Order, or fails to fulfill in a timely and proper manner its material obligations
under this Contract or any Work Order, as applicable, then comply with the conditions
of this Contract in a timely manner, HCA has the right to suspend or terminate this
Contract. HCA shall notify the Contractor, in writing, of the need to take corrective
action. If corrective action is not taken within three (3) days, or other time period
agreed to in writing, the Contract may be terminated. HCA reserves the right to
suspend all or part of the Contract, withhold further payments, or prohibit the
Contractor from incurring additional obligations of funds during investigation of the
alleged compliance breach and pending corrective action by the Contractor or a
decision by HCA to terminate the Contract.
In the event of termination, the Contractor shall 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 the Contractor: (i)was not in default, or(ii)
failure to perform was outside of his or her control, fault or negligence, the
termination shall be deemed a "Termination for Convenience" and the provisions of
Subsection 3.43.3 will apply.
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3.41.2 TERMINATION DUE TO CHANGE IN FUNDING, SUSPENSION OR CONTRACT
RENOGTIATION
If the funds HCA relied upon to establish this Contract are 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:
3.41.2.1 At HCA's discretion, the Contract may be renegotiated under the revised
funding conditions.
3.41.2.2 At HCA's discretion, HCA may give notice to Contractor to suspend
performance 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.
3.41.2.2.1 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.
3.41.2.2.2 When HCA determines 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.
3.41.2.2.3 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 shall be liable only for payment
in accordance with the terms of this Contract for services
rendered prior to the retroactive date of termination.
3.41.2.3 HCA may immediately terminate this Contract by providing written notice
to the Contractor. The termination shall be effective on the date specified
in the termination notice. HCA shall 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 shall accrue to HCA in the
event the termination option in this section is exercised.
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3.41.3 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) Business Day's
notice. If this Contract is so terminated, HCA shall be liable only for payment in
accordance with the terms of this Contract for services rendered prior to the effective
date of termination.
The Contractor, at their discretion, may terminate this Contract in whole or in part by
providing fifteen (15) Business Day's written notice to HCA before the beginning
of the next calendar quarter.
3.41.4 TERMINATION PROCEDURES
Upon termination of this Contract, HCA, in addition to any other rights provided in this
Contract or available under law, may require the Contractor to deliver to HCA any
property specifically produced or acquired for the performance of such part of this
Contract as has been terminated.
HCA shall pay to the Contractor the agreed upon price, if separately stated, for
completed work and service 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
which are accepted by HCA; and (iv)the protection and preservation of property,
unless the termination is for default, in which case the HCA shall determine the
extent of the liability. Failure to agree with such determination shall be a dispute
within the meaning of the "Disputes" clause of this Contract. 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.
Upon receipt of notice of termination, and except as otherwise directed by the HCA,
the Contractor shall:
3.41.4.1 Stop work under the Contract on the date, and to the extent specified in
the notice;
3.41.4.2 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;
3.41.4.3 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;
3.41.4.4 Settle all outstanding liabilities and all claims arising out of such
termination of orders and subcontracts, with the approval or ratification of
HCA the extent HCA may require, which approval or ratification shall be
final for all the purposes of this clause;
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3.41.4.5 Transfer title to HCA and deliver in the manner, at the times, and to the
extent directed by HCA any property which, if the Contract has been
completed, would have been required to be furnished to HCA;
3.41.4.6 Complete performance of such part of the work as shall not have been
terminated by HCA; and
3.41.4.7 Take such action as may be necessary, or as HCA may direct, for the
protection and preservation of the property related to this Contract which
is in the possession of the Contractor and in which HCA has or may
acquire an interest.
3.41.5 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 terminate this Contract in whole or in part, under
Section 3.43.3 of this Contract. No penalty will accrue to HCA in the event this
section is exercised. This Section shall not be construed so as to permit HCA to
terminate this Contract in order to acquire similar Services from a third party.
3.42 WAIVER
Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver
of breach of any provision of this Contract shall not be deemed to be a waiver of any other or
subsequent breach and shall not be construed to be a modification of the terms of this
Contract unless stated to be such in writing signed by HCA and attached to the original
Contract.
