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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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12/13/2018 1:33:30 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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is prohibited from using any training materials without express, written approval from <br />HCA; <br />viii. Evaluate RMTS and claiming data prior to issuing quarterly reimbursements to ensure <br />the RMTS results and claimed costs are appropriate according to all applicable laws, <br />Regulations and guidelines specific to the MAC program. This evaluation will also be <br />used to identify trends, best practices for the MAC program, quality assurance, training <br />needs, areas in need of improvement, or other concerns related to the MAC program <br />and HCA's oversight responsibilities; <br />ix. Issue corrective action plans as necessary and determined by HCA's oversight <br />capacity that includes but is not limited to, quarterly reviews of RMTS and claiming <br />data, the contractor's failure to be in compliance with all applicable laws, Regulations <br />and guidelines specific to the MAC program and this Agreement, or other quality <br />assurance needs. The contractor is required to comply with any corrective action plan <br />issued. Failure to do so will result in sanctions that may include, but is not limited to, <br />reduced reimbursement and/or termination of this Agreement; and <br />X. Produce and update the CAP, Manual, contracts, training materials, or other MAC <br />related documentation as needed and make it available to the Contractor. <br />3. MINIMUM RESPONSE RATE AND NON -RESPONSES <br />Non -responses are moments not completed by Participant within five (5) business days, with the <br />exception of expired moments where the Participant was on paid or unpaid leave. The return rate of <br />valid responses for the RMTS must be a minimum of eighty five percent (85%). The following <br />remedial action is required of the Contractor if the RMTS response rate drops below eighty five <br />percent (85%). <br />a) Non -response rates greater than fifteen percent (15%): <br />HCA will send written notification to the Contractor requesting a Corrective Action Plan <br />to ensure a minimum eighty five percent (85%) compliance rate for the RMTS is <br />achieved in subsequent quarters. <br />The Contractor must develop and submit the plan to HCA for approval within thirty (30) <br />business days of HCA's notification. <br />iii. Failure to provide a timely corrective action plan within thirty (30) business days may <br />result in the Contractor being prohibited from participation in MAC for the following <br />quarter. <br />iv. An eighty five percent (85%) compliance rate for the RMTS must be met in the following <br />quarter. <br />b) Non -response rates greater than fifteen percent (15%) for two (2) consecutive quarters: <br />HCA will reduce reimbursement by thirty five percent (35%) for the second <br />consecutive quarter. <br />The Contractor will be notified via Certified Mail of the reduced reimbursement. <br />Local Health Jurisdiction Page 49 of 59 Medicaid Administrative Claiming <br />Washington State Health Care Authority Contract # K3069 <br />
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