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SCHEDULE A <br />STATEMENT OF WORK <br />1. GENERAL <br />The Contractor shall provide services and deliverables, and otherwise do all things necessary for or <br />incidental to the performance of work as set forth below. The Contractor must: <br />a) Provide the necessary staff to perform the allowable MAC activities described in the Cost a) <br />Allocation Plan (CAP), and perform the work necessary to ensure all applicable laws, <br />regulations and guidelines specific to the MAC program and this Agreement are in compliance <br />including, but not limited to: <br />i. Code of Federal Regulation (CFR) Title 42 and Title 45. <br />ii. 1903(w)(6)(A) of the Social Security Act. <br />iii. Medicaid School -Based Administrative Claiming Guide May 2003. <br />iv. Revised Code of Washington (RCW). <br />V. The MAC Coordinator Manual. <br />vi. 2 CFR 225 Cost Principles for State, Local, and Indian Tribal Governments. <br />vii. OMB Compliance Supplements. <br />viii. Washington State Medicaid Plan. <br />ix. Secretary of State (SOS) records retention schedule. <br />b) Maintain documentation to support each administrative claim submitted to HCA for <br />reimbursement as required by federal, state, HCA and CMS Regulations, the CAP, the Manual <br />and this Agreement. The documentation must be sufficiently detailed in order to determine <br />whether the activities are necessary for the proper and efficient administration of the Medicaid <br />State Plan and support the appropriateness of the administrative claim. The Contractor must: <br />Maintain all documentation related to staff participation in the RMTS according to <br />section 1902(a)(4) of the Act and 42 CFR § 431.17; see also 45 CFR § 74.53 and 42 <br />CFR § 433.32(a) (requiring source documentation to support accounting records) and <br />45 CFR § 74.20 and 42 CFR § 433.32(b and c) (retention period for records) and as <br />described in the Medicaid School -Based Administrative Claiming Guide May 2003; <br />ii. Maintain all documentation related to MAC claiming, according to section 1902(a)(4) of <br />the Act and 42 CFR § 431.17; see also 45 CFR § 74.53 and 42 CFR § 433.32(a) <br />(requiring source documentation to support accounting records) and 45 CFR § 74.20 <br />and 42 CFR § 433.32(b and c) (retention period for records) and as described in <br />Medicaid School -Based Administrative Claiming Guide May 2003; <br />iii. Comply with the SOS records retention schedule; <br />iv. Assure all documentation is immediately accessible and available, must be in a useful <br />and readable format, and must be stored electronically within the System at every <br />opportunity as determined by HCA; <br />Provide any and all information and documentation requested by HCA within thirty (30) <br />business days, or within a written, mutually agreed upon time frame; and <br />Local Health Jurisdiction Page 44 of 59 Medicaid Administrative Claiming <br />Washington State Health Care Authority Contract # K3069 <br />