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SCHEDULE A
STATEMENT OF WORK
1. DEFINITIONS
Definitions specific to this Agreement. The words and phrases listed below, as used in this
Agreement, shall each have the following definitions:
a) "A19-1A" 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.
b) "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.
c) "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.
d) "Allocated" or"Allocated Cost" means an Operating Expense that is Allocated across more
than one cost pool.
e) "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.
f) "Centers for Medicare and Medicaid Services" or "CMS" means the federal office under the
United States Department of Health and Human Services responsible for the administration
of the Medicare, Medicaid and Children's Health Insurance Program.
g) "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.
h) "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).
i) "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.
j) "Client" means an individual served within budget unit or cost center of the Contractor.
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k) "Cognizant Agency" means the single agency representing all others in dealing with
grantees in common areas and who reviews and approves grantees' indirect cost rates.
OMB published a list of Cognizant Agency assignments for some State agencies, cities and
counties on January 6, 1986 (51 FR 552). The Cognizant Agency for governmental units not
on that list is the one that provides the most grant funds to the entity.
I) "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.
m) "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.
n) "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.
o) "Data" means the information that is disclosed or exchanged as described in the CAP,
manual or this Agreement.
p) "Direct Charge Method" means the method of accounting for Direct Costs without a step-
down allocation for single funding sources expenses wholly attributed to the MAC program.
q) "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.
r) "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."
s) "Duty Statements" means the form on which the Contractor describes the current duties and
responsibilities of a specific position and how it relates to the Medicaid program.
t) "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 for eligible for claiming their
staff time costs for conducting Medicaid Administrative Claiming activities.
u) "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 Code of
Federal Regulations (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.
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v) "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.
w) "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.
x) "Integral Activity" or "Extension Activity" means an activity that is necessary for or incidental
to the provision of a direct medical service
y) "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.
z) "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.
aa) "Medicaid Administrative Claiming" or"MAC" means the program within title XIX of the Social
Security Act(the Act) authorizing federal grants to states for a proportion of expenditures for
medical assistance under the approved Medicaid state plan, and for expenditures necessary
for administration of the state plan. This joint federal-state financing of expenditures is
described in section 1903(a) of the Act, which sets forth the rates of federal financing for
different types of expenditures. In order for Medicaid administrative expenditures to be
claimed for federal matching funds an allocation methodology must appears in the state's
approved Public Assistance Cost Allocation Plan (42 CFR §433.34) and be described in
detail in a MAC CAP.
bb) "Medicaid Administrative Claiming Program Specialist" means the HCA employee assigned
responsibility for oversight and monitoring of the Contractor's MAC program and claiming
and identified as the point of contact on this Agreement.
cc) "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.
dd) "Medicaid Outreach Unit" means the unit within HCA's Health Care Services division that
administers and monitors Washington State's MAC program.
ee) "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 (CPE).
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ff) "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.
gg) "Potential Medicaid Client" means a Washington resident who may be determined by HCA to
meet the eligibility criteria for enrollment in Medicaid.
hh) "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.
ii) "Regulation" means any federal, state, or local Regulation, rule, or ordinance.
jj) "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.
kk) "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.
II) "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.
mm) "State Fiscal Year" means a twelve-month period beginning on July 1st of one calendar year
and ending on June 30th of the following calendar year.
nn) "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.
oo) "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.
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2. 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
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) Washington Administrative Code (WAC).
vi) The MAC Coordinator Manual.
vii) OMB 2 CFR 225 Cost Principles for State, Local, and Indian Tribal Governments.
viii) OMB Circular A-133 Compliance Supplement 2014.
ix) Washington State Medicaid Plan.
x) 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:
i) 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;
ii) 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
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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 A-
133 Compliance Supplement 2014 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.
3. RESPONSIBILITIES
a) Contractor:
The Contractor is responsible for monitoring its MAC program and any subcontractor MAC
participation, 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, and
this Agreement that includes, but is not limited to, the following. 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. These requirements
extend to Subcontractor staff. 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 whose costs are
included in the FQHC cost report;
(a) Subcontract FQHC staff are prohibited from being included in the RMTS or claimed
reimbursement;
(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
(8) Have a duty statement on file for the job position and maintained in the RMTS and
claiming System (System).
