Health Care Authority 2019 - Laserfiche WebLink

Home Browse Search

X. Complete a one hundred percent (100%) code review of all RMTS moments to ensure the code and narrative correlate, within forty five (45) calendar days after the end of the quarter; (1) Finalize and certify the accuracy of the 10% quality assurance review within 10 (ten) calendar days A. Monitor the RMTS non response rate and identify any deficiencies in staff responses. Corrective action must: (1) Be implemented within ten (10) business days; and (2) Be documented and available to HCA upon request. xii. Use a System that is statistically valid and in compliance with all state, and federal laws and Regulations whether through a third -party or other means as stated in the CAP; xiii. Not participate in a time study or claiming process for the HCA MAC program with any entity that does not have an executed agreement with HCA. xiv. Not participate in an RMTS consortium without prior written approval from HCA; (1) If identified as a Lead Agency for the RMTS_ Consortium, the Contractor must perform the Lead Agency duties described in the CAP and Manual and participate in the current statewide LHJ Steering Committee. xv. Ensure all interpreter staff have been tested and certified by Washington State Department of Social and Health Services (DSHS) as defined by DSHS; (1) The contractor is prohibited from claiming the enhanced seventy five percent (75%) rate for any interpretation activities unless the staff has been certified by DSHS; (2) The contractor is prohibited from claiming the enhanced seventy five percent (75%) rate for any interpretation activities unless MAC activities performed is part of the staff's assigned job duties; and (3) The contractor is prohibited from claiming the enhanced seventy five percent (75%) rate unless an allowable MAC activity was performed on behalf of children under twenty one (21). xvi. Ensure all Coordinators and Participants have completed and have certified their understanding of the training prior to participating in the MAC program, and annually thereafter. The contractor is prohibited from allowing any staff to participate in the program unless they have completed and have certified their understanding of the training. The Contractor must: (1) Ensure all Coordinators receive HCA approved training prior to participation; (2) Ensure all Participants certify completion of the online training before performing any duties within the System or participating in the RMTS; (3) Ensure all Participants fully understand each activity code and how to answer moments according to what activity they are doing exactly at the sampled moment; Local Health Jurisdiction Page 47 of 59 Medicaid Administrative Claiming Washington State Health Care Authority Contract # K3069