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2018-12-18 10:00 AM - Commissioners' Agenda
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Health Care Authority 2019
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12/13/2018 1:36:32 PM
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Meeting
Date
12/18/2018
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Alpha Order
p
Item
Request to Approve a Contract with the Washington State Health Care Authority for Professional Services for Medicaid Administrative Claiming
Order
16
Placement
Consent Agenda
Row ID
50104
Type
Contract
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(4) Train all Participants to maintain proper documentation for MAC related activities; <br />(5) Only use training materials that have been approved in writing by HCA; and <br />(6) Track the completion and certification of training within the System, and must be <br />available upon request by HCA. <br />xvi. Comply with all HCA revisions and RMTS/claiming requirements as described in <br />the Manual; <br />xvii. Only use the activity codes (or their successor) in the Manual as approved by <br />HCA, for participation in MAC and are responsible for ensuring all Participating <br />Staff understand each code. <br />b) Health Care Authorit is responsible for performing oversight of the Contractor's MAC program <br />to ensure the effective administration of the MAC program and complying with all roles, <br />responsibilities, limitations, restrictions, and documentation requirements described in the <br />CAP, Manual, and this Agreement includes, but is not limited to, the following. HCA must: <br />Maintain oversight of the Contractor's MAC program and monitoring activities including <br />review of all components of the time study, claiming, training, or anything MAC related. <br />The contractor is required to monitor its own MAC program to ensure compliance with <br />all applicable Regulations and facilitating HCA's oversight of the program; <br />ii. Direct the MAC activities reimbursable at the enhanced seventy five percent (75%) <br />rate for all Skilled Professional Medical Personnel (SPMP) participating in the <br />Contractor's MAC program. The contractor is prohibited from claiming the enhanced <br />rate for any SPMP activities without express, written approval from HCA, see section <br />8, Skilled Professional Medical Personnel (SPMP) below; <br />iii. Review the Contractor's monitoring activities to ensure monitoring is occurring and any <br />identified issues are addressed as deemed appropriate by HCA. This includes, but is <br />not limited to, review of time study responses, accuracy of coding, appropriateness of <br />code changes, sufficiency of backup documentation, non -response rates; <br />iv. Verify the Contractor has entered all necessary data into the System and verify all <br />data entered was certified by the Contractor as accurate; <br />v. Review all claimed costs prior to issuing reimbursement to ensure they are allowable, <br />reasonable, and are supported by documentation that is sufficiently detailed to permit <br />HCA, CMS, or others to determine whether the costs are necessary for the proper and <br />efficient administration of the state plan. This includes but is not limited to; source <br />documentation of staff costs, operating expenses, and subcontracted vendor costs. <br />vi. Review the RMTS Consortia organization and membership, including the Lead Agency <br />identified, annually and issuing an official notice of approval or denial. The Contractor is <br />prohibited from participating in a Consortium without express, written approval of the <br />Consortia organization and membership; <br />vii. Review all MAC related training materials prior to their use in the MAC program and <br />issuing an official notice of approval or denial. This includes multimedia video, audio, <br />digital or other electronic sources, and paper based training materials. The Contractor <br />Local Health Jurisdiction Page 48 of 59 Medicaid Administrative Claiming <br />Washington State Health Care Authority Contract # K3069 <br />
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