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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.
(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, thirty (30)
business days before any changes are made.
(3) The Coordinators must ensure federal, state and HCA MAC policies are
implemented.
(4) 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 at least thirty(30) business days prior to
January first.
(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 to the HCA Contract Manager a quarterly MER certification with each invoice
validating the accuracy of the MER;
vii) Submit a quarterly CPE certification with each invoice validating the accuracy of the
CPE;
viii) Submit a certificate of indirect costs and approval letter from their Cognizant Agency
annually;
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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;
x) Complete a one hundred percent(100%) code review of all RMTS moments to ensure
the code and narrative correlate, within forty five (45) days after the end of the quarter;
xi) 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 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;
xiv) 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).
xv) 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;
(4) Train all Participants to maintain proper documentation for MAC related activities;
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(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) Be prohibited from entering into a Subcontract without prior written approval from HCA,
and assumes all responsibility for its Subcontractors; and
xviii) 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 Authority
HCA 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:
i) 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 10 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 MAC Subcontracts to ensure all Subcontractor requirements are in
compliance and issue prior written approval for the MAC Contractor to enter into a
Subcontract for work contemplated within this Agreement. Subcontract review extends to
all entities Subcontracted to perform MAC activities, including but not limited to, billing
agents, vendors, associations, or any entity entering into an Agreement with the
Contractor for any purpose related to MAC. HCA does not perform a legal review of the
subcontracts;
vi) Review the Contractor's annual monitoring report and/or corrective action plans for all
Subcontractors;
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vii) 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;
viii) 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 is
prohibited from using any training materials without express, written approval from HCA;
ix) 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;
x) 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
xi) Produce and update the CAP, manual, contracts, training materials, or other MAC
related documentation as needed and make it available to the Contractor.
4. SUBCONTRACTING
For purposes of the MAC program and this Agreement all entities contracted to perform MAC
activities, including but not limited to, billing agents, vendors, associations, or any entity entering
into an Agreement with the Contractor for any purpose related to MAC are considered a
Subcontractor. As described in this section, the Contractor is prohibited from entering into a
Subcontract without prior written approval from HCA and assumes all responsibility for any and all
Subcontracts. Prior written approval from HCA is not a legal review of the Contractor's
subcontract.
a) In order to obtain prior written approval to enter into a Subcontract, the Contractor must
complete and submit the Medicaid Administrative Claiming Subcontractor Requirements and
Questionnaire HCA form 09-021 at least thirty(30) business days prior to implementation or
execution.
i) The Subcontract must comply with all requirements described in HCA form 09-021;
ii) The Subcontract must not begin participating in MAC mid-quarter; and
iii) A signed copy of the Subcontract must be submitted to the HCA Contract Manager within
the (10) business days of execution.
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b) Once HCA has granted authorization for the Contractor to enter into a Subcontract, the
Contractor is responsible for ensuring:
i) Any amendments to the Subcontract are submitted to HCA at least thirty(30) business
days prior to implementation using HCA form 09-021;
ii) The Subcontractor is not paid contingent upon, or as a percentage of, the claim or
reimbursement amount;
iii) The Subcontractor is not charged an Administrative Fee for participation in MAC;
iv) The Subcontractor abides by all limitations, restrictions, and documentation requirements
of MAC activities as specified in the CAP, Manual, this Agreement and the Subcontract;
and
v) The Subcontractor MAC coordinator monitors the Subcontractor's MAC program and
participation.
c) The Contractor is required to monitor their Subcontracts to ensure program integrity, and
produce an annual monitoring report compliant with the terms and conditions of the
Subcontract to be submitted to the HCA Contract Manager.
d) Other outreach/linkage contracts. The Contractor must submit copies of any other outreach
and linkage Subcontracts prior to implementation. Examples of these Subcontracts include,
but are not limited to:
i) In-person assister or Navigator contracts
ii) School districts
iii) Hospitals.
