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"Medicaid Administrative Claiming" or "MAC" means the source of funding for <br />reimbursements provided in this agreement is shared between the contractor and the <br />Federal Financial Participation (FFP). <br />"Medicaid Eligibility Rate" or "MER" means the proportional share of Medicaid <br />individuals to the total number of individuals in the target population (Contractor's <br />jurisdiction) as defined in the CAP, Manual and this Agreement. <br />"Medicaid Outreach Unit" means the unit within HCA's Health Care Services division <br />that administers and monitors Washington State's MAC program. <br />"National Institutional Reimbursement Team (NIRT)" means the group of individuals <br />comprised from both the CMS central office and regional offices who are responsible for <br />providing technical assistance to the states on Medicaid institutional reimbursement issues <br />and the development and promulgation of all Medicaid institutional reimbursement <br />regulations and policies including review and approval of donated funds Certified as Public <br />Expenditures. <br />"Operating Expense" means those costs incurred by the Contractor to perform business <br />activities and includes both Direct Costs and Indirect Costs. Only operating expenses <br />necessary to operate the Contractor's MAC program are allowable for FFP <br />reimbursement. <br />"Overpayment" means any payment or benefit to the Contractor in excess of that to which the <br />Contractor is entitled by law, rule, or this Contract, including amounts in dispute. <br />"Potential Medicaid Client" means a Washington resident who may be determined by <br />HCA to meet the eligibility criteria for enrollment in Medicaid. <br />"Proprietary Information" means information owned by Contractor to which Contractor claims <br />a protectable interest under law. Proprietary Information includes, but is not limited to, <br />information protected by copyright, patent, trademark, or trade secret laws. <br />"Protected Health Information" or "PHI" means individually identifiable information that <br />relates to the provision of health care to an individual; the past, present, or future physical or <br />mental health or condition of an individual; or past, present, or future payment for provision of <br />health care to an individual, as defined in 45 CFR 160.103. Individually identifiable information <br />is information that identifies the individual or about which there is a reasonable basis to believe <br />it can be used to identify the individual, and includes demographic information. PHI is <br />information transmitted, maintained, or stored in any form or medium. 45 CFR 164.501. PHI <br />does not include education records covered by the Family Educational Rights and Privacy Act, <br />as amended, 20 USC 1232g(a)(4)(b)(iv). <br />"Random Moment Time Study (RMTS)" or "System" or "Time Study" means an <br />electronic System that quantifies the daily activities of eligible time study Participants <br />through a statistically valid sampling methodology and allocates allowable participant <br />costs to the MAC program. The System calculates the amount of FFP reimbursement <br />based on the Contractors RMTS results, staff costs, MER, costs and other applicable <br />calculations as described in the CAP, Manual and this Agreement. <br />Local Health Jurisdiction Page 8 of 59 Medicaid Administrative Claiming <br />Washington State Health Care Authority Contract # K3069 <br />