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DocuSign Envelope ID: 78CDD188-656B-44E9-9F46-9AFBF222884F <br />(g) The forms must be maintained according to SOS records retention schedule. <br />(3) The above data from all patient encounter forms, except Client Name/ID <br />Information, must be available. Upon request, must be provided in a mutually <br />agreed upon format. <br />(4) The Contractor is prohibited from altering the information on the patient <br />encounter forms. <br />e) Calculation and application of the pertinent MER. <br />i) All MERs must be calculated quarterly; <br />ii) All MERs must be based on the quarter claimed; <br />iii) All MAC activities that benefit the Contractor's Clients directly and are performed <br />within a program that identifies Clients must use a Client-based MER as described <br />in the CAP and Manual; <br />iv) All MAC activities that benefit the Contractor's Clients directly and are performed <br />within a program that operates a primary care or specialty clinic must use a clinic- <br />based MER as described in the CAP and Manual; <br />v) All MAC activities that benefit a larger population in the geographical region served <br />by the Contractor, or in programs that do not identify Clients or collect demographic <br />data must use the modified county-wide MER; and <br />vi) The Contractor is required to collect and maintain demographic data used to <br />determine Medicaid enrollment for all Clients served within budget units whose <br />costs are included in the FFP reimbursement. The Contractor is prohibited from <br />including Clients from any budget unit that is not allowable within the MAC <br />program. <br />(1) All data related to Medicaid enrollment and the MER must be maintained <br />according to the SOS records retention schedule; <br />(2) The information collected must be sufficiently detailed to determine Medicaid <br />enrollment through HCA's ProviderOne System; <br />(3) The information must be entered in the Contractor's Client information <br />System or data base; <br />(4) The Contractor must produce a single electronic list of all unduplicated <br />Clients served over the quarter within thirty (30) calendar days of the end of <br />the quarter; <br />(5) The Contractor is prohibited from including the same Client more than once <br />(duplicating) on the quarterly list; and <br />(6) The Contractor must submit the quarterly list to either its third party System <br />operator or other System operator which calculates the Client-based and <br />clinic-based MER. <br />State of Washington <br />Health Care Authority <br />Page 37 of 42 HCA Contract No. K1407-1