5. 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%):
i) 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.
ii) 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.
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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.
iii) 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:
i) 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.
6. 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
peruse 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; and
e) Failure to meet time study minimum response rates.
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7. ADMINISTRATIVE FEE
a) Two times per year, HCA will invoice the Contractor for an Administrative Fee. This fee offsets
and will not exceed the costs for administering the MAC program for the State of Washington.
Administrative Fees charged to MAC contractors are used to provide the state share of match
required to operate the program.
b) The Contractor must submit payment of Administrative Fees within forty-five (45) business
days of the date on the Administrative Fee invoice. The Administrative Fee must be paid with
non-federal dollars. HCA will not process any Al 9s until the Administrative Fee is paid to
HCA.
c) The Administrative Fee is an unallowable expense and the Contractor is prohibited from
including any portion of the Administrative Fee in their calculations for FFP reimbursement.
Contractor must mail Administrative Fee payment to the following address:
Health Care Authority
Financial Services/Accounting
PO Box 45500
Olympia, Washington 98504-5500
8. TIMELY FILING AND OVERPAYMENT REQUIREMENTS:
The Contractor must submit invoices for reimbursement within one hundred twenty(120) calendar
days following the end of each Billing Quarter.
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).
9. 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. This extends to all Subcontractors participating in MAC.
i) The Contractor must submit invoices to HCA for FFP on a quarterly basis;
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ii) 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 cost/expenditure 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;
(4) Calculation and application of the indirect cost rate; and
(5) Application of the appropriate FFP rate.
b) Cost pool construction
i) 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.
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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.
(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
iv) 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 an HCA approved form.
(a) The form must be maintained according to SOS Record's retention schedule.
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(b) All forms must have a quarterly summary rolling up all time over the quarter by
interpreter.
(c) The contractor is prohibited from altering the information on the form and
certifies the accuracy of the data by signing the Al 9 by an authorized
Contractor representative.
(3) The invoice must report the name of the interpreting staff, the amount of time spent
performing allowable MAC activities, and total dollar amount claimed for
reimbursement individually for each Interpretation Service contract.
e) Calculation and application of the pertinent MER.
i) All MERs must be calculated quarterly;
ii) 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
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(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 Office of Management and Budget 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;
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:
i) 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.
ii) 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:
i) 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;
ii) 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 by signing the A19;
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iii) 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);
iv) 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;
v) Must have funds available for MAC activities and the funds must be within the
Contractor's control and budget;
vi) Is prohibited from using provider-related donations or impermissible heath care related
tax source for CPE;
vii) 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);
viii) 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 o committee regarding the
award, amendment, modification, extension, or renewal of a state or federal contract
grant; and
x) Must reimburse 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:
i) 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;
ii) Required to certify the accuracy of the funds that are offset and the accuracy of the
requested FFP reimbursement by signing the A19;
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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;
(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 31st 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.
10. 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;
Washington State Page 41 of 50 Contract No. K1409
Health Care Authority
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
vi) Any activities that are not directly related to the administration of the State Medicaid plan.
d) Track all SPMP activities within the System and provide the System generated report to HCA
with each quarterly A19 or more often if requested by HCA;
e) Provide HCA with a written report documenting progress, accomplishments, barriers and
suggested recommendations related to the performance of SPMP activities as requested by
HCA, within a mutually agreed upon time frame;
f) 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.
g) Comply with any changes to the allowable SPMP activities as directed by the CMO;
i) Failure to comply with CMO directives may result in termination of SPMP participation in
the MAC program.
h) 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;
i) Comply with any changes to allowable SPMP activities as directed by the CMO that may
include, but is not limited to:
i) 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.
Washington State Page 42 of 50 Contract No. K1409
Health Care Authority
(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.
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.
Washington State Page 43 of 50 Contract No. K1409
Health Care Authority
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 eo 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. K1409.
