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Docusign Envelope lD: 97E7029C-8CD5-4FBF-9DC4-1 837DD2691 89 <br />3.3. Data Collection Format <br />Contractor shall provide the required reports via Managed File Transfer (MFT). <br />3.3.1. HCA anticipates shifting the data collection format at least in part from MFT to the <br />Program Data Acquisition Management and Storage (PDAMS) system prior to the <br />end date of this Contract. <br />3.3.1.1 . Contractor shall continue to collect data via MFT method until notified <br />otherwise by the HCA Contract Manager in writing. <br />3.3.1.2. HCA Contract Manager shall notify Contractor of this change no less <br />than ten (10) Business Days before implementing the new collection <br />format. <br />4. COST REIMBURSEMENT <br />The payment format for this Contract is established as cost reimbursement. Reports and receipts <br />must be submitted monthly with each A-19 invoice, as identified in this section and in Contract <br />Section 3.4, lnvoice and Payment. <br />4.',. Allowable Expenses <br />Only purchases and staff time which are not part of a Medicaid billable service are allowable. <br />Refer to the following documents for Medicaid billing guidance and fee schedules. <br />4.1.1. Reentrv from a carceral settinq I Washinqton State Health Care Authoritv <br />4.1.2. Reentrv lnitiative Policv and Operations Guide <br />4.1.3. Provider billinq quides and fee schedules I Washinqton State Health Care Authoritv <br />4.1.4. Email questions to hcareentrvdemonstrationproiect@hca.wa.oov. <br />4.2. Monthly Estimated Costs <br />The estimated monthly cost reimbursement is as follows: <br />4.2.1. July 1 ,2025 - June 30,2026 <br />$17,416 <br />Monthly Estimated Cost <br />1 2 <br />Number of Months <br />$209,000 <br />TotalCosts <br />4.2.2. <br />4.2.3 <br />Adjustments revising twenty-five percent (25%) or more of the Monthly Estimated <br />Costs as identified in this section 4.2 must be submitted to the HCA Contract <br />Manager or designee for approval in writing, via email, at least fifteen (15) Business <br />Days prior to expending the adjusted funds. <br />HCA approval must be granted, in writing, prior to expending funds. <br />4.3. lnvoicing <br />lnvoices must be submitted in conjunction with the monthly reports identified in Section 3, <br />Reporting, and as follows: <br />HCA Contract No. K5885-04 Page 9 of 13