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) Circular A-133, as well as all
applicable federal and state statutes and regulations. A sub-awardee who expends$500,000 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 Circular A-133.
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.
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.
Washington State Page 44 of 50 K1409
Health Care Authority Attachment 1
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.
h. 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.
j. 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.qov/ocr/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
II. 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, Lewis County Public Health &Social Services. The federal
Circulars which provide the applicable administrative requirements, cost principles and audit requirements
are identified by sub-awardee organization type.
III.
OMB CIRCULAR
ENTITY TYPE ADMINISTRATIVE COST AUDIT REQUIREMENTS
REQUIREMENTS PRINCIPLES
State. Local and Indian Tribal A-102 &Common A-87 A-133
Governments and Rule
Governmental Hospitals
Non-Profit Organizations and A-110 A-122 A-133
Non-Profit Hospitals
Colleges or Universities and A-110 A-21 A-133
Affiliated Hospitals
For-Profit Organizations A-110 48 CFR 31.2 Requirements established by the pass-
through entity, pursuant to A-133,
§_.210(e)
Washington State Page 45 of 50 K1409
Health Care Authority Attachment 1
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.
IV. 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 Should the contractor not be able to provide this
DEBARMENT AND SUSPENSION certification, an explanation as to why should be
placed after the assurances page in the
The undersigned (authorized official signing for contract.
the contracting organization) certifies to the best
of his or her knowledge and belief, that the The contractor agrees by signing this contract
contractor, defined as the primary participant in that it will include, without modification, the
accordance with 45 CFR Part 76, and its clause titled "Certification Regarding Debarment,
principals: Suspension, In eligibility, and Voluntary
Exclusion--Lower Tier Covered Transactions" in
a) are not presently debarred, suspended, all lower tier covered transactions (i.e.,
proposed for debarment, declared ineligible, transactions with sub-grantees and/or
or voluntarily excluded from covered contractors) and in all solicitations for lower tier
transactions by any Federal Department or covered transactions in accordance with 45 CFR
agency; Part 76.
b) have not within a 3-year period preceding
this contract been convicted of or had a civil 2. CERTIFICATION REGARDING DRUG-
judgment rendered against them for FREE WORKPLACE REQUIREMENTS
commission of fraud or a criminal offense in
connection with obtaining, attempting to The undersigned (authorized official signing for
obtain, or performing a public (Federal, the contracting organization) certifies that the
State, or local) transaction or contract under contractor will, or will continue to, provide a
a public transaction; violation of Federal or drug-free workplace in accordance with 45 CFR
State antitrust statutes or commission of Part 76 by:
embezzlement, theft, forgery, bribery,
falsification or destruction of records, making a) Publishing a statement notifying employees
false statements, or receiving stolen that the unlawful manufacture, distribution,
property; dispensing, possession or use of a
controlled substance is prohibited in the
c) are not presently indicted or otherwise grantee's workplace and specifying the
criminally or civilly charged by a actions that will be taken against employees
governmental entity(Federal, State, or local) for violation of such prohibition;
with commission of any of the offenses
enumerated in paragraph (b) of this b) Establishing an ongoing drug-free
certification; and awareness program to inform employees
about
d) have not within a 3-year period preceding (1) The dangers of drug abuse in the
this contract had one or more public workplace;
transactions (Federal, State, or local) (2) The contractor's policy of maintaining a
terminated for cause or default. drug-free workplace;
Washington State Page 46 of 50 K1409
Health Care Authority Attachment 1
(3)Any available drug counseling, g) Making a good faith effort to continue to
rehabilitation, and employee assistance maintain a drug-free workplace through
programs; and implementation of paragraphs (a), (b), (c),
(4) The penalties that may be imposed upon (d), (e), and (f).
employees for drug abuse violations
occurring in the workplace; For purposes of paragraph (e) regarding agency
notification of criminal drug convictions,
c) Making it a requirement that each employee Authority has designated the following central
to be engaged in the performance of the point for receipt of such notices:
contract be given a copy of the statement
required by paragraph (a)above; Legal Services Manager
WA State Health Care Authority
d) Notifying the employee in the statement PO Box 42700
required by paragraph (a), above, that, as a Olympia,WA 98504-2700
condition of employment under the contract,
the employee will—
(1)Abide by the terms of the statement; and 3. CERTIFICATION REGARDING LOBBYING
(2) Notify the employer in writing of his or
her conviction for a violation of a criminal Title 31, United States Code, Section 1352,
drug statute occurring in the workplace no entitled "Limitation on use of appropriated funds
later than five calendar days after such to influence certain Federal contracting and
conviction; financial transactions," generally prohibits
recipients of Federal grants and cooperative
e) Notifying the agency in writing within ten agreements from using Federal (appropriated)
calendar days after receiving notice under funds for lobbying the Executive or Legislative
paragraph (d)(2) from an employee or Branches of the Federal Government in
otherwise receiving actual notice of such connection with a SPECIFIC grant or
conviction. Employers of convicted cooperative agreement. Section 1352 also
employees must provide notice, including requires that each person who requests or
position title, to every contract officer or receives a Federal grant or cooperative
other designee on whose contract activity agreement must disclose lobbying undertaken
the convicted employee was working, unless with non-Federal (nonappropriated) funds.
the Federal agency has designated a central These requirements apply to grants and
point for the receipt of such notices. Notice cooperative agreements EXCEEDING $100,000
shall include the identification number(s) of in total costs (45 CFR Part 93).
each affected grant;
The undersigned (authorized official signing for
f) Taking one of the following actions, within the contracting organization)certifies, to the best
30 calendar days of receiving notice under of his or her knowledge and belief, that:
paragraph (d) (2), with respect to any
employee who is so convicted— (1) No Federal appropriated funds have been
(1)Taking appropriate personnel action paid or will be paid, by or on behalf of the
against such an employee, up to undersigned, to any person for influencing or
and including termination, attempting to influence an officer or
consistent with the requirements of employee of any agency, a Member of
the Rehabilitation Act of 1973, as Congress, an officer or employee of
amended; or Congress, or an employee of a Member of
(2)Requiring such employee to Congress in connection with the awarding of
participate satisfactorily in a drug any Federal contract, the making of any
abuse assistance or rehabilitation Federal grant, the making of any Federal
program approved for such loan, the entering into of any cooperative
purposes by a Federal, State, or agreement, and the extension, continuation,
local health, law enforcement, or renewal, amendment, or modification of any
other appropriate agency; Federal contract, grant, loan, or cooperative
agreement.
Washington State Page 47 of 50 K1409
Health Care Authority Attachment 1
(2) If any funds other than Federally facility owned or leased or contracted for by an
appropriated funds have been paid or will be entity and used routinely or regularly for the
paid to any person for influencing or provision of health, day care, early childhood
attempting to influence an officer or development services, education or library
employee of any agency, a Member of services to children under the age of 18, if the
Congress, an officer or employee of services are funded by Federal programs either
Congress, or an employee of a Member of directly or through State or local governments,
Congress in connection with this Federal by Federal grant, contract, loan, or loan
contract, grant, loan, or cooperative guarantee. The law also applies to children's
agreement, the undersigned shall complete services that are provided in indoor facilities that
and submit Standard Form-LLL, "Disclosure are constructed, operated, or maintained with
of Lobbying Activities," in accordance with such Federal funds. The law does not apply to
its instructions. (If needed, Standard Form- children's services provided in private residence,
LLL, "Disclosure of Lobbying Activities," its portions of facilities used for inpatient drug or
instructions, and continuation sheet are alcohol treatment, service providers whose sole
included at the end of this application form.) source of applicable Federal funds is Medicare
or Medicaid, or facilities where WIC coupons are
(3) The undersigned shall require that the redeemed.
language of this certification be included in
the award documents for all subcontracts at Failure to comply with the provisions of the law
all tiers (including subcontracts, may result in the imposition of a civil monetary
subcontracts, and contracts under grants, penalty of up to$1,000 for each violation and/or
loans and cooperative agreements) and that the imposition of an administrative compliance
all sub-recipients shall certify and disclose order on the responsible entity.
accordingly.
By signing the certification, the undersigned
This certification is a material representation of certifies that the contracting organization will
fact upon which reliance was placed when this comply with the requirements of the Act and will
transaction was made or entered into. Submission not allow smoking within any portion of any
of this certification is a prerequisite for making or indoor facility used for the provision of services
entering into this transaction imposed by Section for children as defined by the Act.
1352, U.S. Code. Any person who fails to file the
required certification shall be subject to a civil The contracting organization agrees that it will
penalty of not less than $10,000 and not more require that the language of this certification be
than$100,000 for each such failure. included in any subcontracts which contain
provisions for children's services and that all
4. CERTIFICATION REGARDING PROGRAM sub-recipients shall certify accordingly.
FRAUD CIVIL REMEDIES ACT (PFCRA)
The Public Health Services strongly
The undersigned (authorized official signing for encourages all recipients to provide a
the contracting organization) certifies that the smoke-free workplace and promote the non-
statements herein are true, complete, and use of tobacco products. This is consistent
accurate to the best of his or her knowledge, with the PHS mission to protect and advance
and that he or she is aware that any false, the physical and mental health of the
fictitious, or fraudulent statements or claims may American people.
subject him or her to criminal, civil, or
administrative penalties. The undersigned 6. CERTIFICATION REGARDING
agrees that the contracting organization will DEBARMENT, SUSPENSION, AND
comply with the Public Health Service terms and OTHER RESPONSIBILITY MATTERS
conditions of award if a contract is awarded. INSTRUCTIONS FOR CERTIFICATION
1) By signing and submitting this proposal, the
5. CERTIFICATION REGARDING prospective contractor is providing the
ENVIRONMENTAL TOBACCO SMOKE certification set out below.
Public Law 103-227, also known as the Pro- 2) The inability of a person to provide the
Children Act of 1994 (Act), requires that smoking certification required below will not
not be permitted in any portion of any indoor necessarily result in denial of participation in
Washington State Page 48 of 50 K1409
Health Care Authority Attachment 1
this covered transaction. The prospective transactions and in all solicitations for lower
contractor shall submit an explanation of tier covered transactions.
why it cannot provide the certification set out 8) A participant in a covered transaction may
below. The certification or explanation will rely upon a certification of a prospective
be considered in connection with the participant in a lower tier covered
department or agency's determination transaction that it is not debarred,
whether to enter into this transaction. suspended, ineligible, or voluntarily
However, failure of the prospective excluded from the covered transaction,
contractor to furnish a certification or an unless it knows that the certification is
explanation shall disqualify such person erroneous. A participant may decide the
from participation in this transaction. method and frequency by which it
3) The certification in this clause is a material determines the eligibility of its principals.
representation of fact upon which reliance Each participant may, but is not required to,
was placed when the department or agency check the Non-procurement List (of
determined to enter into this transaction. If it excluded parties).
is later determined that the prospective 9) Nothing contained in the foregoing shall be
contractor knowingly rendered an erroneous construed to require establishment of a
certification, in addition to other remedies system of records in order to render in good
available to the Federal Government, the faith the certification required by this clause.
department or agency may terminate this The knowledge and information of a
transaction for cause of default. participant is not required to exceed that
4) The prospective contractor shall provide which is normally possessed by a prudent
immediate written notice to the department person in the ordinary course of business
or agency to whom this contract is submitted dealings.
if at any time the prospective contractor 10) Except for transactions authorized under
learns that its certification was erroneous paragraph 6 of these instructions, if a
when submitted or has become erroneous participant in a covered transaction
by reason of changed circumstances. knowingly enters into a lower tier covered
5) The terms covered transaction, debarred, transaction with a person who is suspended,
suspended, ineligible, lower tier covered debarred, ineligible, or voluntarily excluded
transaction, participant, person, primary from participation in this transaction, in
covered transaction, principal, proposal, and addition to other remedies available to the
voluntarily excluded, as used in this clause, Federal Government, Authority may
have the meanings set out in the Definitions terminate this transaction for cause or
and Coverage sections of the rules default.
implementing Executive Order 12549. You
may contact the person to whom this 7. CERTIFICATION REGARDING
contract is submitted for assistance in DEBARMENT, SUSPENSION,AND
obtaining a copy of those regulations. OTHER RESPONSIBILITY MATTERS --
6) The prospective contractor agrees by PRIMARY COVERED TRANSACTIONS
submitting this contract that, should the
proposed covered transaction be entered 1) The prospective contractor certifies to the
into, it shall not knowingly enter into any best of its knowledge and belief, that it and
lower tier covered transaction with a person its principals:
who is debarred, suspended, declared a) Are not presently debarred, suspended,
ineligible, or voluntarily excluded from proposed for debarment, declared
participation in this covered transaction, ineligible, or voluntarily excluded from
unless authorized by Authority. covered transactions by any Federal
7) The prospective contractor further agrees by department or agency;
submitting this contract that it will include the b) Have not within a three-year period
clause titled "Certification Regarding preceding this contract been convicted of or
Debarment, Suspension, Ineligibility and had a civil judgment rendered against them
Voluntary Exclusion -- Lower Tier Covered for commission of fraud or a criminal offense
Transaction," provided by HHS, without in connection with obtaining, attempting to
modification, in all lower tier covered obtain, or performing a public (Federal,
State or local) transaction or contract under
Washington State Page 49 of 50 K1409
Health Care Authority Attachment 1
Executive Summary
BOCC Meeting Date:
2015-02-09
Contact:
Danette York
Department:
Public Health and Social Services
Wording
Approve contract between Washington State Health Care Authority (HCA) and Lewis County
Description
The federal-level Centers for Medicare & Medicaid Services (CMS) encourage government entities
such as county health departments to participate in the Medicaid Administrative Claiming program.
Administrative claiming is allowed under federal law when local agencies provide services which are
classified as outreach and linkage to individuals who are potentially eligible for Medicaid. These
services include activities associated with informing potentially eligible people about Medicaid,
connecting them to service providers, and the development of community services.
Reimbursing local agencies is possible because HCA has limited staff but is required by their contract
with CMS to provide these services. Reimbursement works by having all staff that may carry out
these activities participate in time studies to document the use of their time.
Quarterly, PHSS submits a bill indicating the amount of time spent on each activity and the staffing
costs. HCA reimburses PHSS at a 50% rate for standard activities and at a 75% rate for activities
which must be carried out by a licensed professional (e.g., RN, MSW). Administrative claiming allows
PHSS to receive additional funding for activities usually done by staff as they carry out their daily work
assignments.
Recommendation
Approve Resolution
Other
Contract is effective April 1, 2015 through March 31, 2017
a,..,. ,w....Mir... ", ,. .........:...®e...,.«W«.«.,,®®....,e..,...® _ W.....�....._ ...
BOCC ACENDA ITEM SUMMARY
Resolution #: 15-b'7 S BOCC Meeting Date: Mar 02, 2015
Suggested Wording for Agenda Item: Agenda Type: Consent
Approve contract between Washington State Health Care Authority(HCA) and Lewis County
Brief Reason for BOCC Action:
Lewis County will participate in the Medicaid Administrative Claiming program.
Submitted By: Andrus, Sandi Phone: 2774
Date Submitted: Jan 27, 2015
Contact Person Who Will Attend BOCC Meeting: Danette York
Action Needed: Approve Resolution
Publication Requirements:
Hearing Date:
Publications:
Publication Dates:
Approvals:
User Group Status
York, Danette 4/ Pending
Carter, Glenn ,1 Pending
Cover Letter To
Jennifer Inman
Washington State Health Care Authority
PO Box 42702
Olympia,WA 98504-2702
Additional Copies
Sandi Andrus
John Abplanalp
Carma Oaksmith
Karen Soukkala
Suzette Smith
Amanda Migliaccio
Paulette Young